Resurfacing with Ablation of Periorbital Skin Technique: Indications, Efficacy, Safety, and 3D Assessment from a Pilot Study

A systematic review of Radiesse® (calcium hydroxylapatite): evidence and recommendations for the body

A filler composed of calcium hydroxylapatite and carboxymethylcellulose gel (CaHA/CMC) has been shown to possess biostimulatory and skin-tightening properties that have been applied not just to the face but also to the body to boost rejuvenation. Recently, evidence and recommendations for CaHA/CMC treatment of the face have been provided, but they are still lacking in terms of body treatment. This article aims to perform a systematic review of the literature on CaHA/CMC applications on the body and provide evidence from the literature. Currently, the only FDA-approved indication on the body is treating the hands and a recent European Union Medical Device Regulation approval has been released for decolletage treatment. The application of hyperdilutions on the neck, feet, arms, thighs, abdomen, and other body parts has been proven to provide a skin-tightening effect. However, despite their wide use with a good safety profile in clinical practice, recent trends and guidelines of diluted and hyperdiluted CaHA/CMC have yet to be supported by randomized controlled trials.

A systematic review of Radiesse/calcium hydroxylapatite and carboxymethylcellulose: evidence and recommendations for treatment of the face

Radiesse® is a filler composed of calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel (CaHA/CMC). It has robust rheological properties that have been associated with its versatility. CaHA/CMC is employed for both on-label indications of filling wrinkles or lines, volumizing, and contouring of areas as well as off-label indications aiming at biostimulation and skin tightening. However, despite the expanding use of CaHA/CMC, overall evidence and recommendations for treatment are currently lacking. This paper aims to provide an up-to-date overview of CaHA/CMC clinical applications, together with a level of evidence of supporting literature, focusing on the face. Based on the data, CaHA/CMC may be considered a safe and effective treatment option for cheeks, jawline, HIV-related facial lipoatrophy, and nasolabial folds. Treatment of marionette lines, chin, pre-jowl, and corner of the mouth also tends to respond with a high degree of efficacy. Despite the recent trend, guidelines, and safety profile of diluted and hyperdiluted Radiesse® , no randomized controlled trials have been published.

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Laser Treatment Monitoring with Reflectance Confocal Microscopy

Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be applied to cosmetically sensitive skin areas such as the face, without the need for skin biopsies. For these reasons, apart from its current use in skin cancer diagnosis, our systematic review reveals how RCM can be employed in the field of laser treatment monitoring, being particularly suitable for the evaluation of variations in epidermis and dermis, and pigmentary and vascular characteristics of the skin. This systematic review article aims to provide an overview on current applications of RCM laser treatment monitoring, while describing RCM features identified for different applications. Studies on human subjects treated with laser treatments, monitored with RCM, were included in the current systematic review. Five groups of treatments were identified and described: skin rejuvenation, scar tissue, pigmentary disorders, vascular disorders and other. Interestingly, RCM can assist treatments with lasers targeting all chromophores in the skin and exploiting laser induced optical breakdown. Treatment monitoring encompasses assessment at baseline and examination of changes after treatment, therefore revealing details in morphologic alterations underlying different skin conditions and mechanisms of actions of laser therapy, as well as objectify results after treatment.

Laser-assisted blepharoplasty: An innovative safe and effective technique

BACKGROUND

Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure.

METHODS

The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored.

RESULTS

Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed.

CONCLUSIONS

Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.

Modern blepharoplasty: From bench to bedside

The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years. Blepharoplasty is one of the most frequently performed procedures worldwide to date. Surgery is currently the first choice in order to achieve permanent and effective results; however, it is burdened by potential surgical complications feared by patients. There is an increasing trend in individuals to request less invasive, non-surgical, effective, and safe procedures for eyelid treatment. The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years. Numerous modern techniques that provide a rejuvenation of the entire area have been described. Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings. Dermal fillers are a commonly chosen option for providing enhanced aesthetic results, especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging. Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits. The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis. Furthermore, techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.

An Open-label Study Assessing the Efficacy and Tolerability of a Post-treatment Skincare Protocol Following Radiofrequency Microneedling for Facial Rejuvenation

BACKGROUND

A post-treatment skincare protocol (Finishing Touch™ Protocol; Colorescience®, Inc.) comprising several commercial products was developed for use after minimally invasive facial procedures.

OBJECTIVE

Our objective was to assess the effect of this post-treatment protocol on subject experiences following radiofrequency microneedling including confidence to resume normal activities, treatment satisfaction and likelihood for retreatment.

METHODS

Healthy female subjects, aged 21 to 65 years with Fitzpatrick Skin Types I to IV seeking facial rejuvenation with radiofrequency microneedling were enrolled (N=29). The microneedling procedure was performed during the baseline visit. Digital images were obtained before and immediately following microneedling, and after post-procedure application of the skincare protocol. A nonmedicated barrier ointment was also applied prior to the skincare protocol immediately following treatment in a third group of subjects. Subsequently, the skincare protocol was applied each morning after regular skincare routines. Subjects returned after four weeks for a final assessment, a self-assessment questionnaire, and treatment satisfaction ratings.

RESULTS

Following skincare protocol application, most subjects (97%) observed improvements in skin redness and/or treatment site marks, felt more confident (90%) and were very or extremely comfortable resuming normal activities (86%). Mild-to-moderate adverse events (n=4) resolved and were consistent with adverse events reported in the literature with no bleeding immediately following the microneedling with radiofrequency treatment.

LIMITATIONS

Primary limitations were the small number of subjects and self-reported outcomes.

CONCLUSION

Based on our results, the studied post-treatment skincare protocol appeared to improve subject confidence, comfort, satisfaction, and the likelihood of a repeat radiofrequency microneedling procedure among the included patients. No reported adverse events incremental to standard microneedling were observed.

Periorbital rejuvenation: A study on the use of dermal threads as monotherapy, with a review of literature

The periorbital region, a major impressionable area holds a special place in aging of the face. It reflects chronological aging which are reflected not only as structural changes but also emotive expressions of sadness and tiredness. Dermal threads have been used in combination with other aesthetic procedures, however their use as monotherapy especially in periorbital region needs evaluation.

Combined CO2 and dye laser technique in the treatment of outcomes due to flap necrosis after surgery for basal cell carcinoma on the nose

BACKGROUND AND OBJECTIVE

Basal cell carcinoma (BCC) is the most frequent cutaneous cancer worldwide, and the nasal area is the most commonly affected region. Skin flaps are usually performed to achieve radical results, but various adverse events often occur. The necrosis of the skin flap is one of the most frequently observed, resulting in scars and anti-aesthetic outcomes. Ablative and non-ablative lasers have been proposed to improve scars resulting from surgical failure and skin flap necrosis.

STUDY DESIGN/MATERIALS AND METHODS

This study aims to evaluate a new laser protocol combining ablative CO₂ -laser with flashlamp pulsed dye laser for the treatment of nasal scars resulting from the necrosis of flap that occurred after surgery. Twelve patients were enrolled in the study, and a total of five laser sessions were planned, spaced from 14 days to 1 month apart.

RESULTS

Seven out of 12 patients underwent all the five laser sessions planned, while 5/12 patients achieved optimal cosmetic results within the fourth session. Eighty percent of the patients reported good/optimal cosmetic results, and no significant side effects were observed during the study.

CONCLUSION

Combining fractionated CO₂ laser with flashlamp pulsed dye laser represents a new effective modality for treating skin flap necrosis after BBC removal, representing a valid alternative to other surgical procedures.

A Validated Photonumeric Scale for the Evaluation of Neck Skin Laxity

BACKGROUND

Neck aging is usually evaluated together with the lower face. To date, a skin laxity scale for the neck as an independent anatomical district is lacking.

OBJECTIVE

To create and validate a proposed photonumeric neck skin laxity (NSL) scale.

MATERIALS AND METHODS

Frontal neck photographic images of 110 subjects were collected. Each standardized neck image was evaluated twice by 3 independent doctors, 1 week apart. A 4-point photonumeric NSL scale was developed (0 = absence of skin laxity and 4 = severe skin laxity) and validated in terms of intraobserver and interobserver correlation and internal consistency.

RESULTS

The intraobserver reliability analysis of the 2 assessments performed by each observer revealed excellent correlation and consistency of the severity grading, independently of the time of evaluation (from 0.96 to 0.99, p < .01). Furthermore, the interobserver reliability analysis revealed an excellent agreement between the evaluators and an internal consistency independent of the evaluator (0.97, p < .01).

CONCLUSION

The newly developed NSL scale is a reliable and reproducible scoring system for the aesthetic evaluation of skin laxity of the neck.

An overview on the role of CO2 laser in general dermatology

Among different laser types, the carbon dioxide (CO₂ ) laser remains one of the most used by dermatologists. Its usefulness has been demonstrated both for therapeutic and cosmetic purposes. This review aims to provide an overview of the applications of CO₂ laser in dermatology, focusing on the treatment of infective, neoplastic, and antiaesthetic lesions.

Hyperdiluted calcium hydroxylapatite for skin laxity and cellulite of the skin above the knee: A pilot study

Despite an increasing request for skin rejuvenation above the knee, very few treatment options have been reported in literature. To evaluate the efficacy and safety of 1:4 hyperdiluted calcium hydroxylapatite (CaHA) in the treatment of skin laxity and dimples of the skin above the knees. A retrospective evaluation of hyperdiluted CaHA treatment for skin laxity and dimples above the knee was performed. Efficacy was classified as blinded evaluation of pre (T0) and 3-month post-treatment (T1) photographs by three investigators according to the validated knee cellulite severity score (KCSS) and patient satisfaction. Safety was evaluated through pain scores and adverse events evaluation. A significant reduction of KCSS at T1, as compared to T0, mainly in subjects with lower KCSS at T0, was observed (P < .05). All blinded assessments resulted in a correct identification of T0 and T1 pictures and evaluations of all investigators were found to be consistent and reliable. All patients were satisfied. Only minor adverse events (swelling, erythema, bruising, and skin irregularities) were reported, lasting 2 to 3 weeks after treatment. Our preliminary results highlight the efficacy and safety of hyperdiluted CaHA in the treatment of skin laxity and cellulite above the knees.

A New Perspective to the Periorbital Aesthetics: Bella Eyes

INTRODUCTION

The term beautiful eyes can be defined as youthful, brilliant, vivid, and attractive eyes. The anthropometric findings about beautiful eyes may differ according to gender or race. In order to form such a beautiful eye, a variety of surgical, nonsurgical, or combination methods for periorbital region rejuvenation have been proposed. The surgical methods include coronal/peritrichial, endoscopic, upper and lower eyelid, or transconjunctival incisional procedures. Neuromodulators, fillers, and laser treatments are some of the nonsurgical approaches. Regardless of the method, while treating this particular area, the aesthetic unit concept should always be taken into consideration.

METHODS

We attempted to combine an endoscopic dynamic canthopexy procedure with endoscopic temporal and brow lift, which we call "bella eyes" to achieve a more attractive look, especially in young people who desire a slanted eyelid. We aim to share our clinical experience from 35 patients and the technical details of the bella eyes procedure.

RESULTS

Patient satisfaction was high, and the endoscopic technique eliminated all of the minor deformities and provided excellent harmony through each subunit of the periocular area with minimal discomfort and well-hidden scars.

CONCLUSION

We believe that this procedure is a good way to achieve a beautiful eye in young women.

LEVEL OF EVIDENCE IV

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.