Facial changes in the mature patient

Paired Treatment Using Radiofrequency Microneedling and 755-nm Picosecond Laser With Fractionated Lens Array for Facial Rejuvenation

BACKGROUND

Patients frequently complain about fine lines, wrinkles, dyschromia, and photoaging, for which lasers and energy-based devices can treat each of these. Pairing various devices in a single treatment session can be safe and effective, but different technologies, mechanisms, histologies, parameters, and techniques must be considered.

OBJECTIVE

To examine the utility of a paired treatment regimen using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array to improve the clinical appearance of facial wrinkles and photoaging.

MATERIALS AND METHODS

A prospective clinical study investigated this paired treatment regimen using 4 monthly sessions.

RESULTS

Twenty-five subjects were enrolled, while 18 subjects completed 3-month follow-up. The mean age was 54 years, and 92% were women. Fitzpatrick Skin Types I to IV were represented. Assessments compared baseline with the 3-month follow-up. Two of 3 blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 94.4% of cases. For physician Global Aesthetic Improvement Scale, 100% of subjects had clinical improvement. Overall, 88.9% of subjects were considered to be satisfied with their treatment. No serious or unanticipated adverse events occurred.

CONCLUSION

Paired treatment using radiofrequency microneedling and 755-nm picosecond laser with fractionated lens array can safely and effectively improve facial wrinkles and photoaging.

Poly-L-Lactic Acid Fillers Improved Dermal Collagen Synthesis by Modulating M2 Macrophage Polarization in Aged Animal Skin

Poly-L-lactic acid (PLLA) fillers correct cutaneous volume loss by stimulating fibroblasts to synthesize collagen and by augmenting the volume. PLLA triggers the macrophage-induced activation of fibroblasts that secrete transforming growth factor-β (TGF-β). However, whether M2 macrophage polarization is involved in PLLA-induced collagen synthesis via fibroblast activation in aged skin is not known. Therefore, we evaluated the effect of PLLA on dermal collagen synthesis via M2 polarization in an H₂O₂-induced cellular senescence model and aged animal skin. H₂O₂-treated macrophages had increased expression levels of the M1 marker CD80 and decreased expression levels of the M2 marker CD163, which were reversed by PLLA. The expression levels of interleukin (IL)-4 and IL-13, which mediate M2 polarization, were decreased in H₂O₂-treated macrophages and increased upon the PLLA treatment. CD163, IL-4, and IL-13 expression levels were decreased in aged skin, but increased after the PLLA treatment. The expression levels of TGF-β, pSMAD2/SMAD2, connective tissue growth factor (CTGF), alpha-smooth muscle actin (α-SMA), collagen type 1A1 (COL1A1), and COL3A1 were also decreased in aged skin, but increased after the PLLA treatment. Moreover, PLLA upregulated phosphatidylinositol 3-kinase p85α (PI3-kinase p85α)/protein kinase B (AKT) signaling, leading to fibroblast proliferation. PLLA decreased the expression of matrix metalloproteinase (MMP) 2 and MMP3, which destroy collagen and elastin fibers in aged skin. The amount of collagen and elastin fibers in aged skin increased following the PLLA treatment. In conclusion, PLLA causes M2 polarization by increasing IL-4 and IL-13 levels and upregulating TGF-β expression and collagen synthesis in aged skin.

Safety and Efficacy of a Thermomechanical Fractional Injury Device for Periorbital Rhytides

BACKGROUND

Periorbital rejuvenation is a common cosmetic concern. A fractional thermomechanical skin rejuvenation system was developed to offer clinical improvements from direct heat transfer.

OBJECTIVE

A prospective study evaluated the efficacy and safety of the device for periorbital fine lines and wrinkles.

MATERIALS AND METHODS

Subjects with moderate-to-severe periorbital rhytides were enrolled and underwent 4 monthly treatments with a novel device using thermomechanical fractional injury (Tixel 2; Novoxel, Netanya, Israel).

RESULTS

Fifty-one subjects were enrolled. Mean age was 56.8 years, and 88.2% were women. Fitzpatrick skin Types I to IV were included. For Fitzpatrick Wrinkle Classification System (FWCS), mean baseline score was 5.7. Per investigator, there was a mean 2.0-grade improvement in FWCS at 3-month follow-up ( p < .0001). Per 3 blinded physician raters, there was a mean improvement of 2.2 ( p < .0001), 2.0 ( p < .0001), and 1.2 ( p < .0001) in FWCS at 3-month follow-up. Each of the raters correctly identified posttreatment images for 87.5%, 77.1%, and 75.0% of subjects. At least 2 raters agreed on grading 83.3% of subjects as responders. There were no severe adverse events. Subjects experienced minimal pain and downtime.

CONCLUSION

A novel device using thermomechanical fractional injury was demonstrated to be safe and effective in the treatment of periorbital rhytides.

Facial Skin Aging Stages in Chinese Females

Background

Facial skin is exposed to the environment, which marks it with obvious signs of aging. Based on multi-dimensional non-invasive evaluation data, female facial skin can be characterized in detail. However, there are few studies on the general aging rules of facial skin. Most skin aging studies divide the ages into 5-10-year intervals, so they have lacked dynamic matching with facial skin aging.

Aim

To explore facial skin aging rules, discuss the main parameters of facial skin aging, propose an unequal-distance aging division method based on the main skin parameters, and study the skin characteristics of Chinese women of different aging stages.

Methods

We comprehensively described the skin status as 24 non-invasive skin parameters belonging to five dimensions: skin wrinkles, texture, stain, color and barrier function. We performed polynomial fitting on the 21 skin parameters that were significantly correlated with age and derived the rules of aging in the different dimensions. Based on the wrinkle dimension, the facial skin aging process was divided into four stages, and the skin characteristics of the different stages were compared.

Results

Skin wrinkles increased, texture deteriorated, acne decreased, pigment spots increased, skin tone darkened, and sebum secretion decreased with age, according to the polynomial fitting. The aging stage was divided into an incubation period (18-30 years old), an aging occurrence period (31-42 years old), a rapid aging period (43-47 years old), and a stable aging period (48-60 years old), according to the wrinkles. Different aging stages had different skin characteristics.

Conclusion

The incubation period is the critical period for the appearance of skin stains; the skin texture gradually deteriorates during the aging occurrence period; the rapid aging period is a critical period for the aging of skin parameters; skin status during the stable aging period is the worst.

Combined Treatment of Monopolar and Bipolar Radiofrequency Increases Skin Elasticity by Decreasing the Accumulation of Advanced Glycated End Products in Aged Animal Skin

It is well known that skin aging is related to the destruction of collagen and elastin fibers by metalloproteinases (MMPs). Aged fibroblasts have a decreased ability to synthesize collagen and elastin. Nuclear factor erythroid 2-related factor 2 (NRF2) involves glyoxalase (GLO) activation, which inhibits the production of advanced glycated end products (AGE) and the expression of its receptor (RAGE). RAGE increases nuclear transcription factor-kappa B (NF-κB), which upregulates MMPs and decreases skin elasticity. NRF2 also decreases M1 macrophages, which secrete tumor necrosis factor-alpha (TNF-α), thereby decreasing AGE production. It is well known that radiofrequency (RF) decreases skin elasticity by increasing collagen synthesis. We evaluated whether RF increases skin elasticity via NRF2/GLO and whether they decrease AGE and RAGE expression in aged animal skin. We also compared the effects of RF based on the modes (monopolar or bipolar) or the combination used. In aged skin, NRF2, GLO-1, and M2 macrophage expression was decreased, and their expression increased when RF was applied. M1 and TNF-α demonstrated increased expression in the aged skin and decreased expression after RF application. AGE accumulation and RAGE, NF-κB, and MMP2/3/9 expression were increased in the aged skin, and they were decreased by RF. The papillary and reticular fibroblast markers showed decreased expression in young skin and increased expression in aged skin. The densities of collagen and elastin fiber in the aged skin were low, and they were increased by RF. In conclusion, RF leads to increased collagen and elastin fibers by increasing NRF2/GLO-1 and modulating M1/M2 polarization, which leads to decreased AGE and RAGE and, consequently, decreased NF-κB, which eventually slows collagen and elastin destruction. RF also leads to increased collagen and elastin fiber synthesis by increasing papillary and reticular fibroblast expression.

Efficacy and Safety of High-Intensity, High-Frequency, Parallel Ultrasound Beams for Fine Lines and Wrinkles

BACKGROUND

Ultrasound energy has been used for cutaneous rejuvenation, including treatment of fine lines and wrinkles. Ultrasound waves of high intensity can induce thermal injury in the dermis, which causes tissue coagulation and remodeling.

OBJECTIVE

To examine the safety and utility of a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams to improve fine lines and wrinkles of the face and neck.

MATERIALS AND METHODS

A prospective, multicenter, clinical study investigated the utility of this novel ultrasound device to improve fine lines and wrinkles. Sixty subjects were enrolled for single treatment to the face and neck.

RESULTS

Fifty-eight subjects completed the study. The mean age was 58 years, and 87.9% were women. Fitzpatrick skin Types I to VI were represented. Assessments compared 12-week follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 78% of subjects. There was significant improvement of 1 to 3 Fitzpatrick Wrinkle and Elastosis Scale units in 86% of subjects. For investigator global improvement scores, 88% of subjects had improvement. Overall, 72% of subjects noted improvement, and the majority were satisfied. There were no device-related adverse events.

CONCLUSION

Treatment with a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams safely improved the clinical appearance of fine lines and wrinkles of the face and neck.

Optimizing skin tightening in aesthetics in men

The field of cosmetic dermatology has recently witnessed unbridled growth in the past several years. Part of this has been due to the increasing popularity of aesthetic treatments in men, who represent a growing patient population. Men tend to have higher levels of collagen density and greater skin thickness, but these begin to decrease earlier on. They can also more frequently have severe photodamage. Their clinical presentations can affect the selection of treatments. Physicians should be familiar with the subtle differences between treating men and women. Early studies and literature are beginning to shed more light on these important distinctions. We review the notable differences in facial aging, pathophysiology, and patient selection and discuss available treatment options with these factors in mind.

Paired facial treatment with 755nm picosecond laser with diffractive lens array and 1060nm laser lipolysis of the submentum: An open-label prospective trial

BACKGROUND

Performing multiple cosmetic treatments in a single session to target different aspects of facial rejuvenation is an effective regimen. Picosecond lasers with a fractionated handpiece can target fine lines, which can supplement submental fat reduction procedures. However, limited data exist on the safety and efficacy of single-session treatment strategies.

AIMS

To assess the safety and utility of paired facial treatment with 755 nm picosecond laser with diffractive lens array (DLA) and 1060 nm laser lipolysis of the submentum.

PATIENTS/METHODS

A prospective clinical study investigated the utility of paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm diode laser lipolysis of the submentum. Subjects received treatments during the same session. Subjects were enrolled to receive up to 3 picosecond laser and 2 lipolysis treatments at 2-8-week intervals.

RESULTS

Eleven subjects completed the study. Mean age was 52.1 years, and 81.8% were female. Fitzpatrick skin types II-VI were represented. For investigator global aesthetics improvement scores (GAIS), 63.6%, 81.8%, and 85.7% had improvement from baseline at 30-, 90-, and 180-day follow-up, respectively. At 180-day follow-up, 100% maintained improvement from 90-day follow-up. At 90-day follow-up, calculations for neck laxity showed a significant improvement of 11.7% from baseline (p < 0.001) with a mean amount of lift of 42.7 mm² , which was above the predetermined threshold (20 mm² ). No serious or unexpected treatment effects were observed.

CONCLUSION

Paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm laser lipolysis of the submentum improved clinical aesthetic outcomes. This treatment regimen was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Differences in the response in the dermis of the tails of young and old SD rats to treatment with bipolar RF

BACKGROUND

The passing of the years is marked by intrinsic (chronological) and extrinsic aging, caused by photoaging, which is characterized by a decrease in collagen and the deposition of abnormal elastic fibers in the dermis. The use of bipolar radiofrequency (RF) increases fibroblast proliferation and differentiation, accompanied by collagen synthesis and a subsequent increase in connective tissue, and it is not known whether the biological effects of this type of radiofrequency on the dermis are similar regardless of the age of the individual or whether such effects are altered by the aging process itself.

AIMS

The objective was to perform a histological study of the changes in the tail dermis of young and old rats after submitting them to bipolar RF, to determine cell proliferation and volume of connective tissue.

METHODS

One part of the rat tail was fixed in formol and processed for light microscopy and another part processed for electron microscopy.

RESULTS

The number of fibroblasts/unit area and cells positive to nuclear proliferation antigen was higher in young animals. Significant differences were observed regarding expression of HSP-47 protein, and the value was always lower in old rats. No significant differences were observed in the percentage of connective tissue. No histological alterations were observed in any rats.

CONCLUSION

Treatment with RF increased the number of fibroblasts located in the connective tissue of the young rats. In addition, the effect of a single treatment on the population of fibroblasts in young animals was sufficient to activate the synthesis of new collagen.

"WAY": A practical means to identify and treat the aging process

Background

Many patients consult a specialist in esthetics to improve certain aspects of their face that are altered by aging. To ensure optimal results and to define the best approach for such interventions, it is important that specialists have a comprehensive understanding of facial anatomy and of the aging process in the regions of interest.

Aims

The main purpose of this article was to provide a practical approach for managing aging process in the mid‐ and lower face. Additionally, this paper also aimed to describe the processes associated with aging that may affect the morphology and the appearance of jaw contour (“W”); prejowl (“A”); tear trough, palpebromalar area, and nasojugal groove (“Y”) (“WAY”) signs.

Methods

The Current paper combined the authors experience with the currently available scientific evidence.

Results

In this study, the anatomy and the changes associated with aging of the mandibular line and that of the tear trough, palpebromalar area, and nasojugal groove was described. The important anatomical changes in these facial regions can be considered through the “WAY” paradigm, signs of aging that can be treated through a variety of surgical and nonsurgical approaches. Although surgical procedures may obtain good results, patients generally prefer less invasive treatments, which have a good efficacy profile, but are safer and have a shorter recovery time.

Conclusions

The “WAY” signs identify anatomical changes in the mandibular line and tear trough, palpebromalar area, and nasojugal groove associated with aging that can be corrected by different procedures, preferably minimally invasive ones.

Tripeptide and hexapeptide topical as adjunct to nonablative fractional resurfacing for photodamage: A randomized split-face trial

BACKGROUND

Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve postprocedural recovery following treatments.

AIMS

A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing.

PATIENTS/METHODS

A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14 days prior to first laser treatment and continuing until 60 days after. All subjects received 2 treatments to entire face approximately 1 month apart with 1927 nm thulium nonablative fractional laser. Clinical measures and immediate postprocedural recovery were assessed.

RESULTS

For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60 days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60 days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed.

CONCLUSION

Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate postprocedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Look at Your Hair the Way You Look at Your Face: Concept of Total Facial Skin and Hair Care

With today's increasing life expectation and quality of life, the desire to look young and beautiful plays a bigger role than ever. Aging of the hair is particularly visible. And yet, cosmetic dermatology has paid comparatively little attention to the care of the aging hair. The professional market for cosmetic interventions into the face has preceded those into the hair for a number of reasons. First, the market for facial rejuvenation has been dominated by plastic surgeons, until the fillers and botulinum toxin were introduced. Second, investigative dermatology found a profound interest in the study of skin aging, particularly as it relates to ultraviolet exposure, and exposed mechanisms at the level of the DNA and repair mechanisms, opening venues for effective preventive measures and pharmacological treatments of aging-related conditions of the skin. Finally, at the level of health professionals, the care for the skin has been overrated in relation to the hair, mostly due to economic reasons. Nevertheless, the hair represents an integral part of the face and our appearance. Moreover, the discovery of pharmacological targets and the development of safe and effective drugs for treatment of hair loss indicate strategies of the drug industry for maintenance of hair growth and quantity, while the hair care industry has become capable of delivering active compounds directed toward meeting the consumer demand for maintenance of hair cosmesis and quality. To offer patients the best outcomes toward a more youthful look, we therefore should look at the whole face including the condition of the hair for a more comprehensive approach toward a total facial skin and hair care concept.

Verruca plana mimicking seborrheic keratosis in the elderly: A case report

Verruca plana is a common viral infection in childhood and early adulthood caused by the human papillomavirus. The clinical presentation can mimic that of benign epithelial neoplasms, particularly seborrheic keratosis, which is common in the elderly. We report a case involving an Asian female patient in her eighties who presented with multiple skin papules resembling seborrheic keratosis on her forehead. Based on the dermatopathologic studies, verruca plana was diagnosed.