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Bajaj S, Orbuch D, Wang JV, Biesman BS, Geronemus RG. Interventional and device treatment of the periocular area. Clin Dermatol 2024; 42:360-372. [PMID: 38336142 DOI: 10.1016/j.clindermatol.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Growth in the research, innovation, and development of laser and energy-based technologies over the past few decades has led to dramatic increases in treatment options for dermatologic and cosmetic concerns of the periorbital area. We highlight recent treatment options using laser and energy-based devices for the clearance of periocular pigmented lesions, including solar lentigines and nevus of Ota; vascular lesions, including port-wine birthmarks, infantile hemangiomas, superficial telangiectasias, and reticular veins; laser ablation of benign tumors, such as xanthelasma; cosmetic rejuvenation; treatment of infraorbital dark circles and festoons; laser removal of eyebrow and eyeliner tattoos; and device-based treatment of chronic dry eyes.
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Affiliation(s)
- Shirin Bajaj
- Laser & Skin Surgery Center of New York, New York, New York, USA
| | - David Orbuch
- Laser & Skin Surgery Center of New York, New York, New York, USA
| | - Jordan V Wang
- Laser & Skin Surgery Center of New York, New York, New York, USA.
| | - Brian S Biesman
- Nashville Centre for Laser and Facial Surgery, Nashville, Tennessee, USA
| | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York, New York, USA
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Koza E, Ma MS, Ahmed A, Haq M, Shi VJ, Whiting D, Paghdal K, Weil A, Voravutinon N, Roongpisuthipong W, Poon E, Alam M. A comparison of 1550-nm fractional photothermolysis versus intense focused ultrasound for treatment of periorbital wrinkles: a randomized control trial. J Am Acad Dermatol 2024; 90:1035-1037. [PMID: 38211707 DOI: 10.1016/j.jaad.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Eric Koza
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melissa S Ma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Areeba Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Misha Haq
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victoria J Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis Whiting
- Department of Dermatology, The University of Chicago, Chicago, Illinois
| | - Kapila Paghdal
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nataya Voravutinon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wanjarus Roongpisuthipong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Department of Medicine, Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Gupta LY, Gupta SS, Bamberger JN, Gupta KR. Mini-Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12-Year Analysis of a Novel Festoon Surgery. Plast Reconstr Surg 2023; 152:987-999. [PMID: 36877611 DOI: 10.1097/prs.0000000000010365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The authors present outcomes with subjective and objective evaluation of an office-based, novel, minimally invasive (1-cm incision) festoon repair: mini-incision direct festoon access, cauterization, and excision (MIDFACE). METHODS Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 patients who met inclusionary criteria were evaluated by three expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from four different views: close-up, profile, full-frontal, and worm's eye) using paired t tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation. RESULTS There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of photographs of 39 patients (78 eyes, 35 women; four men; mean age, 58 ± 7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same preoperatively and postoperatively, indicating incisions could not be detected by photography. Average patient satisfaction score was 9.5 on a Likert scale of 0 to 10. Possible factors for festoon formation or exacerbation included genetics (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%). CONCLUSION MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Wong A, Lowery AS, Bloom JD. Ultrasound Therapy for the Skin. Facial Plast Surg Clin North Am 2023; 31:503-510. [PMID: 37806683 DOI: 10.1016/j.fsc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Ultrasound energy is delivered to the dermal and subdermal tissue to induce thermal injury, leading to collagen remodeling and resulting in lifting and tightening of the skin. Ulthera and Sofwave are two Food and Drug Administration-approved systems that have demonstrated clinically significant results in providing eyebrow, submental, and neck lift and minimizing facial fine lines and wrinkles. Patient selection and management of expectations are important components to a successful treatment process. Both devices boast high patient satisfaction rates, minimal recovery time, and excellent safety profile. Ultrasound technology is an effective, nonsurgical option for facial rejuvenation.
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Affiliation(s)
- Anni Wong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3737 Market Street, Suite 302, Philadelphia, PA 19104, USA
| | - Anne S Lowery
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jason D Bloom
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Bloom Facial Plastic Surgery, Two Town Place, Suite 110, Bryn Mawr, PA 19010, USA.
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Fabi S, Zoumalan C, Fagien S, Downie J, Yoelin S, Sartor M, Chawla S. Effectiveness of Volbella (VYC-15L) for Infraorbital Hollowing: Patient-Reported Outcomes From a Prospective, Multicenter, Single-Blind, Randomized, Controlled Study. Aesthet Surg J 2023; 43:1357-1366. [PMID: 37066828 PMCID: PMC10575619 DOI: 10.1093/asj/sjad100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Infraorbital hollowing can be addressed with hyaluronic acid soft tissue fillers. A prospective, multicenter, evaluator-blinded, randomized, controlled study (NCT03418545) demonstrated the safety and effectiveness of Juvéderm Volbella XC (VYC-15L, Allergan Aesthetics, an AbbVie company, Irvine, CA) in adults seeking correction for infraorbital hollows. OBJECTIVE The objective of the current analysis was to examine patient-reported outcomes from the clinical study. METHODS Participants were randomly assigned 3:1 to the VYC-15L treatment group or the no-treatment control group. Outcome measurements included: evaluating investigator (EI)- and participant-assessed Global Aesthetic Improvement Scale (GAIS) scores, as well as participant responses to the FACE-Q Appraisal of Lower Eyelids, questions on treatment satisfaction, the extent to which patients were bothered by dark circles under their eyes, and willingness to recommend treatment to a friend. RESULTS The modified intent-to-treat population included 135 participants (median age, 47 years; 91.9% female). At Month 3, the majority of VYC-15L-treated participants showed improvements in the EI- and participant-assessed GAIS. The mean change from baseline to Month 3 score (32.7% increase) showed statistically significant improvement (mean [standard deviation], 17.8 [19.8], P < .0001). At Months 3 and 12 posttreatment, most VYC-15L-treated participants reported feeling satisfied with treatment and not feeling moderately or very bothered by dark circles under their eyes, and would recommend treatment to a friend. CONCLUSIONS The current analysis demonstrated the effectiveness of VYC-15L treatment to reduce infraorbital hollowing and to improve overall satisfaction based on validated patient-reported outcomes. Participant-assessed improvements aligned with EI-assessed outcomes and lasted for 1 year. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Sabrina Fabi
- Corresponding Author: Dr Sabrina Fabi, 9339 Genesee Avenue, Unit 300, San Diego, CA 92121, USA. E-mail:
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Oh S, Rhee DY, Batsukh S, Son KH, Byun K. High-Intensity Focused Ultrasound Increases Collagen and Elastin Fiber Synthesis by Modulating Caveolin-1 in Aging Skin. Cells 2023; 12:2275. [PMID: 37759497 PMCID: PMC10527789 DOI: 10.3390/cells12182275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Caveolin-1 (Cav-1) induces cellular senescence by reducing extracellular signal-regulated kinase (ERK)1/2 phosphorylation and activating p53 via inhibition of mouse double minute 2 homolog (MDM2) and sirtuin 1 (Sirt1), promoting cell cycle arrest and decreasing fibroblast proliferation and collagen synthesis. High-intensity focused ultrasound (HIFU) treatment increases collagen synthesis, rejuvenating skin. Using H2O2-induced senescent fibroblasts and the skin of 12-month-old mice, we tested the hypothesis that HIFU increases collagen production through Cav-1 modulation. HIFU was administered at 0.3, 0.5, or 0.7 J in the LINEAR and DOT modes. In both models, HIFU administration decreased Cav-1 levels, increased ERK1/2 phosphorylation, and decreased the binding of Cav-1 with both MDM2 and Sirt1. HIFU administration decreased p53 activation (acetylated p53) and p21 levels and increased cyclin D1, cyclin-dependent kinase 2, and proliferating cell nuclear antigen levels in both models. HIFU treatment increased collagen and elastin expression, collagen fiber accumulation, and elastin fiber density in aging skin, with 0.5 J in LINEAR mode resulting in the most prominent effects. HIFU treatment increased collagen synthesis to levels similar to those in Cav-1-silenced senescent fibroblasts. Our results suggest that HIFU administration increases dermal collagen and elastin fibers in aging skin via Cav-1 modulation and reduced p53 activity.
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Affiliation(s)
- Seyeon Oh
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University of Medicine, Incheon 21999, Republic of Korea
| | | | - Sosorburam Batsukh
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University of Medicine, Incheon 21999, Republic of Korea
- Department of Anatomy & Cell Biology, College of Medicine, Gachon University, Incheon 21936, Republic of Korea
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea
| | - Kyunghee Byun
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University of Medicine, Incheon 21999, Republic of Korea
- Department of Anatomy & Cell Biology, College of Medicine, Gachon University, Incheon 21936, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health & Sciences and Technology (GAIHST), Gachon University, Incheon 21999, Republic of Korea
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Wilde C, Kaushik M, Neumann I, Verma P, Azzopardi EA, Ezra DG. Safety and efficacy of subcutaneous diode laser as a novel treatment in the management of festoons. Lasers Med Sci 2023; 38:170. [PMID: 37522966 DOI: 10.1007/s10103-023-03830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Caroline Wilde
- Adnexal Department, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK.
| | - Megha Kaushik
- Adnexal Department, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK
| | - Inga Neumann
- Adnexal Department, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK
| | - Priya Verma
- School of Population Health and Environmental Sciences, Kings College, London, UK
| | - Ernest A Azzopardi
- UCL Division of Surgery and Interventional Sciences Royal Free Hospital, 9Th Floor (East), 2QG, 10 Pond St, London, NW3 2PS, UK
- Faculty of Medicine and Surgery, University of Malta, Imsida, Malta
- Neo Clinic, 152 Harley Street, London, W1G 7LH, UK
| | - Daniel G Ezra
- Adnexal Department, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK
- Neo Clinic, 152 Harley Street, London, W1G 7LH, UK
- UCL Institute of Ophthalmology, Bath Street, London, UK
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Lim JTE. Safety and efficacy of superficial micro-focused ultrasound with visualization for melasma in Asians: An uncontrolled pilot study. J Cosmet Dermatol 2023; 22:1764-1773. [PMID: 36762392 DOI: 10.1111/jocd.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The pathophysiology of melasma is multifactorial, resulting in treatment resistance and a high recurrence rate. Recent research suggests that focused ultrasound might treat melasma effectively. OBJECTIVES To investigate the efficacy and safety of superficial micro-focused ultrasound with visualization (MFU-V) for melasma in Asians. METHODS Patients (n = 20) with mixed melasma on both cheeks received 2 MFU-V treatments spaced 1 month apart. At monthly visits over 5 months, treatment efficacy and safety were evaluated. Standardized photographs were clinically assessed using the modified Melasma Area and Severity Index (mMASI), and 6-point grading scales for melasma lightening and area of involvement. Patients provided pain, global aesthetic improvement scale (GAIS), and satisfaction assessments. RESULTS In 40 cheeks, the mean mMASI score was significantly reduced from 13.2 at baseline to 2.4 at month 4, and 2.8 at month 5. Twenty-nine cheeks (72.5%) showed lightening of melasma at month 4 that persisted until month 5, with improvements up to 75% compared to baseline. Melasma area decreased overall, with sites containing >30% melasma involvement decreasing from 55% to 20% by month 5, and none with 70%-89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as 1 month after index MFU-V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient GAIS and satisfaction scores. Procedure was well tolerated with only mild-to-moderate pain reported in 92.5% of treatments. CONCLUSION Superficial MFU-V is a safe and effective treatment for melasma.
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Ikoma T, Shibata T, Shibata N, Mito T, Kubo E, Sasaki H. Acute cataract by a high-intensity focused ultrasound procedure: a case report. BMC Ophthalmol 2022; 22:164. [PMID: 35397531 PMCID: PMC8994384 DOI: 10.1186/s12886-022-02390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background We report a case of acute onset of cataract after eyelid rejuvenation tightening with intense focused ultrasound (IFUS) treatment without using a protection device. Case presentation A 47-year-old female patient presented at the outpatient clinic with blurred vision in her left eye immediately after undergoing an eyelid tightening procedure, using IFUS, seven days prior. The patient had decreased vision in her left eye, caused by an acute cataract with several drop-like opacities and a rosette-like posterior subcapsular cataract. One month after her first visit, the patient’s visual acuity in her left eye decreased to 20/630. A Swept-Source Anterior Segment optical coherence tomography confirmed that the posterior capsule was not ruptured. The patient underwent uneventful phacoemulsification cataract surgery with intraocular lens implantation, which resulted in full visual recovery. Conclusions This case emphasized the need to evaluate possible ocular side effects, resulting from periocular IFUS without a protection device, including severe cataract requiring surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02390-2.
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Lio ML, Chang CC, Chuang ADC, Tsai LC, Chen CC. Quantified Facial Rejuvenation Utilizing High Intense Focus Ultrasound with Multiple Penetrative Depths. Clin Cosmet Investig Dermatol 2022; 15:489-496. [PMID: 35368623 PMCID: PMC8968221 DOI: 10.2147/ccid.s350556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Multiple penetration depths of high-intensity focused ultrasound (HIFU) treatment for facial rejuvenation have not been quantified. Methods We enrolled 12 participants (n=24) to undergo one session of HIFU rejuvenation between January 1, 2019, and January 10, 2020. We used a 2-, 4.5-, and 6-mm focal depth transducer on the upper and middle face. We evaluated efficacy on days 60 and 90 by using our specific assessment system. Results The average eyebrow peak and pupil-eyebrow peak angles significantly increased by 2° (p < 0.0005) and decreased by 1° (p < 0.0001), respectively, at day 90. The shortened eyebrow-iris length indicated that the forehead tissues had lifted and moved medially to the central face. Supraorbital tissues were also vertically elevated, marked by the eyebrow-orbital (p = 0.0016) and vertical palpebral fissure lengths (p = 0.0052), which both exhibited a 0.8-cm elevation. For the midface, the increased canthus-oral-nasal angle (p = 0.5881) and decreased tragus-oral length (p = 0.5881) indicated that laxity had been corrected through lifted oral commissure, though the data were not statistically significant. No serious side effects were observed. Conclusion HIFU treatment with multiple depths quantitatively improved both upper-facial rejuvenation and midface rejuvenation after a single session.
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Affiliation(s)
- Man-Lok Lio
- Department of General Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Chang-Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Cosmeceutics and Graduate Institute of Cosmeceutics, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan
| | - Andy Deng-Chi Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Li-Cheng Tsai
- Department of Dermatology, China Medical College Hospital, Taichung, Taiwan
| | - Chien-Chou Chen
- Department of Dermatology, Joe Chen Beauty Skin Clinic, Taichung City, Taiwan
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Lee DH, Suh YJ, Kim DH, Lee SJ, Shin MK. Objective assessment of facial laxity changes after monopolar radiofrequency treatment by using moiré topography. J COSMET LASER THER 2022; 23:170-175. [PMID: 35243964 DOI: 10.1080/14764172.2022.2048671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Radiofrequency (RF) has been widely used as a noninvasive technique for skin tightening and rejuvenation. Moiré is a type of interference pattern corresponding to the shape of the face. We aimed to objectively evaluate the effect of RF on facial skin laxity using moiré. Ten subjects participated and were treated with a monopolar RF on the face. Clinical photographs and moiré images were obtained at the baseline and after treatment. The periorbital angle from the upper third of the face, zygomatic length ratio (L1/L2), angle from the middle third, perioral perpendicular length, and angle from the lower third were analyzed. After one session of RF treatment, the mean zygomatic length ratio (L1/L2) from the middle third of the face significantly increased in the 4th week (by 49.68%, P = .047). The L1/L2 ratio increased to nearly one, which were not significant after 8 weeks. The mean perioral perpendicular length decreased to 282.25 ± 84.069 pixels (px) after 4 weeks, and to 281.38 ± 76.03 px after 24 weeks; these differences were statistically significant. The parameters of zygomatic length ratio and perioral perpendicular length extracted from illuminated moiré images can be useful for objectively assessing various facial tightening treatments in clinical settings.
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Affiliation(s)
- Dong Hye Lee
- Department of Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Republic of Korea
| | - Ye-Jin Suh
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | | | - Sang Jun Lee
- Department of Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Republic of Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Gao L, Song W, Qian L, Zhang J, Li K, Yang J, Wang G. Clinical efficacy of different therapeutic modes of CO 2 fractional laser for treatment of static periocular wrinkles in Asian skin. J Cosmet Dermatol 2021; 21:1045-1050. [PMID: 34889041 DOI: 10.1111/jocd.14640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/20/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Periocular fine lines and wrinkles usually appear as a first visible sign of facial aging. Fractional ablative laser has been used to treat periorbital wrinkles. OBJECTIVE To compare the efficacy on treatment of static periorbital wrinkles using different emission modes of CO2 fractional laser. METHODS A total of 30 patients with static periorbital wrinkles were enrolled. The subjects were randomly assigned into two split-face groups: One side was treated with a deep (n = 15) or mid-mode of CO2 superficial laser (n = 15), and the other side of periocular region was treated by a fusion mode in combination of both modes (n = 30). RESULTS The patients in three groups showed significant improvements on indexes of periocular wrinkles, skin textures, and elasticity at three-month follow-up as compared with baseline (p < 0.05). Fusion mode resulted in a significantly progressive improvement on periocular wrinkles at three-month follow-up as compared with one-month follow-up (p < 0.05), which were not observed in other modes. Fusion mode delivered better improvements of periocular wrinkles and skin textures as compared to deep and mid-modes at three-month follow-up (p < 0.05). Fusion mode also resulted in better scores of global esthetic improvement scale and patient satisfaction as compared to other modes at both follow-ups. CONCLUSION The fusion mode has a synergistic effect in periorbital static wrinkle treatment, which is worthy of further evaluation and investigation.
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Affiliation(s)
- Lin Gao
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wenting Song
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Linhan Qian
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jine Zhang
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Kai Li
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Juan Yang
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Gang Wang
- Department of Dermatology, XiJing Hospital, The Fourth Military Medical University, Xi'an, China
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Single Treatment, Single Depth Superficial Microfocused Ultrasound with Visualization for Rhytid Improvement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3662. [PMID: 34277316 PMCID: PMC8277253 DOI: 10.1097/gox.0000000000003662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
Background Standard lifting and tightening protocols with microfocused ultrasound with visualization (MFU-V, Ultherapy) comprise the use of multiple transducer depths. We developed a shortened, single depth treatment protocol for patients seeking skin rejuvenation. Methods Single-center, prospective case series. Subjects with static periorbital wrinkles, perioral wrinkles, or accordion lines had a single MFU-V treatment comprising up to 340 lines (periorbital 120, perioral 100, and accordion 120) with the superficial depth transducer (10.0 MHz/1.5 mm). Efficacy was assessed using established rating scales as well as clinician- and subject-reported Global Aesthetic Improvement Scales at baseline, 90, and 180 days, and each subject served as their own control. Adverse events were documented. Results Nine subjects, women aged 38-64, received treatment. At 180 days, post treatment clinicians reported visible improvements in periorbital lines (6/6 cases), accordion lines (5/6 cases), and perioral lines (3/6 cases). Subjects' self-assessments mirrored those of the clinicians, reporting improvements in accordion lines (5/6 cases improved, 1/6 cases much improved), periorbital lines (3/6 cases improved, 3/6 cases much improved) and perioral lines (2/6 cases improved, 2/6 cases much improved). Subject-rated satisfaction was high (accordion lines 6/6 cases, periorbital lines 4/6 cases and perioral lines 4/6 cases). All subjects experienced mild, transient erythema; in one subject, wheals persisted for 24 hours, resolving on application of mild topical corticosteroid. Conclusions Shortened protocol, single depth MFU-V treatment was well-tolerated. It provided aesthetic improvements in periorbital and accordion lines, and to a lesser extent in perioral lines. Its utility as a noninvasive therapy for superficial skin rejuvenation warrants further investigation.
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Heitmiller K, Ring C, Saedi N, Biesman B. Nonsurgical Light and Energy-Based Devices: Utility in Eyelid and Periorbital Surgery. Facial Plast Surg Clin North Am 2021; 29:323-334. [PMID: 33906764 DOI: 10.1016/j.fsc.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.
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Affiliation(s)
- Kerry Heitmiller
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina Ring
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Brian Biesman
- Ophthalmology, Dermatology, Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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Lim HG, Kim H, Kim K, Park J, Kim Y, Yoo J, Heo D, Baik J, Park SM, Kim HH. Thermal Ablation and High-Resolution Imaging Using a Back-to-Back (BTB) Dual-Mode Ultrasonic Transducer: In Vivo Results. SENSORS (BASEL, SWITZERLAND) 2021; 21:1580. [PMID: 33668260 PMCID: PMC7956793 DOI: 10.3390/s21051580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/13/2021] [Accepted: 02/20/2021] [Indexed: 02/06/2023]
Abstract
We present a back-to-back (BTB) structured, dual-mode ultrasonic device that incorporates a single-element 5.3 MHz transducer for high-intensity focused ultrasound (HIFU) treatment and a single-element 20.0 MHz transducer for high-resolution ultrasound imaging. Ultrasound image-guided surgical systems have been developed for lesion monitoring to ensure that ultrasonic treatment is correctly administered at the right locations. In this study, we developed a dual-element transducer composed of two elements that share the same housing but work independently with a BTB structure, enabling a mode change between therapy and imaging via 180-degree mechanical rotation. The optic fibers were embedded in the HIFU focal region of ex vivo chicken breasts and the temperature change was measured. Images were obtained in vivo mice before and after treatment and compared to identify the treated region. We successfully acquired B-mode and C-scan images that display the hyperechoic region indicating coagulation necrosis in the HIFU-treated volume up to a depth of 10 mm. The compact BTB dual-mode ultrasonic transducer may be used for subcutaneous thermal ablation and monitoring, minimally invasive surgery, and other clinical applications, all with ultrasound only.
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Affiliation(s)
- Hae Gyun Lim
- Department of Biomedical Engineering, Pukyong National University, Busan 48513, Korea;
| | - Hyunhee Kim
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Kyungmin Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Jeongwoo Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Yeonggeun Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Jinhee Yoo
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
| | - Dasom Heo
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Jinhwan Baik
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
| | - Hyung Ham Kim
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang 37673, Korea; (H.K.); (J.P.); (J.Y.)
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (K.K.); (Y.K.); (J.B.); (S.-M.P.)
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
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Kołodziejczak A, Rotsztejn H. The eye area as the most difficult area of activity for esthetic treatment. J DERMATOL TREAT 2020; 33:1257-1264. [DOI: 10.1080/09546634.2020.1832189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Anna Kołodziejczak
- Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lódź, Łódź, Poland
| | - Helena Rotsztejn
- Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lódź, Łódź, Poland
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Žgaljardić Z, Žgaljardić I, Jurić F. Treatment of malar mound and festoon with fractional microneedle bipolar radiofrequency combined with 15% TCA peel. J Cosmet Dermatol 2020; 20:1810-1812. [PMID: 32985067 DOI: 10.1111/jocd.13740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/06/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anatomy of the periorbital region is very complex. Malar oedema/mounds/festoons often remain unaddressed. There are various treatments proposed for this pathologic entity as well as non-standardized nomenclature. Implementation of technology in aesthetic medicine and surgery resulted in novel treatments for this entity. AIMS The aim of this case presentation was to show the combination of fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel as a great tool in treating malar bags with no complication and excellent result. PATIENTS/METHODS We report a case of 44-year-old women with malar mound and festoon. The treatment consisted of rejuvenation of whole periorbital region- upper and lower blepharoplasty and novel treatment combination-fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel in 2 sittings. RESULTS After 6 weeks, excellent results can be observed with malar mound and festoon completely resolved. No complications were observed. CONCLUSION Fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel is a safe and effective treatment option for malar bags.
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Affiliation(s)
| | | | - Filip Jurić
- Department for Pediatric Surgery, Clinic for Children's Diseases Zagreb, Zagreb, Croatia
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18
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Intra-rater reproducibility of shear wave elastography in the evaluation of facial skin. Postepy Dermatol Alergol 2020; 37:371-376. [PMID: 32792878 PMCID: PMC7394148 DOI: 10.5114/ada.2018.81144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Recently, esthetic medicine has been gaining its momentum worldwide, mostly due to the development of minimally invasive techniques. In our opinion, elastography can be a candidate for an objective quantitative method to evaluate facial skin condition. The aim of this study was to determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. Aim To determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. Material and methods The study included 57 women between 40 and 67 years of age (mean: 51.5 ±7.3 years). Prior to the laser treatment, all participants were subjected to ultrasonographic examination and elastography of the skin. Upon visualization of the area of interest, the thickness of the dermis, subcutaneous tissue and superficial muscular aponeurotic system (SMAS) in millimeters was measured. Then, SWE was performed. Results No statistically significant differences were found in intraclass coefficient values (ICC) for elastographic parameters of the skin on the right and left side of the face (0.953 ±0.001 vs. 0.953 ±0.001, p = 0.992). Moreover, no significant differences were observed in the ICC values for the SWE parameters of various skin layers: dermis, subcutaneous tissue and SMAS (0.945 ±0.001 vs. 0.953 ±.001 vs. 0.961 ±0.001, p = 0.597). Women with normal body weight and overweight did not differ significantly in terms of their elastographic parameters of facial skin. Conclusions Shear wave elastography is a reliable method for the evaluation of facial skin elasticity, providing highly reproducible results in all patients, regardless of their age and body weight.
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Peng HLP, Peng JH. Treating the tear trough-eye bag complex: Treatment targets, treatment selection, and injection algorithms with case studies. J Cosmet Dermatol 2020; 19:2237-2245. [PMID: 32716132 DOI: 10.1111/jocd.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The tear trough is a commonly requested area for aesthetic correction, but is difficult to treat well, especially when concurrent with other deformities such as eye bags. There are multiple possible treatment methods for the tear trough and eye bag, such as surgery and hyaluronic acid (HA) filler injection, with the latter gaining popularity in recent years. AIMS To explore tear trough and eye bags etiology, describe the process for treatment selection, outline possible contraindications for filler injection, and expand upon the previously published atrophy-bulging-laxity (ABL) system of tear trough classification and treatment algorithm, with special focus on tear troughs complicated with eye bags. METHODS Six major etiologies of the eye bag were described, and three main contraindications for HA injection were outlined. Three useful tests (snap test, push test, lift test) to aid in treatment selection were described. A comprehensive treatment algorithm was developed to counteract each etiology: "Lifting" injections at the zygoma and anteromedial cheek help counteract senescent or congenital bone deficiency; "Supporting" injections into the anteromedial cheek fat pads help counteract fat atrophy or prolapse; and "Volumization" injections directly at the deformity help smooth out structural grooves or troughs. RESULTS Patients with pronounced eye bags and tear troughs were treated according to this algorithm and obtained good, long-lasting outcomes. CONCLUSIONS Tear troughs complicated with eye bags can be successfully classified and treated with the ABL system and the additional procedures described by this report.
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Affiliation(s)
- Hsien-Li Peter Peng
- P-Skin Professional Clinic, Kaohsiung City, Taiwan.,Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Hui Peng
- Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung City, Taiwan
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20
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Newberry CI, Mccrary H, Thomas JR, Cerrati EW. Updated Management of Malar Edema, Mounds, and Festoons: A Systematic Review. Aesthet Surg J 2020; 40:246-258. [PMID: 31051517 DOI: 10.1093/asj/sjz137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To deliver a natural, aesthetically pleasing periorbital rejuvenation, restoration of the youthful lid-cheek junction and malar eminence is often essential. However, the management of malar bags is complex secondary to the diverse pathophysiology and varying severity of malar edema, mounds, and festoons. Treatment must be individualized based on extent and content. This scoping review updates the audience on the anatomy, pathophysiology, and evaluation of malar bags in addition to the latest literature regarding minimally invasive intervention and surgical refinements. A modernized treatment algorithm is proposed. LEVEL OF EVIDENCE: 4
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21
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Ayatollahi A, Gholami J, Saberi M, Hosseini H, Firooz A. Systematic review and meta-analysis of safety and efficacy of high-intensity focused ultrasound (HIFU) for face and neck rejuvenation. Lasers Med Sci 2020; 35:1007-1024. [PMID: 32026164 DOI: 10.1007/s10103-020-02957-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/02/2020] [Indexed: 11/26/2022]
Abstract
High-intensity focused ultrasound (HIFU) is widely used for skin rejuvenation and tightening. The aim of this study was to determine the safety and efficacy of HIFU for face and neck rejuvenation. A systematic search of peer reviewed articles published before December 2017 was performed using Medline, Web of Science, and Scopus databases. Retrieved studies were screened, and clinical trials or follow-up studies which were evaluated the effect of HIFU on rejuvenation treatments of face and neck area were included. Risk of bias for each study was assessed and was reported. Safety and efficacy variables, which were reported more often in papers, were included in meta-analysis. Seventeen studies involving 477 participants were included in the analysis. Meta-analysis showed moderate improvement as scores of 2.74 (95% CI 2.06-3.43) and 2.68 (95% CI 1.92-3.45), out of 5 maximum score, for objective improvement score and subjective satisfaction score, respectively. Meta-analysis of mean pain score, assessed by a 0-10 Likert score, was 4.2 (95% CI 4.27-5.19). Edema and erythema showed considerable heterogeneity, and no hyperpigmentation was reported by included studies. Included studies used multiple and different outcome variables with different scoring at various time points. Long follow-up was not reported by majority of studies. HIFU is safe procedure in short term and has a moderate effect on rejuvenation of face and neck areas.
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Affiliation(s)
- Azin Ayatollahi
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saberi
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Hosseini
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Jeon HC, Kim DY, Jin SP, Lee DH. A new treatment protocol of microfocused ultrasound for lower eyelid fat bulging. J DERMATOL TREAT 2020; 32:1005-1009. [PMID: 31971035 DOI: 10.1080/09546634.2020.1720581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Microfocused ultrasound (MFU) causes tissue tightening by producing thermal injury zones and is used to treat various age-related changes including lower eyelid fat bulging. OBJECTIVE To investigate the efficacy of a new treatment protocol of MFU for lower eyelid fat bulging. METHODS AND MATERIALS We reviewed the medical records of all patients who began MFU for lower eyelid fat bulging from March 2017 to September 2018. MFU was performed in two steps to tighten the lower eyelid dermis and orbital septum. Data on age, sex, bulging severity, and the number of treatment sessions were obtained. Associations of these variables with treatment response were determined through an ordinal logistic regression analysis. RESULTS Among 191 enrolled patients, 119 (62.3%) and 47 (24.6%) achieved fair and good responses, respectively. In the multivariable analysis, multiple treatment sessions (odds ratio (OR) 6.618; 95% confidence interval (CI) 3.242-13.513; p < .001), moderate bulging (OR 4.328; 95% CI 1.755-10.671; p = .001), and severe bulging (OR 7.570; 95% CI 2.537-22.585; p < .001) were associated with greater treatment response. There were no serious adverse events. CONCLUSIONS The new treatment protocol of MFU is an effective and safe strategy for lower eyelid fat bulging.
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Affiliation(s)
| | - Do-Yeop Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Seon-Pil Jin
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment. Dermatol Surg 2019; 45:1620-1626. [DOI: 10.1097/dss.0000000000001881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park JY, Byun EJ, Kim HS. Rejuvenation of periocular region in Koreans: A multimodal approach combining botulinum toxin, fillers, and micro‐focused ultrasound with visualization for optimal results. Dermatol Ther 2019; 33:e13159. [DOI: 10.1111/dth.13159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Je Young Park
- Department of DermatologyOracle Dermatology Clinic, Seoul National University Seoul South Korea
| | - Eun Jung Byun
- Department of DermatologyIncheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon South Korea
| | - Hei Sung Kim
- Department of DermatologyIncheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon South Korea
- Department of Biomedicine & Health SciencesThe Catholic University of Korea Seoul South Korea
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Suh DH, Park HJ, Lee SJ, Song KY, Shin MK. Superficial intense focused ultrasound on periorbital wrinkle. J COSMET LASER THER 2019; 21:412-416. [PMID: 31696744 DOI: 10.1080/14764172.2019.1689272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The periorbital wrinkles are easily perceived evidence of aging, so become a major concern for many patients. Various treatments have been attempted to improve periorbital wrinkles, but the need for new treatments that are less invasive and more effective is still high. In this study, we evaluated the safety, clinical and histological effects of intense focused ultrasound using only a 1.5 mm transducer in the management of periorbital wrinkles. Ten adult Korean females were enrolled. The treatment effect and safety profile were evaluated up to 3 months after 1 session of IFUS treatment on the periorbital wrinkles. The mean subjective satisfaction score was 3.2 ± 0.79 (mean ± standard deviation) by 5- point scale. The mean objective clinical improvement score was highest in the fine wrinkle on the crow's feet area and lowest in the deep wrinkles of the infraorbital and crow's feet area. Histometrically, increase of collagen and elastic fiber density was observed in the all layers of dermis. No serious side effects occurred after the treatment. In conclusion, intense focused ultrasound treatment using a 1.5-mm transducer alone can significantly improve periocular wrinkles after a single treatment with a good safety profile.
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Affiliation(s)
- Dong Hye Suh
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea (the Republic of)
| | - Hyung Jin Park
- Dermatology, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Sang Jun Lee
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea (the Republic of)
| | - Kye-Yong Song
- Pathology, Choongang University College of Medicine, Seoul, Korea (the Republic of)
| | - Min Kyung Shin
- Dermatology, Kyung Hee University, Seoul, Korea (the Republic of)
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27
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Ruiz-Rodriguez R, Martin-Gorgojo A. Integral Facial Management of the Aesthetic Patient: The Skin Age Management Protocol. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ruiz-Rodriguez R, Martin-Gorgojo A. Abordaje facial global del paciente estético: protocolo Skin Age Management. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:197-205. [DOI: 10.1016/j.ad.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
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Cotofana S, Gotkin RH, Ascher B, Morozov SP, Gombolevsky VA, Laipan AS, Pyatintsky IA, Movsisyan TV, Koban KC, Hladik C, Frank K. Calvarial Volume Loss and Facial Aging: A Computed Tomographic (CT)-Based Study. Aesthet Surg J 2018; 38:1043-1051. [PMID: 29635393 DOI: 10.1093/asj/sjy096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our understanding of the aging changes involving the cranium and its impact on the overlying soft tissues is limited. OBJECTIVES This study was designed to look at the changes that occur in the cranium with aging and to propose an additional mechanism for loss of support for overlying soft tissues. METHODS One hundred and fifty-seven white individuals (10 males and 10 females in each decade: 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80-89 years, and 8 males and 9 females aged 90-98 years) were investigated. Computed tomographic (CT) multiplanar scans with standardized measurements of cranial thickness were performed for the frontal bone, nasion, vertex, pterion, lambda, calvarial and midfacial height, and sagittal and transverse diameter. RESULTS Increasing age correlated with a decrease in sagittal diameter in both males (rp = -0.201) and females (rp = -0.055) but with an increase in transverse diameter in both males (rp = 0.233) and females (rp = 0.207). Frontal bone thickness decreased in males -1.57mm/-18.14%, whereas it increased slightly in females +0.26mm/+3.04%. At the pterion, bone thickness increased significantly in both genders. Calvarial volume decreased with increased age in both males and females: -70.2 ml/-5.35% and -61.4 ml/-5.10%, respectively. CONCLUSIONS The lateral expansion of the skull may favor a skeletonized appearance of the face in elderly individuals. The computed volume of the calvaria decreased with advancing age in both genders, providing an additional element in the multifactorial model for facial soft-tissue laxity. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Benjamin Ascher
- Plastic and Reconstructive Surgeon, Iena Plastic Surgery Clinic, Paris, France
| | - Sergey P Morozov
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Victor A Gombolevsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Albina S Laipan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Ilya A Pyatintsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Tigran V Movsisyan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Konstantin C Koban
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
| | - Casey Hladik
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
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Chen Y, Shi Z, Shen Y. Eye damage due to cosmetic ultrasound treatment: a case report. BMC Ophthalmol 2018; 18:214. [PMID: 30157786 PMCID: PMC6114535 DOI: 10.1186/s12886-018-0891-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background Rejuvenation of aging eyelids is one of cosmetic changes to the individual to create the appearance of youth. Tightening treatment of eyelid by ultrasonic heat could possibly develop acute eye injury, including acute increase of IOP, cataract and rarely myopia. Case presentation A case report of rejuvenation tightening treatment caused eye injury with 6 months’ follow-up. All examinations were performed at a university teaching hospital. A healthy 32-year-old Asian woman had pain, photophobia and blurred vision in the right eye after rejuvenation tightening eye brow treatment. Intraocular pressure (IOP) was 31 mmHg in the right eye. Tyndall phenomena were observed. Visual acuity of the right eye dropped to 20/200 (from 20/20), with best-corrected visual acuities (BCVAs) 20/20. An iris pigment detachment was found. Neuro-ophthalmic examination was relative afferent pupillary defect (RAPD) positive with pericentral scotoma in the right eye, indicating optic nerve damage. In the optical quality analysis system (OQAS) exam, the objective scatter index (OSI) was 1.0 in the right eye and 0.7 in the left. Clearing additional plus lens power was difficult for this patient, indicating accommodation spasm in the right eye. Conclusions Rejuvenation with intense-focused ultrasound (IFUS) could cause heat injury, leads to acute increase of IOP. Heat damage in zonular fibers could cause accommodation spasm and myopia. Eye injuries caused by IFUS has been seldom reported. We recommend that cosmetic treatment in the eye area should be highly aware of side effect. Electronic supplementary material The online version of this article (10.1186/s12886-018-0891-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuanyuan Chen
- Eye Center, Wuhan University Renmin Hospital, 238 Jie Fang Road, Wu Chang District, Wuhan, 430060, China
| | - Zhongyu Shi
- Eye Center, Wuhan University Renmin Hospital, 238 Jie Fang Road, Wu Chang District, Wuhan, 430060, China
| | - Yin Shen
- Eye Center, Wuhan University Renmin Hospital, 238 Jie Fang Road, Wu Chang District, Wuhan, 430060, China.
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A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology. Dermatol Surg 2018; 44:949-963. [DOI: 10.1097/dss.0000000000001551] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Safran T, Gorsky K, Viezel-Mathieu A, Kanevsky J, Gilardino MS. The role of ultrasound technology in plastic surgery. J Plast Reconstr Aesthet Surg 2018; 71:416-424. [DOI: 10.1016/j.bjps.2017.08.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/19/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
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Vachiramon V, Jurairattanaporn N, Harnchoowong S, Chayavichitsilp P. Non-invasive high-intensity focused ultrasound for UV-induced hyperpigmentation in Fitzpatrick skin types III and IV: a prospective, randomized, controlled, evaluator-blinded trial. Lasers Med Sci 2017; 33:361-367. [PMID: 29177714 DOI: 10.1007/s10103-017-2393-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/19/2017] [Indexed: 11/25/2022]
Abstract
Skin hyperpigmentation is a frequently encountered problem, particularly in darker skin types. Unfortunately, standard treatments for this condition have shown disappointing results. High-intensity focused ultrasound (HIFU) is commonly indicated for skin laxity, but recently was used to treat UV-induced hyperpigmentation in animal models. This study is aimed to evaluate the efficacy and safety of high-intensity focused ultrasound for UVB-induced hyperpigmentation in human subjects. A randomized, evaluator-blinded pilot study was conducted on 20 subjects. Each subject was induced three hyperpigmentary spots by local broadband UVB. After 2 weeks, each spot was randomly allocated to control, low-energy, and high-energy HIFU. Subjects were instructed to follow up weekly for a duration of 1 month. Lightness index measurements, mean improvement scores, subjects' satisfaction, pain scores, and side effects were evaluated. All 20 subjects completed the study. Fourteen subjects had Fitzpatrick (FPT) skin type III and six subjects had FPT skin type IV. Twelve subjects showed greater improvement at control sites while eight subjects showed greater improvement at HIFU-treated sites. In FPT skin type III, HIFU appeared to be inferior to control in both lightness index and mean improvement scores, but in FPT skin type IV, HIFU had greater lightness index improvement and higher improvement scores than control. Side effects were more frequent in high-energy-treated areas. Focused ultrasound may be offered in some patients with hyperpigmentary conditions. More research is needed to determine proper energy settings for optimal outcome.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Rajthevi, Bangkok, 10400, Thailand.
| | - Natthachat Jurairattanaporn
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Rajthevi, Bangkok, 10400, Thailand
| | - Sarawin Harnchoowong
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Rajthevi, Bangkok, 10400, Thailand
| | - Pamela Chayavichitsilp
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI road, Rajthevi, Bangkok, 10400, Thailand
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Friedmann DP, Bourgeois GP, Chan HH, Zedlitz AC, Butterwick KJ. Complications from microfocused transcutaneous ultrasound: Case series and review of the literature. Lasers Surg Med 2017; 50:13-19. [DOI: 10.1002/lsm.22768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel P. Friedmann
- Westlake Dermatology Clinical Research Center; Westlake Dermatology & Cosmetic Surgery; Austin Texas
| | | | - Henry H.L. Chan
- Hong Kong Dermatology and Laser Centre; Hong Kong China
- Division of Dermatology, Department of Medicine; University of Hong Kong; Hong Kong China
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
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Abstract
BACKGROUND Facial rejuvenation continues to be an increasing trend among males. The periorbital region deserves special mention given the overall differences in aesthetics between sexes. OBJECTIVE To examine the aesthetics of the upper eyelid, lower eyelid, lateral canthus, and brow with respect to male periorbital rejuvenation. METHODS The upper eyelid, lower eyelid, lateral canthus, and brow are examined, highlighting aesthetic differences in males and females. RESULTS The authors outline principles so as to maintain a masculine appearance when treating the male upper eyelid, lower eyelid, lateral canthus, and brow. CONCLUSION With guiding principles, the male upper lid, lower lid, brow, and lateral canthus can be managed to achieve optimal, consistent results.
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Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of infraorbital hollows (i.e., tear troughs) before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Infraorbital Hollows Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 297) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 0.90 [0.79-1.02] for clinically different image pairs and 0.33 [0.19-0.46] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was substantial (mean weighted kappa = 0.79). Interrater agreement was substantial during the second rating session (0.70, primary end point). CONCLUSION The Allergan Infraorbital Hollows Scale is a validated and reliable scale for physician rating severity of hollowing in the infraorbital area.
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Abstract
In the setting of rapidly changing technology tone must make a decision on whether he or she places a premium on being an "early adopter" of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Laser devices are a significant capital expenditure, and therefore members of the second group who base their purchasing decisions on evidence-based medicine may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appeared.
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Abstract
Microfocused ultrasound (MFU) has been recently developed to meet the ever-growing public demand for achieving significant, noninvasive skin lifting and tightening. MFU can be focused on subcutaneous tissue where the temperature briefly reaches greater than 60°C, producing small (<1 mm3) thermal coagulation points to a depth of up to 5 mm within the mid-to-deep reticular layer of the dermis and subdermis. The intervening papillary dermal and epidermal layers of skin remain unaffected. The application of heat at these discrete thermal coagulation points causes collagen fibers in the facial planes such as the superficial musculoaponeurotic system and platysma, as well as the deep reticular dermis, to become denatured, contracting and stimulating de novo collagen. A commercially available device combines MFU with high-resolution ultrasound imaging (MFU-V), which enables visualization of tissue planes to a depth of 8 mm and allows the user to see where the MFU energy will be applied (Ultherapy®; Ulthera Inc., Mesa, AZ, USA). Using different transducers, MFU-V treatment can be customized to meet the unique physical characteristics of each patient by adjusting energy and focal depth of the emitted ultrasound. By targeting the facial superficial musculoaponeurotic system, noninvasive tightening and lifting of sagging facial and neck skin and improvements in the appearance of wrinkles can be achieved. MFU-V can also improve lines and wrinkles of the décolleté. Treatment protocols for the use of MFU-V continue to be refined, and its use in combination with other rejuvenation techniques has been demonstrated. Brief discomfort that often occurs during treatment can be minimized with oral nonsteroidal anti-inflammatory drugs. Other treatment-related adverse events include transient erythema, edema, and occasional bruising. MFU-V is best suited for patients with mild-to-moderate skin and soft tissue laxity. For older patients with severe skin laxity and marked platysmal banding, surgical treatment should be considered.
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Affiliation(s)
- Sabrina Guillen Fabi
- Goldman, Butterwick, Fitzpatrick, Groff and Fabi, Cosmetic Laser Dermatology, San Diego, CA, USA
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