Clinical evaluation of the efficacy and safety of combined bipolar radiofrequency and optical energies vs. optical energy alone for the treatment of aging hands

Microneedle fractional radiofrequency in the treatment of periorbital dark circles

BACKGROUND

Periorbital hyperpigmentation (POH) is a common disorder in the patients. Women are more upset with POH in compare to males. Several methods have been used to the POH, with different efficacy and adverse reactions.

AIM

The aim of the present study is to evaluate the efficacy of microneedle fractional radiofrequency (MRF) in treating POH.

METHODS

So, nine patients with POH and the age range of 25-57 years, were treated by microneedle fractional radiofrequency (MRF). The outcome was evaluated via biometric assessment. The colorimeter was used to assess the skin lightness. Mexameter was used for evaluated the amount of Melanin in the periorbital skin. Cutometer was used for skin elasticity assessment. The skin ultrasound imaging system was utilized to estimate the epidermis and dermis diameter and density. Furthermore, Visioface was applied to assessed the skin color and wrinkles. Also patient's satisfaction and physician's assessment were evaluated.

RESULTS

The results displayed that the periorbital skin lightness 32.38% ± 5.67 and elasticity of the R2: 40.29% ± 8.18, R5: 39.03 ± 5.38 and R7: 42.03% ± 14.16 were significantly improved after treatment (p < 0.05). Also the melanin content of the skin was decreased (49.41% ± 9.12). The skin layers were denser in the dermis and also in the epidermis (skin density: 30.21% ± 10.16 and skin thickness: 41.12% ± 13.21) (p < 0.05). The results revealed the decrease in the percent change of the skin color (30.34% ± 9.30) and wrinkle (area: 25.84% ± 6.43 and volume: 30.66% ± 8.12) (p < 0.05). Similarly, the physician and patient's assessment were confirmed the obtained outcomes.

CONCLUSION

In conclusion, the microneedle RF technique is practicable, effective and safe method for periorbital dark circles treatment.

Safety and Effectiveness of Endodermal Radiofrequency for Skin Rejuvenation: A Systematic Review

BACKGROUND

With the advent of new technologies, the demand for non-invasive and effective procedures to treat skin laxity has increased. In this research, we aimed to review studies conducted on the safety and effectiveness of endodermal radiofrequency (ER) for skin rejuvenation.

METHODS

We searched the databases of Embase, PubMed, Scopus, and Google Scholar from 2000 to 2020 to conduct a systematic review based on the PRISMA statement. Screening of titles, abstracts, and full-text articles was performed independently by two reviewers according to inclusion and exclusion criteria.

RESULTS

This study showed that ER resulted in improvement in wrinkles and sagging, reduction of fat, tightening of skin of the face, neck, and jawline, improvement in skin elasticity, pigmentation, contouring of the body, and epidermal thickness decrease. ER technology leads to a significant and satisfactory improvement in skin rejuvenation, lower contouring of skin of the face and neck, as well as patients' satisfaction. Side effects of ER are temporary, and usually disappear spontaneously after a few days to one month.

CONCLUSION

Cosmetic services providers can use this effective and safe technology to treat skin laxity and skin rejuvenation as a substitute for surgery. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Efficacy of Intense Pulsed Light as a Treatment for Benign Pigmented Lesions on the Dorsal Hand

BACKGROUND

Intense pulsed light (IPL) is a noninvasive therapeutic option to treat benign pigmented lesions by targeting melanin.

OBJECTIVE

The purpose of this study was to assess IPL as a treatment for benign pigmented dorsal hand lesions.

MATERIALS AND METHODS

A total of fifteen subjects, 40 to 73 years old, received 3 monthly IPL treatments over the dorsal hands. Subjects followed up 1 and 3 months after treatment. At every visit, photographs were taken using the VISIA Complexion Analysis System (Canfield Scientific, Fairfield, NJ) and analyzed using the RBX Brown Spots Analysis algorithm. The Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale were completed at both follow-up visits.

RESULTS

A total of fifteen subjects completed all six visits. The number of brown spots decreased 9.26% ( p = .0004) and 7.52% ( p = .0132) at each follow-up visit. The mean brown intensity decreased 6.15% ( p = .0183) and 7.67% ( p = .0178), whereas the mean contrast intensity decreased 8.88% ( p < .0001) and 6.60% ( p = .0007) 1 and 3 months after treatment, respectively. The mean Clinician Global Aesthetic Improvement Scale was 2.03 and 2.23, whereas the mean Subject Global Aesthetic Improvement Scale 1 and 3 months after treatment was 1.6 and 1.8, respectively.

CONCLUSION

Objective analysis, along with clinician and subject assessments, showed an improvement in the appearance of benign pigmented lesions in the treated area after 3 IPL treatments.

A Prospective Trial of the Microneedle Fractional Radiofrequency System Application in the Treatment of Infraorbital Dark Circles

Background

Infraorbital dark circles (IDC) are commonly consulted in aesthetic practice. There is not yet a multifactorial approach to facilitating their treatment.

Objective

To investigate the safety and efficacy of the microneedle fractional radiofrequency (MRF) system for the treatment of IDC.

Methods

A prospective, split-face, evaluator-blind clinical trial was conducted to study the change in the overall appearance, color, and wrinkles in 21 female patients with mixed type IDC before and after MFR treatment.

Results

Both patients and independent evaluators found significant improvement on the global aesthetic scales after the MFR treatment, especially on periorbital wrinkles (p=0.031). Trends in decreased melanin density in the IDC area were found, but no statistical differences were established. No side effects were observed.

Conclusion

MFR is a safe and effective modality for improving mixed type IDC by correcting the structural factors.

A Single-Center Pilot Study to Classify Signs of Dorsal Hand Aging Using 3 Grading Scales

Background

While validated scales must be created in order to systemically evaluate patients and quantify outcomes of aesthetic hand treatments, scales currently available are limited to the analysis of volume loss alone.

Objectives

The purpose of this study was to develop 3 validated scales for the assessment of dorsal hand aging that also take into consideration wrinkling and pigmentation.

Methods

Fifty (50) healthy volunteers (40 females and 10 males) with Fitzpatrick skin types I-IV were recruited, and standard photographs of their left and right dorsal hands were taken with a Nikon D7100 (Nikon; Minato, Tokyo, Japan) camera. Using 25 randomized photographs, 11 plastic surgery physicians (3 chief residents, 6 senior residents, and 2 aesthetic surgery fellows) were trained on the 3 scales under investigation as well as the already-validated Merz Hand Grading Scale (MHGS). The evaluators then viewed the remaining 75 photographs independently and assigned a grade for each of the 4 scales to each photograph. Inter-rater variability was calculated for each scale.

Results

The Kappa score for the MHGS was 0.25, indicating fair agreement; 0.40 for wrinkle scale, indicating fair agreement; and 0.48 and 0.46 for the pigmentation density and intensity scales, respectively, indicating moderate agreement (P < 0.001).

Conclusions

The results show that after receiving training, the inter-rater agreement for the 3 scales under investigation was similar or slightly higher than that for the MHGS. These 3 photographic classification systems can be used consistently and reliably to characterize multiple signs of dorsal hand aging.

Level of Evidence: 2

Intense Pulsed Light on skin rejuvenation: a systematic review

Aged skin is characterized by appearance of wrinkles, vascular lesions, hyperpigmentation, lentignes, texture, rhytides, and pores. These changes occur under the influence of intrinsic and extrinsic factors, as hormone alterations and exposure to ultraviolet light (UV) irradiation, respectively. Skin changes associated with aging have been assuming an important role in nowadays and bring to affect the quality of life. Intense Pulsed Light (ILP) is a noncollimated, polychromatic, and noncoherent non-surgical cosmetic therapy to skin rejuvenation. This is the first systematic review evaluating ILP treatment on skin rejuvenation evaluated by digital photographs and self-reported treatment efficacy. A PRISMA compliant review includes a search of the databases Scopus and PubMed. Sixteen studies treating 637 participants (with Fitzpatrick skin types I to IV and age varying from 21 to 80 years) were included. Patients were treated a mean of 4.29 sessions (range 3-7). The most studies results showed the efficacy of IPL treatment in telangiectasia, wrinkles, pore, erythema, rhytids, texture, lentigines, hiperpigmentation, and photoaging score. Six studies showed IPL-positive effects in association with other treatment and seven studies showed superior effect of other treatment or association to IPL with other treatment related to IPL alone. Nine studies showed low methodological quality. In conclusion, ILP treatment is effective on skin rejuvenation. However, there is no consensus about the parameters and future studies are needed to sample size limitations, made RCTs with low risk of bias, and improve the methodological quality its. Trial registration: Prospero Systematic Review Registration ID: CRD42021237817.

Dorsal Hand Rejuvenation: A Systematic Review of the Literature

BACKGROUND

Dorsal hand appearance undergoes changes with aging. Grading systems have been designed to provide numerical scores to dorsal hand appearance. Various modalities have been utilized to improve the aesthetic appearance and rejuvenate the dorsal hand.

METHODS

The MEDLINE database was searched for articles investigating dorsal hand rejuvenation. Studies were grouped by method including fat grafting, injectable filler, laser/light-based treatments and miscellaneous treatments. Treatment protocols and outcomes were compiled along with patient information and complications.

RESULTS

Forty-six articles were identified for inclusion. This included 9 studies of fat grafting procedures, 20 studies of injectable filler, 10 studies of laser/light-based treatments and 7 miscellaneous. Most studies showed overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with the other modalities. The average patient age for included studies ranged from 41.5 to 69. Across all studies, 96.8% of patients were female and 3.2% male.

CONCLUSIONS

Procedures for dorsal hand rejuvenation in the literature include procedures to address volume atrophy and superficial wrinkling. These procedures are overall safe with most studies reporting no complications or only mild adverse events. With high satisfaction rates and anecdotal reports of increasing patient interest, these procedures represent a developing area in aesthetic surgery likely to continue increasing in popularity.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of Q-switched 1064-nm dymium-doped yttrium aluminum garnet laser on the skin barrier and collagen synthesis through miR-24-3p

Due to the increase of the world’s population aging, how to restore youthfulness to the skin has attracted much attention. It is well known that collagen synthesis and changes in skin barrier play an important role in the process of skin aging. However, whether Q-switched 1064-nm Nd:YAG laser (1064-QSNYL) determines the involvement of miRNAs in skin collagen synthesis and skin barrier changes remains to be elucidated. Upstream miRNAs of p38 molecular pathway have been predicted by bioinformatic database and the relationship between miRNAs and p38 verified by dual-luciferase reporter gene and Western blotting. RT-qPCR analysis detected the expression of miR-24-3p and mRNA for collagen and skin barrier–related molecules, such as keratin 10 (K10), filaggrin, and Aquaporin 4 (APQ4), in mice back skin and in the keratinocyte cell line HaCaT. Western blotting and immunofluorescence (IF) have been used to detect collagen expression and to localize, as well as quantify K10, filaggrin, and APQ4, respectively. In this study, we show that p38 is the main target gene of miRNA-24-3p, and laser irradiation at 1.5 J/cm² inhibits miR-24-3p expression. Irradiation treatment upregulates the moisture, elasticity, hydroxyproline, and superoxide dismutase content of mice skin, as well as inhibits trans-epidermal water loss. Irradiation also increases collagen, K10, filaggrin, and APQ4 in both mice skin and HaCaT cells. Interestingly, we found that miR-24-3p overexpression inhibits the effect of irradiation on collagen synthesis and skin barrier. We show for the first time that 1064-QSNYL promotes collagen synthesis and protective effects on skin barrier by downregulating miR-24-3p.

Intended Human Exposure to Non-ionizing Radiation for Cosmetic Purposes

Cosmetic devices using non-ionizing radiation (NIR) are increasingly available for people who wish to modify their appearance for aesthetic purposes. There are a wide range of NIR modalities used for cosmetic procedures, including devices that use optical radiation (laser, intense pulsed light, and light-emitting diode), electromagnetic fields, and ultrasound. Common procedures involving the application of NIR include epilation, skin rejuvenation, body sculpting and contouring, treatment of vascular and skin lesions, tattoo removal, and scar reduction. The majority of research on the use of NIR cosmetic devices has focused on the efficacy of the treatment rather than adverse effects or complications. Studies that assessed safety consisted mostly of case reports and small case series. Common adverse effects on the skin reported include mild and transient pain, erythema, swelling, and changes in pigmentation. Less common, more severe side effects include burns, blisters, scarring, persisting erythema, altered pigmentation, and eye damage. Some of the latter may have resulted from treatment errors. Particular groups of people that may be at greater risk from optical radiation include people with dark skin, with high sun exposure, and taking photosensitizing medications or supplements. There is lack of evidence for the safety profile of cosmetic NIR procedures during pregnancy. Reports of injuries to workers administering treatments with cosmetic NIR devices are rare, but inadvertent damage to the eye from optical devices may occur. Randomized controlled trials are required to fully assess potential adverse effects from the use of NIR cosmetic devices. Regulation varies worldwide and some regions apply the same safety classification and guidance as for medical devices. In order to reduce harm associated with the use of cosmetic devices, ICNIRP considers it important that regulations that cover all types and frequencies of cosmetic NIR devices are adopted worldwide and that there is greater oversight regarding their use.