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McCarthy AD, Soares DJ, Chandawarkar A, El-Banna R, de Lima Faria GE, Hagedorn N. Comparative Rheology of Hyaluronic Acid Fillers, Poly-l-lactic Acid, and Varying Dilutions of Calcium Hydroxylapatite. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6068. [PMID: 39148505 PMCID: PMC11326459 DOI: 10.1097/gox.0000000000006068] [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: 03/01/2024] [Accepted: 06/25/2024] [Indexed: 08/17/2024]
Abstract
Background This study examines the rheological properties of various dermal fillers, including hyaluronic acid (HA) fillers, poly-L-lactic acid (PLLA), and calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) gels, with a particular focus on the impact of aqueous dilution on CaHA-CMC's rheology and potential clinical implications. Methods Using standardized rheological analysis, we measured and compared the elastic modulus (G'), viscous modulus (G″), and the tan δ values of different dilutions of CaHA-CMC against published values of HA and PLLA fillers. The study aimed to determine the potential clinical use of application-specific CaHA-CMC hydrogel dilutions along a range of gel strength and cohesion for hydrogel fillers in current use. Results The findings demonstrate that CaHA-CMC's rheological properties can be tailored across a broad spectrum of viscoelastic parameters through titrated dilution, ranging from high elasticity to low cohesion. Varying the aqueous volume allows for the rheomodulation of CaHA-CMC, potentially matching the entire rheological spectrum of HA fillers and suggesting an expanded range of clinical applications. Conclusions The versatility of CaHA-CMC through dilution may offer a customizable approach for clinical applications, providing practitioners with the ability to fine-tune the properties of fillers to meet specific patient needs and treatment goals. This study lays the groundwork for the potential future use of filler dilutional rheomodulation in clinical practice, tailored to patient- and application-specific needs.
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Affiliation(s)
- Alec D McCarthy
- From the Merz Aesthetics, Global Medical Affairs, Raleigh, N.C
| | - Danny J Soares
- American Foundation for Aesthetic Medicine, Fruitland Park, Fla
| | | | - Radia El-Banna
- Merz Aesthetics GmbH, Filler and Medical Device Development, Frankfurt, Germany
| | | | - Nadine Hagedorn
- Merz Aesthetics GmbH, Filler and Medical Device Development, Frankfurt, Germany
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2
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Khalifian S, McCarthy AD, Yoelin SG. Hyperdiluting Calcium Hydroxylapatite With Platelet-Rich Plasma and Hyaluronidase for Improving Neck Laxity and Wrinkle Severity. Cureus 2024; 16:e63969. [PMID: 39105002 PMCID: PMC11299635 DOI: 10.7759/cureus.63969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
The two cases discussed in this report investigate the efficacy and safety of a novel injectable therapy for treating neck wrinkles and skin laxity, utilizing a combination of hyperdiluted calcium hydroxylapatite (CaHA), platelet-rich plasma (PRP), and hyaluronidase. Two patients presenting with moderate neck wrinkles and laxity underwent treatment and were evaluated several months later. The combined therapy demonstrated improvements in skin texture and laxity following a single treatment. The rationale behind incorporating PRP and hyaluronidase was their potential to amplify the regenerative effects of CaHA. PRP contains growth factors that stimulate collagen production and tissue regeneration while hyaluronidase facilitates the breakdown of hyaluronic acid, promoting better diffusion and more even product dispersion. The findings from these cases provide emerging preliminary evidence supporting the safety and efficacy of this innovative combination therapy for addressing neck wrinkles and laxity. This is the first documented instance of skin priming CaHA with hyaluronidase and PRP. Future investigations are warranted to explore the application of this treatment for other anatomical regions and to delineate the role of each injected component.
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Affiliation(s)
| | - Alec D McCarthy
- Medical Affairs, Merz Aesthetics, Raleigh, USA
- Department of Surgery: Transplant, University of Nebraska Medical Center, Omaha, USA
| | - Steven G Yoelin
- Ophthalmology, Steve Yoelin MD Associates, Newport Beach, USA
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McCarthy AD, Soares DJ, Chandawarkar A, El-Banna R, Hagedorn N. Dilutional rheology of Radiesse: Implications for regeneration and vascular safety. J Cosmet Dermatol 2024; 23:1973-1984. [PMID: 38357772 DOI: 10.1111/jocd.16216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) injectables have emerged as dual-purpose fillers with bioregenerative and direct filling capabilities. AIMS This study investigates the rheological properties of CaHA-CMC and its CMC carrier gel at various dilutions. METHODS The storage modulus (G'), loss modulus (G″), complex viscosity (η*), loss factor (tan δ), cohesivity, and extrusion force were evaluated for a range of CaHA-CMC aqueous dilutions with an oscillatory rheometer, drop weight testing, and force analysis, respectively. RESULTS Results revealed a significant decrease in G', η*, and increase in tan(δ) with increasing dilution, indicating a decline in the product's direct filling capabilities. Cohesivity decreased dramatically with dilution, potentially enhancing tissue biointegration and the product's biostimulatory effects. The CMC gel carrier displayed inelastic and non-resilient properties, with rheological changes differing from CaHA-CMC. Dilutional rheology was also correlated with previously published dilution-dependent biostimulatory data where hyperdiluted CaHA-CMC (>1:2) demonstrated a regenerative profile and diluted or hypodiluted mixtures retained meaningful filling properties and increased regeneration. CONCLUSIONS These findings offer a continuum for tailoring the product's rheological profile to match specific tissue requirements. Customizable rheology allows CaHA-CMC to be tuned for either filling and contouring or optimal regenerative effects. Importantly, safety implications related to vascular occlusion suggest that dilutional rheomodulation decreases the risk of vascular events. In conclusion, this study highlights the significant impact of aqueous dilution on the rheological properties of CaHA-CMC and its carrier gel. The findings support the clinical application of tailored dilutions to achieve desired outcomes, providing versatility and safety for aesthetic applications.
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Affiliation(s)
- Alec D McCarthy
- Medical Affairs North America, Merz Aesthetics, Raleigh, North Carolina, USA
| | - Danny J Soares
- College of Medicine, University of Central Florida, Orlando, Florida, USA
- American Foundation for Aesthetic Medicine, Fruitland Park, Florida, USA
| | | | - Radia El-Banna
- Filler and Medical Device Development, Merz Aesthetics GmbH, Frankfurt, Germany
| | - Nadine Hagedorn
- Filler and Medical Device Development, Merz Aesthetics GmbH, Frankfurt, Germany
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4
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Durairaj K, Baker O, Yambao M, Linnemann-Heath J, Shirinyan A. Safety and Efficacy of Diluted Calcium Hydroxylapatite for the Treatment of Cellulite Dimpling on the Buttocks: Results from an Open-Label, Investigator-Initiated, Single-Center, Prospective Clinical Study. Aesthetic Plast Surg 2024; 48:1797-1806. [PMID: 38253886 DOI: 10.1007/s00266-023-03815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Cellulite is a condition characterized by dimpling and contour irregularities in the gluteal and thigh regions, affecting an estimated 80-98% of postpubertal women. Innovative treatments for cellulite dimpling in the buttocks have gained popularity in recent years, seeking new solutions for a historically challenging condition. In this open-label, investigator-initiated, single-center, prospective clinical study, the authors sought to evaluate the safety and efficacy of diluted calcium hydroxylapatite (CaHA; Radiesse®, Merz Aesthetics, Raleigh, NC) for the treatment of cellulite dimpling in the buttocks of adult women. METHODS Subjects underwent three treatment sessions, receiving a total of 12 syringes of 1:1 diluted CaHA administered using a cannula-based subcision technique. Endpoints included the cellulite severity scale (CSS), the global aesthetic improvement scale (GAIS), subject satisfaction measured on a 5-point scale, and three-dimensional imaging analysis via the Quantificare 3D Track®. RESULTS Twenty-four subjects completed the study (mean age, 35 years; mean BMI, 26.88 kg/m2; mean body fat percentage, 31.29%), and no serious complications were reported. Quantitative analysis at week 14 revealed a mean reduction of 54.0% in the number of visible dimples and 50.09% in dimple depth compared to baseline. The mean CSS score decreased by 4.29 points, representing a 43.92% improvement in cellulite severity from baseline (p < 0.0001). Both physician-assessed and subject-assessed GAIS ratings also demonstrated significant improvement, with 91.6% of subjects rating their cellulite appearance as "improved" or greater. CONCLUSION The results of this study support the safety and efficacy of diluted CaHA for treating cellulite dimpling in adult women. LEVEL OF EVIDENCE II 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 . CLINICAL TRIALS REGISTRATION This study is registered with clinicaltrials.gov (ID: NCT05885035) and can be found at this link: https://clinicaltrials.gov/study/NCT05885035 .
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Affiliation(s)
- Kay Durairaj
- A Medical Corp, 800 S Fairmount Ave, Suite 325, Pasadena, CA, 91105, USA.
| | - Omer Baker
- A Medical Corp, 800 S Fairmount Ave, Suite 325, Pasadena, CA, 91105, USA
| | - Monalea Yambao
- A Medical Corp, 800 S Fairmount Ave, Suite 325, Pasadena, CA, 91105, USA
| | | | - Ani Shirinyan
- Division of Physician Assistant Studies, USC Keck School of Medicine, Los Angeles, CA, USA
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Khalil S, Galadari HI. Cellulite: An Update on Pathogenesis and Management. Dermatol Clin 2024; 42:129-137. [PMID: 37977679 DOI: 10.1016/j.det.2023.06.008] [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: 11/19/2023]
Abstract
Cellulite is a common cosmetic concern among postpubertal women. Despite its high prevalence, there have been only a few high-quality studies assessing its exact prevalence, risk factors, and pathophysiologic mechanisms. It has been difficult to achieve long-lasting results with the available treatments, including topical agents, energy-based devices, subcision, and injectables. In this review, the authors summarize the proposed etiologic factors, grading scales, and treatment options. Further well-designed studies are essential to improve our knowledge of the condition and lead to improved treatment strategies.
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Affiliation(s)
| | - Hassan I Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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6
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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7
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Teodoro MDS, Di Sessa D, Barros JHDFA, de Vasconcelos RCF, Miot HA. Buttocks Beautification 3D with Calcium Hydroxylapatite (Radiesse TM): An Individualized Approach to Diagnosing and Treating Contour, Sagging, and Cellulite of the Buttocks in Seven Cases. Clin Cosmet Investig Dermatol 2023; 16:3039-3051. [PMID: 37901152 PMCID: PMC10612506 DOI: 10.2147/ccid.s431391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023]
Abstract
Background The demand for body procedures is increasing, and buttocks beautification is one of the most sought-after procedures in dermatological and plastic surgery clinics. Several aspects affect the beauty of this area, including sagging, cellulite, contour irregularity, and volume reduction. This makes treatment of the area more challenging. Calcium hydroxylapatite (CaHA), which may be injected into the buttocks, stimulates local neocollagenesis, provides volume replacement, increases the strength and elasticity of the dermis, and thickens the underlying superficial fascia. However, no protocol for buttocks beautification tailors the dilution and deep application of CaHA filler simultaneously according to clinical assessments and personal priorities regarding contour, sagging, and cellulite. Purpose To report the results of a minimally invasive protocol using different dilutions of CaHA (Buttocks Beautification 3D) in the buttocks with application in different planes. The treatment was performed according to a previous individualized evaluation to improve the area aesthetically. Patients and methods Six women and one man were submitted to the protocol. An assessment was performed to determine the shape, sagging, cellulite (in women), and patients' preferences for buttocks beautification. The dilution, volume, depth, and injection technique for CaHA were based on these assessments. The results of the treatment were then assessed using standardized photographs and patient satisfaction. Results We reported favorable results in six women and one man with different grades of sagging, female cellulite, and shapes of the gluteal region who were treated with CaHA injections according to a tailored protocol. All participants reported high satisfaction with the procedure. Conclusion Highly satisfactory results were achieved in seven adult patients who were assessed and treated for the buttocks with CaHA using an individualized protocol. Prospective studies should be performed to corroborate our findings and optimize the use of Buttocks Beautification 3D as a reliable modality of treatment for this body area.
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Aguilera SB, McCarthy A, Khalifian S, Lorenc ZP, Goldie K, Chernoff WG. The Role of Calcium Hydroxylapatite (Radiesse) as a Regenerative Aesthetic Treatment: A Narrative Review. Aesthet Surg J 2023; 43:1063-1090. [PMID: 37635437 PMCID: PMC11025388 DOI: 10.1093/asj/sjad173] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
For decades, a wide variety of natural and synthetic materials have been used to augment human tissue to improve aesthetic outcomes. Dermal fillers are some of the most widely used aesthetic treatments throughout the body. Initially, the primary function of dermal fillers was to restore depleted volume. As biomaterial research has advanced, however, a variety of biostimulatory fillers have become staples in aesthetic medicine. Such fillers often contain a carrying vehicle and a biostimulatory material that induces de novo synthesis of major structural components of the extracellular matrix. One such filler, Radiesse (Merz Aesthetics, Raleigh, NC), is composed of calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel. In addition to immediate volumization, Radiesse treatment results in increases of collagen, elastin, vasculature, proteoglycans, and fibroblast populations via a cell-biomaterial-mediated interaction. When injected, Radiesse acts as a cell scaffold and clinically manifests as immediate restoration of depleted volume, improvements in skin quality and appearance, and regeneration of endogenous extracellular matrices. This narrative review contextualizes Radiesse as a regenerative aesthetic treatment, summarizes its unique use cases, reviews its rheological, material, and regenerative properties, and hypothesizes future combination treatments in the age of regenerative aesthetics. LEVEL OF EVIDENCE: 5
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Affiliation(s)
| | - Alec McCarthy
- Corresponding Author: Dr Alec McCarthy, Medical Affairs North America, Merz Aesthetics, 6501 Six Forks Road, Raleigh, NC 27615, USA. E-mail:
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9
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Niaz G, Alajmi A, Lee K. Hyperdilute calcium hydroxyapatite for treatment of cellulite dimples in the buttock. JAAD Case Rep 2023; 38:127-129. [PMID: 37521195 PMCID: PMC10382841 DOI: 10.1016/j.jdcr.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Ghassan Niaz
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ali Alajmi
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
| | - Kachiu Lee
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
- Department of Dermatology, Temple University, Philadelphia, Pennsylvania
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10
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Gabriel A, Chan V, Caldarella M, Wayne T, O’Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum 2023; 5:ojad050. [PMID: 37424836 PMCID: PMC10324940 DOI: 10.1093/asjof/ojad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Cellulite is an aesthetically distressing skin condition that manifests as dimples and depressions, producing an uneven surface to the skin. Occurring in 80% to 90% of females, mostly on the thighs, buttocks, and hips, it is associated with profound negative psychosocial and quality of life issues. Its ethiopathogenesis and pathophysiology are likely to be multifactorial and complex and not fully understood. There is no effective treatment for cellulite, although a number of different treatment modalities are available, from noninvasive to minimally invasive. The efficacy of most treatments is unpredictable and improvements in cellulite appearance are short lived, although significant progress has been made with newer treatments. This review provides an update on the current state of knowledge about cellulite, with an emphasis on patient assessment and an individualized treatment approach for optimal results. Level of Evidence 5
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Affiliation(s)
- Allen Gabriel
- Corresponding Author: Dr Allen Gabriel, Department of Plastic Surgery, 703 Broadway, Suite 700, Vancouver, WA 98660, USA. E-mail:
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11
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LaTowsky B, Jacob C, Hibler BP, Lorenc PZ, Petraki C, Palm M. Cellulite: Current Treatments, New Technology, and Clinical Management. Dermatol Surg 2023; 49:S8-S14. [PMID: 37000913 DOI: 10.1097/dss.0000000000003747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Cellulite is a well-known concern for many women; however, treatment can prove challenging because of the complexities of cellulite etiology, the various factors contributing to its appearance, and the multitude of therapies and procedures available. OBJECTIVE To discuss current cellulite treatment options and effective clinical management. METHODS A roundtable meeting was convened to discuss and share views on current cellulite treatment options, new technologies, and clinical management. The participants' views helped guide a narrative review on this topic. RESULTS Advanced interventions for cellulite treatment-such as physical and acoustic subcision, radiofrequency, and injectable biostimulators-are gradually being established, with accumulating evidence showing efficacy, patient satisfaction, and potentially long-lasting outcomes. Cellulite severity rating scales are necessary for assessing treatment outcomes, but these can be complex to use in clinical practice, and the majority do not include patient or clinician perspectives. CONCLUSION With the advent of new treatments and technologies, cosmetic surgeons and dermatologists will need to tailor their approach to each patient's needs and manage patient expectations because multimodal methods are likely to be required to address the various factors underlying cellulite appearance.
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12
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Nowag B, Casabona G, Kippenberger S, Zöller N, Hengl T. Calcium hydroxylapatite microspheres activate fibroblasts through direct contact to stimulate neocollagenesis. J Cosmet Dermatol 2023; 22:426-432. [PMID: 36575882 DOI: 10.1111/jocd.15521] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Calcium hydroxylapatite (CaHA; Radiesse, Merz North America) restores volume and stimulates collagen production. The aim of this research was to explore the role of dilution and diffusion in microsphere distribution and the effect of CaHA concentration on activation of fibroblasts to produce collagen. METHODS Ex vivo: Tissue dispersion of CaHA was assessed in abdominal tissue segments obtained from patients which were subsequently injected with CaHA diluted to 1:1 and hyperdiluted to 1:2. In vitro: Collagen type III (COLIII) and type I (COLI) expression of fibroblasts was evaluated after 24 and 72 h of incubation with CaHA concentrations of 1.5 (high dilution), 3.0, and 4.5 mg/ml (low dilution). RESULTS Ex vivo: The 1:2 CaHA hyperdilution increased dispersion and decreased concentration of CaHA microspheres compared with the 1:1 dilution. In vitro: CaHA incubation resulted in an increased mean COLIII expression of 123% at 24 h. COLI synthesis did not change after 24 h but increased up to 124% at 72 h. Only fibroblasts in direct contact with CaHA increased COLIII expression. COLIII high-expressing cells were fully activated by CaHA and resulted in the same level of COLIII expression per cell independent of the CaHA dilution. CONCLUSIONS A 1:2 hyperdilution of CaHA increased tissue dispersion of CaHA microspheres. Direct contact of CaHA with fibroblasts was a key factor for inducing neocollagenesis. COLIII high-expressing cells were fully activated by CaHA and resulted in the same expression level of COLIII per cell independent of the CaHA amount in each dilution. This indicates that increased collagen expression was due to the activation of more fibroblasts.
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Affiliation(s)
| | | | - Stefan Kippenberger
- Department of Dermatology, Venereology and Allergology, University Hospital Goethe University, Frankfurt, Germany
| | - Nadja Zöller
- Department of Dermatology, Venereology and Allergology, University Hospital Goethe University, Frankfurt, Germany
| | - Thomas Hengl
- R&D, Merz Aesthetics GmbH, Frankfurt am Main, Germany
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13
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Juhász M, Yale KL, Thatiparthi A, Babadjouni A, Mesinkovska NA. Combination of Microfocused Ultrasound with Visualization and Dilute Calcium Hydroxylapatite Filler for Moderate to Severe Knee Skin Laxity. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:14-18. [PMID: 36909867 PMCID: PMC10005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Background Microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite (CaHA) filler are modalities for improving skin laxity. Their use in combination on body sites other than the face is expanding. Objective To investigate the effectiveness and safety of combination MFU-V and dilute CaHA (dCaHA) for lower anterior thigh and knee laxity over 12 and 24 weeks. Methods Twenty women (40-71 years) with moderate to severe laxity of the anterior thigh and knee were enrolled in this split-body trial. Subjects received dual-depth (3.0mm, 1.5mm) or triple-depth MFU-V (4.5mm, 3.0mm, 1.5mm) to the inferior anterior thigh (127-381 lines) along with dCaHA (1:1 normal saline) injection (0.5-3mL). Clinical effectiveness was monitored using photography, qualitative clinician and subject assessments, and quantitative analysis of skin topography by three-dimensional imaging and dermal thickness by optical coherence tomography. Results At 12 and 24 weeks, the treated thigh and knee experienced significant improvement in qualitative clinician scales (p<0.01), with subjective improvement on photography and subject-reported assessments; no significant changes were noted by quantitative measures. Adverse events were reported in 68 percent of patients, including mild bruising (n=12) and swelling (n=10). Conclusion Combining MFU-V and dCaHA is safe and results in clinical improvement of anterior thigh and knee laxity.
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Affiliation(s)
- Margit Juhász
- Drs. Juhász, Yale, and Mesinkovska are with the Department of Dermatology at the University of California Irvine in Irvine, California
| | - Katerina L Yale
- Drs. Juhász, Yale, and Mesinkovska are with the Department of Dermatology at the University of California Irvine in Irvine, California
| | - Akshitha Thatiparthi
- Ms. Thatiparthi is with Western University of Health Sciences and the College of Osteopathic Medicine of the Pacific in Pomona, California
| | - Arash Babadjouni
- Mr. Babadjouni is with Midwestern University and the Arizona College of Osteopathic Medicine in Glendale, Arizona
| | - Natasha Atanaskova Mesinkovska
- Drs. Juhász, Yale, and Mesinkovska are with the Department of Dermatology at the University of California Irvine in Irvine, California
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14
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Atiyeh B, Ghieh F, Oneisi A. Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review. Aesthetic Plast Surg 2023; 47:245-259. [PMID: 35999464 DOI: 10.1007/s00266-022-03049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs. MATERIALS AND METHODS To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective. RESULTS In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts. CONCLUSION Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns. 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 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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15
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Mazzuco R, Evangelista C, Gobbato DO, de Almeida LM. Clinical and histological comparative outcomes after injections of poly-L-lactic acid and calcium hydroxyapatite in arms: A split side study. J Cosmet Dermatol 2022; 21:6727-6733. [PMID: 36098704 DOI: 10.1111/jocd.15356] [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: 08/03/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although much has been published on the use of poly-L-lactic acid (PLLA) and calcium hydroxyapatite (CaHA) for off-face indications, questions remain regarding their exact mechanisms of action in subcutaneous tissue and their comparative efficacy. OBJECTIVE To present the clinical and histological results of the PLLA and CaHA injections into the opposing arms of the same patients. METHODS Five women received superficial subcutaneous injections of PLLA into the left arm and CaHA into the right arm. After three sessions, the clinical and histological outcomes were analyzed. RESULTS After the first session, three patients showed improvement in the right arm (CaHA), but at the end of study, two patients showed better results in the left arm (PLLA). Histologically, moderate to intense lymphocytic and giant cell infiltrate, as well as collagen and elastic fiber neoformation, were observed equally near the particles of both products. Dermis had no inflammatory or fiber alterations. CONCLUSION In this study, there were no clinical differences between these two fillers. Despite current thinking and previous histological studies, we found both products produced moderate to intense inflammatory reaction, as well as collagenic/elastogenic fiber neoformation, only in the subcutaneous tissue of the immediate vicinity and surrounding the individual filler particles.
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Affiliation(s)
- Rosemarie Mazzuco
- Private Clinic, Carazinho, Rio Grande do Sul and Mato Grosso, Brazil
| | | | | | - Luiz Mauricio de Almeida
- School of Medical Sciences, Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
- Dermatology Residency Preceptor, Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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Park JY, Chen JF, Choi H, Ho WWS, Lesthari NNI, Lim JTE, Lim TS, Lowe S, Ong-Amoranto B, Vachiramon V, Wanitphakdeedecha R, Kerscher M. Insights on Skin Quality and Clinical Practice Trends in Asia Pacific and a Practical Guide to Good Skin Quality from the Inside Out. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:10-21. [PMID: 35783570 PMCID: PMC9239129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We sought to examine the current skin quality trends and gaps in clinical practice in the Asia Pacific region and develop a practical guide to improve skin quality. METHODS Medical practitioners from 11 countries in the Asia Pacific region completed an online survey on current trends in skin quality treatment. A panel of 12 leading experts convened for a virtual meeting to develop a practical guide for skin quality improvement. RESULTS A total of 153 practitioners completed the survey. The four most common skin quality issues were uneven skin tone, skin surface unevenness, skin laxity, and sebaceous gland hyperactivity and enlarged pores. Most practitioners reported using a combination of treatment modalities for each skin quality issue. It was also observed that each treatment modality could be used to treat several skin quality issues. A multimodal approach targeting different interrelated issues across the tissue planes was recommended for balanced results. The panel developed a practical guide for the appropriate combinations and sequence of treatments, and created treatment protocols for specific skin quality outcome goals. The guide employed an "inside-out" approach, treating the deeper tissue planes prior to the superficial layers to achieve harmonious results. LIMITATIONS Future studies are needed to support the recommended treatment protocols for skin quality improvement. CONCLUSION These findings provide valuable insights on current skin quality trends and gaps in clinical practice. The practical guide provides a framework for practitioners to customize their treatment plan according to each patient's needs.
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Affiliation(s)
- Je-Young Park
- Dr. Park is with the Apkoo-Jung Oracle Dermatology Clinic in Seoul, South Korea
| | - Jeng-Feng Chen
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
| | - Hosung Choi
- Dr. Choi is with the Piena Clinic in Seoul, South Korea
| | - Wilson W S Ho
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
| | | | - Joyce Teng Ee Lim
- Dr. Teng Ee Lim is with Joyce Lim Skin and Laser Clinic in Singapore
| | - Ting Song Lim
- Dr. Ting Song Lim is with the Clique Clinic in Kuala Lumpur, Malaysia
| | - Stephen Lowe
- Dr. Lowe is with MUSE Clinic in Sydney, Australia
| | - Beverly Ong-Amoranto
- Dr. Ong-Amoranto is with the Department of Dermatology at Asian Hospital and Medical Center in Metro Manila, Philippines
| | - Vasanop Vachiramon
- Dr. Vachiramon is with the Division of Dermatology, Faculty of Medicine Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| | - Rungsima Wanitphakdeedecha
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
| | - Martina Kerscher
- Dr. Kerscher is with the Division of Cosmetic Science and Aesthetics at the University of Hamburg in Hamburg, Germany
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17
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Casabona G, Kaye KO. Invited Discussion on: Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler. Aesthetic Plast Surg 2022; 46:382-384. [PMID: 34435222 DOI: 10.1007/s00266-021-02548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kai O Kaye
- Ocean Clinic, Av Ramon y Cajal 7, Marbella, Spain
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18
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Ramirez S, Puah IBK. Effectiveness of combined microfocused ultrasound with visualization and subdermal calcium hydroxyapatite injections for the management of brachial skin laxity. J Cosmet Dermatol 2021; 20:3871-3879. [PMID: 34716645 PMCID: PMC9297859 DOI: 10.1111/jocd.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
Background There is no publication to date on the combined use of microfocused ultrasound with visualization (MFU‐V) and calcium hydroxylapatite (CaHA) for brachial skin laxity. Aim To assess the effectiveness of combining MFU‐V with diluted/hyperdiluted CaHA in a single session for treating brachial skin laxity. Subjects/Methods Female subjects who had skin laxity in the brachial regions and who desired non‐surgical intervention were enrolled into this prospective, single‐arm pilot study. MFU‐V (Ultherapy®, Merz North America, Inc. Raleigh, N.C.) was applied using the 4.0 MHz‐4.5 mm and 7.0 MHz‐3.0 mm depth transducers, followed by subdermal injections of diluted (1:1)/hyperdiluted (1:2) CaHA (Radiesse®, Merz North America, Inc). Subjects were followed for six months after treatment. Objective biophysical skin assessments were conducted using a cutometer (Cutometer® Dual 580 MPA; Courage & Khazaka, Cologne, Germany). Subjective assessments included the arm visual analogue scale (VAS), global aesthetic improvement scale (GAIS), and subject global satisfaction scale. Results Twelve subjects participated in the study. The mean R0 reading (measure of skin firmness) progressively improved from 0.515 mm at baseline to 0.433 mm at 24 weeks (p < 0.05 for 12 and 24 weeks). The mean R2 reading (measure of skin elasticity) and mean arm VAS improved significantly from baseline at all visits (p < 0.05 for all). The majority of subjects at each visit showed improved arm appearance and were satisfied with their treatment. Both procedures were well‐tolerated. Conclusions Combined use of MFU‐V with diluted/hyperdiluted CaHA demonstrates significant improvements in both objective and subjective measures of brachial skin laxity.
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19
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Guida S, Longhitano S, Spadafora M, Lazzarotto A, Farnetani F, Zerbinati N, Pellacani G, Galadari H. Hyperdiluted calcium hydroxylapatite for the treatment of skin laxity of the neck. Dermatol Ther 2021; 34:e15090. [PMID: 34363289 DOI: 10.1111/dth.15090] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
Despite being a common concern, there are very few minimally invasive treatments targeting neck skin laxity (NSL) reported in the literature. To assess the efficacy of hyperdiluted calcium hydroxyapatite (hy-CaHA) for the treatment of NSL, according to the NSL scale, and to estimate safety. Twenty patients showing NSL were treated with hy-CaHA 1:2. To evaluate the efficacy of hy-CaHA treatment for NSL, pictures of treated subjects were collected before and 3 months after treatment and graded according to the NSL scale, and T-student's test was applied to estimate differences. Hy-CaHA for the neck was effective according to the previously unreported NSL scale (p < 0.001) and safe. There were no major adverse events reported. This study supports the efficacy (according to the NSL scale) and safety of hy-CaHA (1:2) for NSL. Our results also highlight the utility of the newly developed NSL scale, being a useful tool to evaluate the level of NSL before treatment and to measure the outcome.
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Affiliation(s)
- Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Longhitano
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Spadafora
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Lazzarotto
- Maxillofacial Surgery Unit, Academic Hospital of Udine, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Hassan Galadari
- Department of Dermatology, United Arab Emirates University, Dubai, United Arab Emirates
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20
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Tanzi EL, Capelli CC, Robertson DW, LaTowsky B, Jacob C, Ibrahim O, Kaminer MS. Improvement in the appearance of cellulite and skin laxity resulting from a single treatment with acoustic subcision: Findings from a multicenter pivotal clinical trial. Lasers Surg Med 2021; 54:121-128. [PMID: 34224601 PMCID: PMC9292379 DOI: 10.1002/lsm.23448] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
Introduction and Objectives Surface depressions and skin laxity together play a role in the appearance of cellulite. Cellulite depressions can be improved through disruption of the subcutaneous fibrous structures. Some currently utilized approaches accomplish this through invasive techniques requiring local anesthesia and potential down time. Skin laxity can exacerbate the appearance of cellulite, however current invasive approaches do little to improve skin laxity. The objective of this study was to evaluate a noninvasive approach to improving both cellulite depressions and skin laxity through the use of rapid acoustic pulses (acoustic subcision). Safety, efficacy, tolerability, and participant satisfaction results were measured. Methods Women (n = 56) with moderate to severe cellulite were treated in a single acoustic subcision treatment session without anesthesia. Posttreatment adverse events (AEs) and tolerability were recorded. At 12‐weeks cellulite outcomes were assessed using a 6‐point simplified Cellulite Severity Scale (CSS), Global Aesthetic Improvement Scale (GAIS), and a participant satisfaction questionnaire. Additionally, laxity improvement was measured using a 4‐point Laxity Score (LS) and GAIS. Results Improvement in cellulite appearance measured at 12‐weeks showed that participants (n = 56) had a mean CSS reduction of 1.01 (a 29.5% reduction from baseline). The posttreatment photograph was correctly identified by blinded independent reviewers from randomized pairs of pre/posttreatment photographs for 96.4% of participants. Cellulite was graded as improved, much improved or very much improved using the GAIS at 90.9% of treated locations. Finally, 92.9% of participants reported positive satisfaction responses. Scoring for improvement in skin laxity appearance at 12‐weeks showed a mean LS reduction of 0.57 (a 27.9% reduction from baseline). GAIS for laxity was graded as improved, much improved or very much improved in 67.3% of treated areas. No unexpected or serious AEs were noted at treatment or follow‐up. Overall average pain score during treatment was 2.4 (0–10 pain scale) and 0.3 immediately posttreatment. Conclusion A single noninvasive acoustic subcision session can safely provide meaningful improvement in the appearance of cellulite in terms of depressions, as well as skin laxity, with minimal treatment pain and no posttreatment down time. Further improvement in appearance is expected with multiple treatments over time. Additional trials to verify this are planned.
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Affiliation(s)
| | | | | | - Brenda LaTowsky
- Clear Dermatology and Aesthetic Center, North Scottsdale, Arizona, USA
| | - Carolyn Jacob
- Chicago Cosmetic Surgery and Dermatology, Chicago, Illinois, USA
| | - Omer Ibrahim
- Chicago Cosmetic Surgery and Dermatology, Chicago, Illinois, USA
| | - Michael S Kaminer
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts, USA
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21
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Park JY, Lin F, Suwanchinda A, Wanitphakdeedecha R, Yu J, Lim TS, Chen JF, Ho W, Lim J, Juniarty L, Kee YS, Youn SJ, Fabi S. Customized Treatment Using Microfocused Ultrasound with Visualization for Optimized Patient Outcomes: A Review of Skin-tightening Energy Technologies and a Pan-Asian Adaptation of the Expert Panel's Gold Standard Consensus. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E70-E79. [PMID: 34188753 PMCID: PMC8211327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND: Noninvasive facial-rejuvenation devices, such as nonablative radiofrequency (RF) and laser-assisted technology, are increasingly replacing higher-risk surgeries for face and body skin laxity. OBJECTIVE: We sought to review published information on noninvasive energy device safety and efficacy in aesthetic skin tightening, compare these with our experiences in Asian patients, and disseminate a consensus for optimizing microfocused ultrasound with visualization (MFU-V) in Asian patients. METHODS: A broad, nonexhaustive, nonsystematic literature search of published studies indexed in PubMed was performed to compare selected energy technologies to MFU-V for noninvasive face and body skin tightening, in particular, among Asian patients. This was supplemented with internal documents to provide evidence and support arguments if no peer-reviewed data were available. RESULTS: We highlighted the differences between devices and platforms and identified factors requiring attention and caution. Due to the increase in new devices lacking strong supporting clinical evidence of both safety and efficacy in Asia, it is necessary to convene physicians with substantial experience in MFU-V and devise a consensus on Asian patient selection, treatment planning, and customization. CONCLUSION: Many platforms duplicate or claim similar technologies, efficacy, or safety without significant peer-reviewed scientific or clinical evidence. We showed that MFU-V satisfies this clinical imperative. Further, the patented DeepSEE® technology allows users to noninvasively "see" through the skin to ensure treatment precision, facilitate optimal skin lifting and tightening, and enhance patient comfort and safety. Therefore, we believe that MFU-V is the gold standard for nonsurgical lifting and skin tightening.
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Affiliation(s)
- Je-Young Park
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Frank Lin
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Atchima Suwanchinda
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Rungsima Wanitphakdeedecha
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Jonathan Yu
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Ting Song Lim
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Jeng Feng Chen
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Wilson Ho
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Joyce Lim
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Lanny Juniarty
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Yong Seng Kee
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Seong Jae Youn
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
| | - Sabrina Fabi
- Dr. Park is with the Apkoo-Jung Department of Oracle Dermatology Center in Seoul, South Korea
- Dr. Lin is with Eastern Plastic Surgery in Melbourne, Australia and the Department of Plastic Surgery at Eastern Health Box Hill Hospital in Melbourne, Australia
- Dr. Suwanchinda is with Medisci Biointegrative and Antiaging Center in Bangkok, Thailand
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
- Dr. Yu is with JY Dermatology & Aesthetic Center in Manila, Philippines
- Dr. T. Lim is with Clique Clinic in Kuala Lumpur, Malaysia
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
- Dr. J. Lim is with Joyce Lim Skin and Laser Clinic in Singapore
- Dr. Juniarty is with Miracle Aesthetic Clinic in Surabaya, Indonesia
- Dr. Kee is with Premier Clinic in Kuala Lumpur, Malaysia
- Dr. Youn is with Leaders Dermatology Clinic in Seoul, South Korea
- Dr. Fabi is with Cosmetic Laser Dermatology and the Department of Dermatology, University of California in San Diego, California
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Treating Striae Distensae Albae in Asians: Efficacy and Safety of Combined MFU-V and CaHA. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3429. [PMID: 33680674 PMCID: PMC7929617 DOI: 10.1097/gox.0000000000003429] [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: 08/10/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022]
Abstract
This study evaluated the efficacy and safety of a single treatment combining microfocused ultrasound with visualization (MFU-V) and subdermal diluted calcium hydroxylapatite with lidocaine (CaHA+) for Striae Distensae Albae (SDA).
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MacGillis D, Vinshtok Y. High-velocity pneumatic injection of non-crosslinked hyaluronic acid for skin regeneration and scar remodeling: A retrospective analysis of 115 patients. J Cosmet Dermatol 2021; 20:1098-1103. [PMID: 33580573 DOI: 10.1111/jocd.14002] [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: 11/15/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumatic-assisted high velocity jet injections are an alternative method for intradermal delivery of hyaluronic acid (HA) and demonstrated efficacy in dermal thickening and scar remodeling with minimal side effects. AIMS We aimed to investigate the clinical efficacy comparing non-crosslinked HA (NCL-HA) and crosslinked HA (CL-HA) for aesthetic skin concerns. METHODS We retrospectively analyzed charts of 115 patients treated with jet injected NCL-HA and CL-HA for skin rejuvenation, age-related laxity and rhytidosis, hypertrophic and acne scars and striae. Global Aesthetic Improvement Scale (GAIS) and the 5-grade patient satisfaction scale were used for assessment of the treatment efficacy at the 3-month follow-up. Efficacy was separately analyzed between patients receiving NCL-HA vs. CL-HA. Longevity of treatment effect was measured by the time to voluntary return for repeat treatment. RESULTS An average of 2.8 treatments was completed per patient with a low incidence of side effects including bruises (7%) and temporary local edema (1%). Patients were highly-satisfied with the treatment results in all categories with the average satisfaction scores of 3.68 (NCL-HA) and 3.76 (CL-HA). An average GAIS score of 1.7 ("much improved") was calculated for neck, décolleté and perioral areas. An overall GAIS score averaged as 1.78 (NCL-HA) and 1.6 (CL-HA). Longevity of the effect averaged 13.1 months for NCL-HA and 13.2 months for CL-HA groups. CONCLUSION Our retrospective data showed similar significant improvement of all aesthetic skin concerns in 115 subjects treated with either NCL-HA or CL-HA delivered intradermally by a high velocity jet-injector device with minimal downtime, pain or side-effects.
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Giesse S. A German Prospective Study of the Safety and Efficacy of a Non-Invasive, High-intensity, Electromagnetic Abdomen and Buttock Contouring Device. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:30-33. [PMID: 33584965 PMCID: PMC7869812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE: This study evaluated the efficacy of a novel treatment method utilizing high-intensity focused electromagnetic field (HIFEM) in reducing fat and strengthening the muscles in the abdominal and gluteal areas. METHODS: A total of 14 patients, aged 23 to 49 years (mean: 33.2 years) received four treatments on the abdomen and/or buttocks, each lasting for 30 minutes. Ultrasound imaging was performed at baseline, immediately post-treatment, and eight weeks after the last treatment to examine the changes in thickness of the rectus abdominis and subcutaneous fat. Additionally, waist circumference, digital photographs, and patient satisfaction were collected at the same time points. The improvement in digital images was evaluated by practitioners and the patients themselves. RESULTS: Two months after the treatments, ultrasound measurements showed, on average, a 15.7-percent reduction of subcutaneous adipose tissue and an average increase in the thickness of the rectus abdominis muscle by 26.1 percent. The abdominal circumference of the treated patients showed an average decrease of 2.84 centimeters. Immediately following the final session, the patient's satisfaction was 87.5 percent; eight weeks later, it was 100 percent. During the patient evaluation of photographs, 25 percent of the patients rated their appearance as improved, 66.7 percent as significantly improved, and 8.3 percent as greatly improved. Using the Global Aesthetic Improvement Scale, the medical practitioners rated the patients as 100-percent improved. No relevant side effects of the treatment were documented. CONCLUSION: The data collected on the HIFEM procedure evaluated here are in line with the results from clinical studies and applications of this treatment in the United States. These results support the efficacy and tolerability of the HIFEM procedure. The treatment achieved high doctor and patient satisfaction.
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Affiliation(s)
- Steffen Giesse
- Dr. Giesse is with the Aesthetic Lounge GmbH, Ludwigshafen in Rhein, Germany
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25
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Guida S, Longhitano S, Shaniko K, Galadari H, Chester J, Ciardo S, Mandel VD, Pellacani G, Urtis GG, Farnetani F. Hyperdiluted calcium hydroxylapatite for skin laxity and cellulite of the skin above the knee: A pilot study. Dermatol Ther 2020; 33:e14076. [PMID: 32713163 DOI: 10.1111/dth.14076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Stefania Guida
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Longhitano
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Kaleci Shaniko
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Johanna Chester
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Desmond Mandel
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.,Department of Clinical and Experimental Medicine, Dermatology Unit, University of Parma, Parma, Italy
| | - Giovanni Pellacani
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Francesca Farnetani
- Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
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Smith JR, Sheehan M, Casas LA. Using the BODY-Q to Evaluate Appearance and Quality of Life Following Treatment of Skin Laxity of the Outer Thigh with Microfocused Ultrasound and Calcium Hydroxylapatite. Aesthet Surg J 2020; 40:1219-1231. [PMID: 31875882 DOI: 10.1093/asj/sjz372] [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: 11/13/2022] Open
Abstract
BACKGROUND Two procedures that have demonstrated collagen-stimulating properties and improvements in skin laxity in a variety of aesthetic indications are microfocused ultrasound with visualization (MFU-V) and injection with calcium hydroxylapatite (CaHA). OBJECTIVES By treating skin laxity with a combination of these therapies, it was hypothesized that our patients would experience improved appearance and quality of life as measured by the BODY-Q. METHODS A total of 60 consecutive female patients aged 30 to 60 years with body mass index less than 28 kg/m2 who expressed interest in treatment for skin laxity affecting the outer thighs completed selected scales (Body Image, Appraisal of Excess Skin, Satisfaction with Hips and Outer Thighs, and Appearance-Related Psychosocial Distress) from the BODY-Q within 1 week of treatment. At the time of treatment, MFU-V was directed to the outer thighs (150 lines at focal depths of 3.0 and 4.5 mm per outer thigh). Immediately following MFU-V, patients received treatment with CaHA injected into the subdermis (1.5 mL diluted 1:1 with 1.5 mL of 2% lidocaine solution per outer thigh). At 90 days posttreatment, these patients repeated the BODY-Q. RESULTS At 90 days posttreatment, with 100% follow-up among the 60 consecutive female patients treated, scores from the BODY-Q scales showed statistically significant improvement (P < 0.01). CONCLUSIONS Following treatment of skin laxity on the outer thighs with a combination of MFU-V and CaHA, our patients reported a statistically significant improvement in appearance and quality of life at 90 days posttreatment. This protocol may be applicable to other areas of the body. LEVEL OF EVIDENCE: 4
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Rovatti PP, Pellacani G, Guida S. Hyperdiluted Calcium Hydroxylapatite 1:2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety. Dermatol Surg 2020; 46:e112-e117. [DOI: 10.1097/dss.0000000000002375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Vachiramon V, Triyangkulsri K, Iamsumang W, Chayavichitsilp P. Efficacy and Safety of Microfocused Ultrasound With Visualization in Abdominal Skin Laxity: A Randomized, Comparative Study. Lasers Surg Med 2020; 52:831-836. [PMID: 32173882 DOI: 10.1002/lsm.23234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Microfocused ultrasound with visualization (MFU-V) has been approved for the treatment of skin laxity on several areas including the eyebrows, neck, and submental area. This study aims to determine the efficacy of MFU-V for the treatment of abdominal skin laxity using two different treatment protocols. STUDY DESIGN/MATERIALS AND METHODS Thirty female patients with abdominal skin laxity were enrolled. Each side of the abdomen was randomly assigned to receive a single session of single-plane MFU-V treatment (4.5 mm) or dual-plane MFU-V treatment (4.5 and 3.0 mm). Improvement scores (0-10) were assigned by a blinded physician and patients at 1, 3, and 6 months after treatment. RESULTS Twenty-eight female patients completed the study. The physician-evaluated mean improvement scores in single-plane treatment were 3.03 (±1.26), 3.43 (±1.35), and 2.18 (±0.86) at 1-, 3-, and 6-month follow-up, respectively. For dual-plane treatment, the scores were 3.11 (±1.23), 3.39 (±1.34), and 2.02 (±0.79). There was no statistically significant difference between single- and dual-plane treatment at each time point. A similar pattern of improvement was observed in patient-rated mean improvement scores. Patients who had undergone childbirth had significantly higher physician and patient-rated mean improvement scores than those who had not in both single- and dual-plane treatments. In addition, a significant reduction of mean waist circumference was observed in patients who had undergone childbirth. The median pain scores were 5.25 for single-plane treatment and 4.29 for dual-plane treatment (P = 0.20). CONCLUSION Both single- and dual-plane MFU-V treatments showed comparable efficacies in treating abdominal skin laxity. The effect is more pronounced in patients who had undergone childbirth. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Bangkok, 10400, Thailand
| | - Korn Triyangkulsri
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Bangkok, 10400, Thailand
| | - Wimolsiri Iamsumang
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Bangkok, 10400, Thailand
| | - Pamela Chayavichitsilp
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Bangkok, 10400, Thailand
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Stepanova TV, Yusova ZY, Baranova EL, Demidion DV. Correction of involutional skin changes using microfocused ultrasound combined with PRP-therapy. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Influence of Age, Sex, and Body Mass Index on the Depth of the Superficial Fascia in the Face and Neck. Dermatol Surg 2019; 45:1365-1373. [DOI: 10.1097/dss.0000000000001909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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31
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Cellulite: Patient Selection and Combination Treatments for Optimal Results—A Review and Our Experience. Dermatol Surg 2019; 45:1171-1184. [DOI: 10.1097/dss.0000000000001776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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32
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Validated Assessment Scales for Skin Laxity on the Posterior Thighs, Buttocks, Anterior Thighs, and Knees in Female Patients. Dermatol Surg 2019; 45 Suppl 1:S12-S21. [DOI: 10.1097/dss.0000000000001994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2160. [PMID: 31044123 PMCID: PMC6467620 DOI: 10.1097/gox.0000000000002160] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022]
Abstract
Background: Calcium hydroxyapatite (CaHA) is a well-established collagen stimulator. In recent years, it has been increasingly used in hyperdiluted form as a biostimulatory agent rather than a volumizing filler to improve skin quality and firmness in both facial and corporal areas. However, guidelines on the techniques required to achieve optimal results are still lacking. The objective of this study was to develop a consensus recommendation for the safe and effective use of hyperdiluted CaHA for face and body biostimulation. Methods: A team of 10 experts with extensive experience in dermal fillers and biostimulatory treatments for facial and body rejuvenation convened for a live meeting. Consensus was defined as approval by 70%–89% of all participants, whereas agreement of ≥90% denoted strong consensus. Results: For most items, the group achieved a majority consensus. Recommendations have been provided for the face, neck, décolletage, buttocks, thighs, arms, abdomen, knees, and elbows with detailed injection techniques, providing information on insertion points, dosages, and volumes for both needle and cannula injections as well as the number of treatment sessions and intervals. Conclusions: The expert consensus supports and provides guidance for the use of CaHA as a biostimulatory agent for face and body rejuvenation. However, further clinical studies are necessary to provide physicians with the best evidence for the best treatment practices.
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Casabona G. Microfocused Ultrasound with Visualization for the Treatment of Stretch Marks. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:20-24. [PMID: 30881579 PMCID: PMC6415706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: Stretch marks (striae) can be distressing for many people, and currently available treatments are less than optimal. A previous study showed that the use of a calcium hydroxylapatite (CaHA) filler followed by the topical application of 20% ascorbic acid solution and microneedling significantly improved striae appearance. We sought to evaluate additional improvements in atrophy and color of striae following treatment with microfocused ultrasound with visualization (MFU-V) in subjects who received previous treatments using CaHA, 20% ascorbic acid, and microneedling. Participants: Subjects with remaining skin atrophy (N=20) were treated with MFU-V using transducers with a frequency of 7MHz and 10MHz and a focal depth of 3.0 mm and 1.5 mm, respectively, applied in a cross-hatch pattern. Measurements: Efficacy was based on changes in Manchester Scar Scale scores. Results: At Day 90 post-treatment, the mean (± standard deviation) baseline Manchester Scar Scale score decreased from 9.35 (±1.18) to 6.30 (±1.26) (p<0.001) and the mean Patient Satisfaction Scale score increased from 3.75 (±0.44) to 4.70 (±0.47) (p<0.001). Most subjects (70%) were very satisfied with their results. No adverse events were reported. Conclusion: The combined use of CaHA, 20% ascorbic acid, and microneedling appears to be effective in improving the appearance of striae. Additional esthetic improvements were seen with the application of MFU-V.
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Affiliation(s)
- Gabriela Casabona
- Dr. Casabona is Scientific Director at Ocean Clinic in MarbelIa, Spain
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35
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Global Consensus Guidelines for the Injection of Diluted and Hyperdiluted Calcium Hydroxylapatite for Skin Tightening. Dermatol Surg 2019; 44 Suppl 1:S32-S41. [PMID: 30358631 DOI: 10.1097/dss.0000000000001685] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Calcium hydroxylapatite (CaHA) is approved to correct moderate-to-severe wrinkles and folds and soft-tissue volume loss in the face and hands. More recently, subdermal injection using diluted CaHA has been used to improve skin laxity. OBJECTIVE To review evidence for the safe and effective use of diluted CaHA in the face and body and provide best practice recommendations. METHODS A global panel of expert aesthetic physicians convened to develop consensus-based guidelines for treating laxity and superficial wrinkles using diluted (ratio of 1:1) and hyperdiluted (≥1:2) CaHA. RESULTS Diluted and hyperdiluted CaHA stimulates targeted neocollagenesis in the injection area to improve laxity and skin quality in the mid- and lower face, neck, décolletage, upper arms, abdomen, upper legs, and buttocks. Treatment can be used as an adjunct to volume augmentation or combined with additional modalities for optimal results. Adverse events are related to the injection and include bruising, swelling, mild pain, and induration. In thinner and darker skin, too-superficial injections of less diluted CaHA can lead to more adverse events. CONCLUSION This report provides preliminary guidelines for the novel off-label use of CaHA for biostimulation in the face and body. Further trials will provide additional clarity regarding treatment paradigms for optimal outcomes.
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Van Loghem JAJ. Use of calcium hydroxylapatite in the upper third of the face: Retrospective analysis of techniques, dilutions and adverse events. J Cosmet Dermatol 2018; 17:1025-1030. [DOI: 10.1111/jocd.12733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
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37
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Sadick N. Treatment for cellulite. Int J Womens Dermatol 2018; 5:68-72. [PMID: 30809581 PMCID: PMC6374708 DOI: 10.1016/j.ijwd.2018.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
Cellulite is a multifactorial condition that is present in 80% to 90% of postpubertal women and is one of the most intolerable esthetic imperfections. There are several theories on the pathophysiology of cellulite, and a number of different therapeutic regimens have been developed, from topical treatments to mechanical or energy-based devices. In this brief review, we summarize the scientific landscape to determine the clinical evidence with regard to the safety and efficacy of cellulite treatment options. Clinical protocols and the author’s experience using a combination of internal and external procedures are also discussed. Studies using laser and light modalities along with radiofrequency have shown improvements in cellulite and a good safety profile, but acoustic wave therapy, subcision, and the 1440-nm Nd:YAG minimally invasive laser have demonstrated the most beneficial results in cellulite reduction. Although there is paucity of scientific evidence for treatments that improve cellulite, future emerging options and their combination may pave the way to eradicate this primarily cosmetic esthetic concern.
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Affiliation(s)
- Neil Sadick
- Department of Dermatology, Weill Cornell Medical College, New York, New York.,Sadick Dermatology, New York, New York
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Casabona G, Nogueira Teixeira D. Microfocused ultrasound in combination with diluted calcium hydroxylapatite for improving skin laxity and the appearance of lines in the neck and décolletage. J Cosmet Dermatol 2017; 17:66-72. [PMID: 29285863 DOI: 10.1111/jocd.12475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skin laxity and wrinkling on the neck and décolletage reveal age as reliably as the face. OBJECTIVE To evaluate the combined use of microfocused ultrasound with visualization (MFU-V; Ultherapy® ) and diluted calcium hydroxylapatite (CaHA; Radiesse® ) for treating the neck and décolletage. METHODS Subjects with moderate-to-severe lines on the neck and/or décolletage were retrospectively enrolled. MFU-V was applied using 7 and 10 MHz transducers followed by subdermal injection of CaHA diluted 1:1 with lidocaine solution. Photographs at baseline and 90 days were assessed by two independent, blinded evaluators using three scales: Merz Aesthetics décolleté wrinkles, Fabi-Bolton chest wrinkle, and Allergan transverse neck lines scales. RESULTS A total of 47 subjects were treated as follows: 29 (neck only), five (décolletage only), and 13 (both areas). Mean neckline score improved from 2.6 (moderate-to-severe lines) at baseline to 1.3 (mild lines) 90 days after treatment (P < .001). Mean décolletage scores improved from 2.6 and 3.3 (moderate-to-severe wrinkles) on the Merz Aesthetics and Fabi-Bolton scales, respectively, to 1.1 and 1.8 (mild wrinkles), respectively, after treatment (both P < .001). Both procedures were well tolerated with high subject satisfaction. CONCLUSIONS Combining MFU-V with 1:1 diluted CaHA is effective for improving the appearance of neck and décolletage lines and wrinkles.
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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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Calcium Hydroxylapatite Combined with Microneedling and Ascorbic Acid is Effective for Treating Stretch Marks. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1474. [PMID: 29062646 PMCID: PMC5640351 DOI: 10.1097/gox.0000000000001474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/10/2017] [Indexed: 11/29/2022]
Abstract
Background: Stretch marks can have a negative psychological impact on some individuals. Methods are available for treating stretch marks, but high-quality evidence supporting their use is limited. We treat stretch marks using injections of diluted calcium hydroxylapatite (CaHA, Radiesse) filler combined with microneedling and topical ascorbic acid. This retrospective study evaluated the effectiveness of this combined therapy. Methods: Subjects presented with red (n = 25) or white (n = 10) striae on their buttocks, thighs, knees, abdomen, and breasts. CaHA filler was diluted 1:1 with lidocaine 2% without epinephrine. A maximum of 3.0 mL of filler was injected per patient at all skin depths using a 23G needle. This was immediately followed by microneedling and topical application of 20% ascorbic acid. Microneedling with ascorbic acid was repeated after 1 and 2 months. Skin biopsies were obtained from a patient who later underwent abdominoplasty. Results: The mean (±SD) pretreatment Manchester Scar Scale scores were 12.0 (±0.8), decreasing to 7.1 (±1.4) 1 month after the final treatment, indicating improvement in stretch mark appearance (P < 0.001). Subjects were very satisfied (n = 22; 62.9%), satisfied (n = 8; 22.9%), neither satisfied nor dissatisfied (n = 4; 11.4%), or unsatisfied (n = 1; 2.8%) with their treatment results. Analysis revealed a significant correlation between Scar Scale scores and Patient Satisfaction scores (r = 0.483; P = 0.003). Skin biopsies showed increased quantity and quality of collagen and elastin fibers in areas treated with combination therapy. Procedures were well tolerated. Conclusion: Combining 1:1 diluted CaHA with microneedling and topical ascorbic is safe and effective for treating stretch marks.
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