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Zhang Z, Shi M, Li J, Chen D, Ren J, Li Z, Tuan H, Zhao Y. The Characteristics and Inheriting Pattern of Skin Aging in Chinese Women: An Intergenerational Study of Mothers and Daughters. Clin Cosmet Investig Dermatol 2024; 17:1773-1782. [PMID: 39132029 PMCID: PMC11315646 DOI: 10.2147/ccid.s468477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
Introduction The aging of the skin, which is affected by both external and internal causes, can reflect the external age and the internal health status. While the aging characteristics differ across ethnic groups, the specific changes in skin aging within the Chinese population have been underexplored. Moreover, investigating the similarity of aging skin characteristics between parent-offspring pairs remains uncharted territory. This study aims to fill these gaps by examining the skin aging features of Chinese women and assessing the similarity in aging skin characteristics between mother-daughter pairs. Methods A total of 40 mother-daughter pairs were recruited and analyzed. The perceived ages of the participants were evaluated, and their aging skin traits were systematically graded. Statistical methods were employed to discern the trends of the aging skin characteristics. By introducing a novel similarity parameter, we compared whether various skin aging characteristics have similar patterns between mothers and daughters. Results Our findings indicate that age 50 represents a pivotal point in skin aging. Beyond this age, the increase in rhytides and laxity scores accelerated noticeably, whereas the escalation in dyschromia scores became less marked. By introducing similar parameters between mother-daughter pairs and the radar map, we discovered that the skin aging characteristics are remarkably consistent between mother-daughter pairs. Conclusion Understanding the main aging skin characteristics of different age groups can allow caregivers to devise treatments for preventing skin aging in women of various ages. The mother's skin aging trend is also significant for the daughter's skin aging prevention.
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Affiliation(s)
- Zhuying Zhang
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Mai Shi
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Jinghui Li
- School of Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Dian Chen
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Jie Ren
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Zhenghui Li
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Hsiaohan Tuan
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China
- Photomedicine Laboratory, Institute of Precision Medicine, Tsinghua University, Beijing, People’s Republic of China
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Al-Jumaily AM, Liaquat H, Paul S. Focused Ultrasound for Dermal Applications. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:8-17. [PMID: 37806924 DOI: 10.1016/j.ultrasmedbio.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Focused ultrasound (FUS) is emerging as one of the most promising, non-invasive treatment techniques. The advancement of transducer technology has paved the way for dermatological applications. A comprehensive review is presented for healthcare practitioners and researchers, summarizing the effect of various operational parameters on the injury zone produced by ultrasound beams for various dermatological applications, which include skin tightening, fat reduction, hyperpigmentation and cancer treatment. In this article, we aim to highlight the efficient operational parameters of FUS to enhance pain relief during surgery and its affordability for skin treatment. Finally, a prospective future technique for efficient FUS is discussed.
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Affiliation(s)
- Ahmed M Al-Jumaily
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand.
| | - Hassan Liaquat
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Sharad Paul
- University of Auckland, Auckland, New Zealand
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Inocêncio GSG, Meneses-Santos D, Costa MDMDA, Vieira WA, de Almeida VL, Rodrigues RPCB, Rode SDM, Paranhos LR. Efficacy, safety, and potential industry bias in using deoxycholic acid for submental fat reduction ‒ A systematic review and meta-analysis of randomized clinical trials. Clinics (Sao Paulo) 2023; 78:100220. [PMID: 37806137 PMCID: PMC10570630 DOI: 10.1016/j.clinsp.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 10/10/2023] Open
Abstract
Lipolytic substance injections to reduce localized fat have been extensively used because it is a low-invasive method. This review aimed to evaluate the efficacy and safety of deoxycholic acid in submental fat reduction compared to a placebo and investigate the potential industry sponsorship bias in the results of randomized clinical trials on this topic. Ten electronic databases were extensively searched for randomized clinical trials without restriction on language and year of publication. Two reviewers extracted the data and assessed the individual risk of bias in the studies with the RoB 2.0 tool. The industry sponsorship bias was evaluated according to citations in the articles regarding industry funding/sponsorship throughout the texts. Fixed and random effects meta-analyses were performed, and the results were reported in Risk Ratio (RR) at a 95% Confidence Interval (95% CI). The initial search provided 5756 results, of which only five were included. Only two studies had a low risk of bias. All studies showed a potential industry bias. The meta-analysis showed that patients treated with deoxycholic acid had significant positive results for all efficacy outcomes and a higher risk of fibrosis, pain, erythema, numbness, swelling, edema, pruritus, nodules, headache, and paresthesia. The low to moderate certainty of evidence found allows concluding that deoxycholic acid is effective in submental fat reduction, causing well-tolerated adverse effects. However, all eligible studies showed a potential industry bias.
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Affiliation(s)
| | - Daniela Meneses-Santos
- Division of Morphology, Centro de Ciências da Saúde e Biológicas, Universidade Federal de Sergipe, SE, Brazil
| | | | - Walbert A Vieira
- Department of Restorative Dentistry, Endodontics Division, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Vinicius Lima de Almeida
- Postgraduate Program in Dentistry, Faculdade de Odontologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | - Sigmar de Mello Rode
- Department of Dental Materials and Prothesis, Instituto de Ciência e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, São José dos Campos, SP, Brazil
| | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, Faculdade de Odontologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
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Wu Y, Roll S, Klein G, Geister TL, Makara MA, Li B. IncobotulinumtoxinA for Glabellar Frown Lines in Chinese Subjects: A Randomized, Double-blind, Active-Controlled Phase-3 Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4956. [PMID: 37250827 PMCID: PMC10219690 DOI: 10.1097/gox.0000000000004956] [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: 10/17/2022] [Accepted: 03/03/2023] [Indexed: 05/31/2023]
Abstract
This study evaluated the efficacy and safety of IncobotulinumtoxinA 20 U for treatment of glabellar frown lines in Chinese subjects. Methods This was a prospective, randomized, double-blind, active-controlled, phase-3 study conducted in China. Subjects with moderate to severe glabellar frown lines at maximum frown were randomized to receive IncobotulinumtoxinA (N = 336) or OnabotulinumtoxinA (N = 167). Results For the primary efficacy endpoint at day 30, response rates at maximum frown (score "none" or "mild") on the Merz Aesthetic Scales Glabella Lines - Dynamic were comparable between IncobotulinumtoxinA (92.5%) and OnabotulinumtoxinA (95.1%) per investigator's live rating. Noninferiority of IncobotulinumtoxinA versus OnabotulinumtoxinA was successfully demonstrated, as the two-sided 95% confidence interval of -0.97% to 0.43% for the difference in Merz Aesthetic Scales-based response rates (-0.27%) lay completely above the predefined noninferiority margin of -15%. For the secondary efficacy endpoints assessed at day 30, Merz Aesthetic Scales-based response rates (score "none" or "mild") at maximum frown were similarly comparable between both groups per subject (>85%) and independent review panel (>96%) rating. Per Global Impression of Change Scales, greater than 80% of subjects and greater than 90% of investigators in both groups rated treatment results as at least "much improved" at day 30 compared with baseline. Safety profiles were consistent between groups; IncobotulinumtoxinA was well tolerated, and no new safety concerns were identified in Chinese subjects. Conclusion IncobotulinumtoxinA 20 U is safe and effective for treatment of moderate to severe glabellar frown lines at maximum frown in Chinese subjects and is noninferior to OnabotulinumtoxinA 20 U.
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Affiliation(s)
- Yan Wu
- From the Peking University First Hospital, Beijing, China
| | - Susanna Roll
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | - Gudrun Klein
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | | | | | - Bi Li
- Peking University Third Hospital, Beijing, China
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Oh JS, Choi J, Choi JW, Lew DH, Roh TS, Song SY, Kim YS, Park H, Youn SW, Kang S, Park J, Oh J, Heo CY. The Study of a Validated Assessment Scale for a Localized Submental Fat Volume. J Clin Med 2023; 12:jcm12031226. [PMID: 36769877 PMCID: PMC9917764 DOI: 10.3390/jcm12031226] [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] [Received: 11/20/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. METHODS The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of the subjects were categorized using validated CR-SMFRS by three plastic surgeons and one dermatologist. The categorized photos were then shown to six different plastic surgeons for evaluation. RESULTS The Cohen's kappa value for the six raters were 0.830, 0.742, 0.703, 0.907, 0.862, and 0.793 with statistical significance (p < 0.001). ICC value was between 0.860 and 0.966 (p < 0.001). Since the Cohen's value and ICC were above 0.6 for all raters, the ratings performed by all six raters were used in the analysis. The ICC values between raters were between 0.899 and 0.902. CONCLUSIONS We came up with a set of reference photos that can be used for submental fat rating scale applicable to Korean subjects. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Joon-Seok Oh
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jinil Choi
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jong-Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Dae-Hyun Lew
- Department of Plastic and Reconstructive Surgery, Department of Medical Education, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Tai-Suk Roh
- Department of Plastic Surgery, Institute for Human Tissue Regeneration, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Seung-Yong Song
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Young-Seok Kim
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Sang-Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Shinhyuk Kang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Jihyun Park
- Research and Development Team, AMI Pharm Co., Ltd., Seongnam 13487, Republic of Korea
| | - Jeongseok Oh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
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Ng JY, Chew FT. A systematic review of skin ageing genes: gene pleiotropy and genes on the chromosomal band 16q24.3 may drive skin ageing. Sci Rep 2022; 12:13099. [PMID: 35907981 PMCID: PMC9338925 DOI: 10.1038/s41598-022-17443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Skin ageing is the result of intrinsic genetic and extrinsic lifestyle factors. However, there is no consensus on skin ageing phenotypes and ways to quantify them. In this systematic review, we first carefully identified 56 skin ageing phenotypes from multiple literature sources and sought the best photo-numeric grading scales to evaluate them. Next, we conducted a systematic review on all 44 Genome-wide Association Studies (GWAS) on skin ageing published to date and identified genetic risk factors (2349 SNPs and 366 genes) associated with skin ageing. We identified 19 promising SNPs found to be significantly (p-Value < 1E-05) associated with skin ageing phenotypes in two or more independent studies. Here we show, using enrichment analyses strategies and gene expression data, that (1) pleiotropy is a recurring theme among skin ageing genes, (2) SNPs associated with skin ageing phenotypes are mostly located in a small handful of 44 pleiotropic and hub genes (mostly on the chromosome band 16q24.3) and 32 skin colour genes. Since numerous genes on the chromosome band 16q24.3 and skin colour genes show pleiotropy, we propose that (1) genes traditionally identified to contribute to skin colour have more than just skin pigmentation roles, and (2) further progress towards understand the development of skin pigmentation requires understanding the contributions of genes on the chromosomal band 16q24.3. We anticipate our systematic review to serve as a hub to locate primary literature sources pertaining to the genetics of skin ageing and to be a starting point for more sophisticated work examining pleiotropic genes, hub genes, and skin ageing phenotypes.
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Affiliation(s)
- Jun Yan Ng
- Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Department of Biological Sciences, Faculty of Science, National University of Singapore, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore
| | - Fook Tim Chew
- Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Department of Biological Sciences, Faculty of Science, National University of Singapore, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, Singapore, 117543, Singapore.
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Kwon HH, Yang SH, Choi M, Jung JY, Park GH. Tightening and Reduction of Unwanted Submental Fat Using Triple-Layer High-Intensity Focused Ultrasound: Clinical and 3-Dimensional Imaging Analysis. Dermatol Surg 2021; 47:1595-1600. [PMID: 34608087 DOI: 10.1097/dss.0000000000003241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence of their use. OBJECTIVE The authors sought to evaluate the safety and efficacy of a novel triple-layer high-intensity focused ultrasound (HIFU) regimen for SMF reduction. METHODS Forty Korean subjects with moderate/severe SMF were evaluated after receiving a session of triple-layer HIFU treatments (using 3.0-, 4.5-, and 6.0-mm focusing transducers). The objective evaluation based on the 5-point Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) and patients' satisfaction based on the 7-point Subject Self-Rating Scale (SSRS) were determined 8 weeks after treatment. Three-dimensional image analysis was also performed. RESULTS At the follow-up visit, the proportion of treatment responders defined as subjects with ≥1-point improvement in CR-SMFRS was 62.5%, and the proportion of patients satisfied with appearance of their face and chin (score ≥4 on the SSRS) was 67.5% of the total patients. The results of 3-dimensional analysis were consistent with clinical observations. Only mild and transient side effects were observed for some patients with no serious adverse effects. CONCLUSION The triple-layer HIFU regimen including the novel 6.0-mm transducer has benefits for tightening and rejuvenation of the area with unwanted SMF, showing reasonable safety profiles.
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Affiliation(s)
| | | | - Mira Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | | | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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Hudson C, Brissett A, Carniol P. Analysis and Assessment of Facial Aging. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00369-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
ABSTRACT Chin augmentation procedures are gaining in popularity. The purpose of this study was to validate the China (Allergan) Chin Retrusion Scale (CACRS) and to evaluate the reliability of the scale. A team of 10 physicians based in Beijing, China, consisting of 1 principal investigator and 9 independent raters, assessed a pool of subject images. Using standardized equipment to capture 2-dimensional images, 100 subjects were photographed from a left, lateral, 90° view. Two measures were used to assess the validity of the scale: rater evaluations of clinically significant differences in 52 pairs of images and rater assessment of chin retrusion using the CACRS to grade the 100 images. The CACRS demonstrated almost perfect inter-rater agreement during 2 validation sessions, with intraclass correlation coefficients of 0.89 and 0.90 at sessions 1 and 2, respectively. Overall inter-rater agreement for all 9 raters was almost perfect, with a weighted kappa of 0.82. Based on inter- and intra-rater agreement, the CACRS was validated for physician ratings of chin retrusion in Chinese subjects. Results from clinical significance evaluations indicated that a 1-grade difference between image pairs was considered clinically meaningful for the CACRS. The CACRS is a validated and reliable photonumeric scale for the assessment of chin retrusion in Chinese men and women. The scale is a clinically significant reference tool for evaluating the effect of chin augmentation.
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Camargo CP, Xia J, Costa CS, Gemperli R, Tatini MD, Bulsara MK, Riera R. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev 2021; 7:CD011301. [PMID: 34224576 PMCID: PMC8407355 DOI: 10.1002/14651858.cd011301.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Botulinum toxin type A (BontA) is the most frequent treatment for facial wrinkles, but its effectiveness and safety have not previously been assessed in a Cochrane Review. OBJECTIVES To assess the effects of all commercially available botulinum toxin type A products for the treatment of any type of facial wrinkles. SEARCH METHODS We searched the following databases up to May 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with over 50 participants, comparing BontA versus placebo, other types of BontA, or fillers (hyaluronic acid), for treating facial wrinkles in adults. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes were participant assessment of success and major adverse events (AEs) (eyelid ptosis, eyelid sensory disorder, strabismus). Secondary outcomes included physician assessment of success; proportion of participants with at least one AE and duration of treatment effect. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 65 RCTs, involving 14,919 randomised participants. Most participants were female, aged 18 to 65 years. All participants were outpatients (private office or day clinic). Study duration was between one week and one year. No studies were assessed as low risk of bias in all domains; the overall risk of bias was unclear for most studies. The most common comparator was placebo (36 studies). An active control was used in 19 studies. There were eight dose-ranging studies of onabotulinumtoxinA, and a small number of studies compared against fillers. Treatment was given in one cycle (54 studies), two cycles (three studies), or three or more cycles (eight studies). The treated regions were glabella (43 studies), crow's feet (seven studies), forehead (two studies), perioral (two studies), full face (one study), or more than two regions (nine studies). Most studies analysed moderate to severe wrinkles; mean duration of treatment was 20 weeks. The following results summarise the main comparisons, based on studies of one treatment cycle for the glabella. AEs were collected over the duration of these studies (over four to 24 weeks). Compared to placebo, onabotulinumtoxinA-20 U probably has a higher success rate when assessed by participants (risk ratio (RR) 19.45, 95% confidence interval (CI) 8.60 to 43.99; 575 participants; 4 studies; moderate-certainty evidence) or physicians (RR 17.10, 95% CI 10.07 to 29.05; 1339 participants; 7 studies; moderate-certainty evidence) at week four. Major AEs are probably higher with onabotulinumtoxinA-20 U (Peto OR 3.62, 95% CI 1.50 to 8.74; 1390 participants; 8 studies; moderate-certainty evidence), but there may be no difference in any AEs (RR 1.14, 95% CI 0.89 to 1.45; 1388 participants; 8 studies; low-certainty evidence). Compared to placebo, abobotulinumtoxinA-50 U has a higher participant-assessed success rate at week four (RR 21.22, 95% CI 7.40 to 60.56; 915 participants; 6 studies; high-certainty evidence); and probably has a higher physician-assessed success rate (RR 14.93, 95% CI 8.09 to 27.55; 1059 participants; 7 studies; moderate-certainty evidence). There are probably more major AEs with abobotulinumtoxinA-50 U (Peto OR 3.36, 95% CI 0.88 to 12.87; 1294 participants; 7 studies; moderate-certainty evidence). Any AE may be more common with abobotulinumtoxinA-50 U (RR 1.25, 95% CI 1.05 to 1.49; 1471 participants; 8 studies; low-certainty evidence). Compared to placebo, incobotulinumtoxinA-20 U probably has a higher participant-assessed success rate at week four (RR 66.57, 95% CI 13.50 to 328.28; 547 participants; 2 studies; moderate-certainty evidence), and physician-assessed success rate (RR 134.62, 95% CI 19.05 to 951.45; 547 participants; 2 studies; moderate-certainty evidence). Major AEs were not observed (547 participants; 2 studies; moderate-certainty evidence). There may be no difference between groups in any AEs (RR 1.17, 95% CI 0.90 to 1.53; 547 participants; 2 studies; low-certainty evidence). AbobotulinumtoxinA-50 U is no different to onabotulinumtoxinA-20 U in participant-assessed success rate (RR 1.00, 95% CI 0.92 to 1.08, 388 participants, 1 study, high-certainty evidence) and physician-assessed success rate (RR 1.01, 95% CI 0.95 to 1.06; 388 participants; 1 study; high-certainty evidence) at week four. Major AEs are probably more likely in the abobotulinumtoxinA-50 U group than the onabotulinumtoxinA-20 U group (Peto OR 2.65, 95% CI 0.77 to 9.09; 433 participants; 1 study; moderate-certainty evidence). There is probably no difference in any AE (RR 1.02, 95% CI 0.67 to 1.54; 492 participants; 2 studies; moderate-certainty evidence). IncobotulinumtoxinA-24 U may be no different to onabotulinumtoxinA-24 U in physician-assessed success rate at week four (RR 1.01, 95% CI 0.96 to 1.05; 381 participants; 1 study; low-certainty evidence) (participant assessment was not measured). One participant reported ptosis with onabotulinumtoxinA, but we are uncertain of the risk of AEs (Peto OR 0.02, 95% CI 0.00 to 1.77; 381 participants; 1 study; very low-certainty evidence). Compared to placebo, daxibotulinumtoxinA-40 U probably has a higher participant-assessed success rate (RR 21.10, 95% CI 11.31 to 39.34; 683 participants; 2 studies; moderate-certainty evidence) and physician-assessed success rate (RR 23.40, 95% CI 12.56 to 43.61; 683 participants; 2 studies; moderate-certainty evidence) at week four. Major AEs were not observed (716 participants; 2 studies; moderate-certainty evidence). There may be an increase in any AE with daxibotulinumtoxinA compared to placebo (RR 2.23, 95% CI 1.46 to 3.40; 716 participants; 2 studies; moderate-certainty evidence). Major AEs reported were mainly ptosis; BontA is also known to carry a risk of strabismus or eyelid sensory disorders. AUTHORS' CONCLUSIONS BontA treatment reduces wrinkles within four weeks of treatment, but probably increases risk of ptosis. We found several heterogeneous studies (different types or doses of BontA, number of cycles, and different facial regions) hindering meta-analyses. The certainty of the evidence for effectiveness outcomes was high, low or moderate; for AEs, very low to moderate. Future RCTs should compare the most common BontA (onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, daxibotulinumtoxinA, prabotulinumtoxinA) and evaluate long-term outcomes. There is a lack of evidence about the effects of multiple cycles of BontA, frequency of major AEs, duration of effect, efficacy of recently-approved BontA and comparisons with other treatments.
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Affiliation(s)
- Cristina Pires Camargo
- Laboratory of Microsurgery and Plastic Surgery (LIM-04), School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Jun Xia
- Nottingham China Health Institute, The University of Nottingham Ningbo, Ningbo, China
| | - Caroline S Costa
- Department of Specialised Medicine, Discipline of Dermatology, Universidade Federal do Piaui, Teresina, Brazil
| | - Rolf Gemperli
- Department of Surgery, Discipline of Plastic Surgery, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dc Tatini
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
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de Maio M, Chatrath V, Hart S, Hoo AJS, Marchac A, Sykianakis D, Lee ILI. Multi-Dimensional Aesthetic Scan Assessment (MD ASA™): Initial experience with a novel consultation, facial assessment, and treatment planning tool. J Cosmet Dermatol 2021; 20:2069-2082. [PMID: 33977669 DOI: 10.1111/jocd.14216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS To describe the MD ASA technique and present its preliminary application. METHODS MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - Izzy Lung I Lee
- Shang-Ho Aesthetic Medical Clinic, Kaohsiung City, Taiwan ROC
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12
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Eiben-Nielson C, Kerscher M. Development and validation of a global photonumeric scale for evaluating skin quality of aged female facial skin. J Cosmet Dermatol 2021; 20:4032-4039. [PMID: 33690945 DOI: 10.1111/jocd.14058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Skin quality plays an important role in overall attractiveness. However, so far, no visual grading scales have been published while their development seems to be an essential key step to provide validated grading scales for the evaluation of efficacy of minimally invasive procedures and cosmeceuticals aims on the improvement of skin quality, esthetic research, and clinical application. OBJECTIVES To develop and validate a visual five-point assessment scale for the evaluation of skin quality of female facial skin. METHODS The five-point photonumeric Scientific Assessment Scale of Skin Quality is based on six parameters. Fifty standardized photos were rated by 13 experts. This examination was carried out in two cycles with an interval of 4 weeks. The intraclass correlation coefficient contributes to the identification of the inter-rater and intrarater reliability. RESULTS Statistical analysis investigated six specific and two general parameters: The results of inter- and intrarater reliability for skin elasticity (ICC 0.816; ICC 0.883), wrinkles (ICC 0.840; 0.885), and age (ICC 0.885; 0.925) were almost perfect. The reliabilities for pigmentation (ICC 0.637; ICC 0.797), erythema (ICC 0.688; ICC 0.797), and overall skin quality (ICC 0.652; ICC 0.756) were substantial and for pore size moderate (ICC 0.405; ICC 0.584). Skin surface roughness (ICC 0.480; ICC 0.645) indicated a substantial intrarater reliability and a moderate interrater reliability. These data revealed good and excellent results. CONCLUSIONS The Scientific Assessment Scale of Skin Quality represents an innovative universal and reliable measurement instrument for a valid and reproducible evaluation of six parameters of aged female facial skin quality.
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Affiliation(s)
- Christine Eiben-Nielson
- Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | - Martina Kerscher
- Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
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13
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Cohen S, Dominsky O, Artzi O, Dayan E, Eckstein J. Deep Layer Radiofrequency Thermo-coagulative Technology for Cervicofacial Contouring: Sonographic and Clinical Results. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3286. [PMID: 33425598 PMCID: PMC7787293 DOI: 10.1097/gox.0000000000003286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
Radiofrequency energy thermally induces collagen contraction and remodeling. The resultant dermal tightening is well established. However, facial aging encompasses also deeper layers of collagen-containing tissues. We present a deep layer radiofrequency-based thermo-coagulative technique for cervicofacial contouring and evaluate its efficacy. METHODS This prospective single center study was conducted from June 2017 to June 2018 and included 10 women. Echogenicity and thickness of layers 1-5 of the lower face, lateral neck, and submental regions were sonographically measured at baseline and at 6 weeks postoperatively. Echogenicity analysis was based on the number of high echogenic pixels counted and processed using Matlab-based image application (The Mathworks, Natick, Mass.). Clinical outcome at 12 months postoperatively was evaluated by 2 independent evaluators using a validated 5-point lower face improvement scale and the Merz jawline scale (0-4). Patient satisfaction and adverse effects were recorded. RESULTS Mean age was 60.2 years (range, 52-76). A statistically significant increase in echogenicity (P ≤ 0.02) and a decrease in thickness (P = 0.01) was noted. Echogenicity increased at 149%, 78%, and 60%, for the lateral neck, lower face, and submental region, respectively. The corresponding decrease in thickness per site was 16%, 6%, and 19%. The average physicians' improvement in lower face contour was 3.8, and the Merz jawline scale was improved from 2.85 at baseline to 1.05 at 12 months postoperatively. Patient satisfaction was high. Side effects were minimal. CONCLUSIONS Deep layer radiofrequency-based technology thermally induces profound soft tissue tightening and neocollagenesis. It is a safe and effective technique for cervicofacial contouring in selected patients.
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Affiliation(s)
- Sarit Cohen
- From the Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Dominsky
- From the Department of Plastic and Reconstructive Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel
| | - Erez Dayan
- Advanced Plastic Surgery Institute, Reno/Tahoe, Nev
| | - Joseph Eckstein
- Diagnostic Radiology Unit, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
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Gold MH, Andriessen A, Hu S, Vega JH, Goldberg DJ, Grover KV, Lorenc ZP, Mandy SH. Physician survey on pre-/postprocedure measures for injectable treatments. J Cosmet Dermatol 2020; 19:2246-2251. [PMID: 32738101 DOI: 10.1111/jocd.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Every year in the United States, over 1 billion dollars are spent on aesthetic injectables, such as soft tissue fillers and neurotoxins. In 2018, the total amount of injectable treatments performed surpassed 2 671 130 procedures. While often mild and transient, adverse events (AEs) can occur following these procedures. AEs may include common side effects such as bruising, or rare, but serious AEs such as infections. While previous investigators have evaluated methods of reducing risks of AEs due to the treatment procedure itself, few investigations have evaluated measures employed before and/or after treatment (ie, peri-procedure). METHODS An electronic survey was sent to aesthetic clinicians with experience performing injectable treatments. The survey collected information regarding general information (eg, demographics and specialty), type of injectable devices used, current peri-procedures, and an exploration of future options for peri-procedural measures. RESULTS Most aesthetic clinicians did not use prophylactic topical or systemic antimicrobials, nor prophylactic topical antiviral therapy. However, approximately 65% of clinicians reported using prophylactic systemic antivirals for patients with a history of herpes simplex virus. A variety of products were used to prepare the skin prior to injectable procedures. Postprocedure, multiple over-the-counter wound repair products were recommended by >70% of injectors. However, there was a large variety of products recommended with no majority consensus. CONCLUSIONS Currently, there are no peri-procedural standards of practice when performing aesthetic injectable treatments. Efforts are underway for the development of best-practice algorithms.
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Affiliation(s)
- Michael H Gold
- Gold Skin Care Center and Tennessee Clinical Research Center, Nashville, TN, USA.,University School of Medicine and Nursing, Nashville, TN, USA
| | - Anneke Andriessen
- Radboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
| | - Shasa Hu
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Dermatology and Cutaneous Surgery, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - David J Goldberg
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, NJ, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Komel V Grover
- Strategic Development, Swiss American CDMO, Dallas, TX, USA
| | - Z Paul Lorenc
- Lorenc Aesthetic Plastic Surgery Center, New York, NY, USA.,Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Stephen H Mandy
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Ye R, Chang W, Hu J, Qiao L, Wang Q. A new method for skin aging evaluation of Chinese women. J Cosmet Dermatol 2020; 20:256-262. [PMID: 32597551 DOI: 10.1111/jocd.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the development of cosmetic industry in China, an aging evaluation method of Chinese women is in great need. AIMS The aim of this study is to establish a skin aging assessment method using convenient portable machine Antera 3D. METHODS The quantitative approach was developed by capturing 11 areas of the face, and overall, 48 parameters were extracted for aging evaluation. Later, 297 subjects were recruited to take facial image and life style questionnaire. Evaluation of age was accomplished by establishing prediction method with detected skin traits. RESULTS The age prediction model was built by using the evaluated facial traits, and a R square of 0.6 is achieved by comparing to the chronological age. The crow's feet, cheek skin pigmentation, forehead skin tone, and wrinkles around the month are critical factors in evaluating Chinese women skin aging. In addition, we also explored life styles associated with important skin aging traits. CONCLUSION The method developed in this research provides reliable alternative in aging study of Chinese women.
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Affiliation(s)
- Rui Ye
- Inertiabiotech Co., LTD, Shanghai, China
| | | | | | | | - Qianqian Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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16
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Histological Analysis of the Effect of ATX-101 (Deoxycholic Acid Injection) on Subcutaneous Fat: Results From a Phase 1 Open-Label Study. Dermatol Surg 2020; 46:70-77. [PMID: 30883481 DOI: 10.1097/dss.0000000000001851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND ATX-101 is approved for submental fat reduction. OBJECTIVE To characterize the histological effect of ATX-101 injection into subcutaneous fat. METHODS This Phase 1 open-label study enrolled 14 adults to receive injections of ATX-101 into abdominal fat at varying concentrations (0.5%, 1.0%, 2.0%, or 4.0%), volumes (0.2 or 0.4 mL), spacing (0.7, 1.0, or 1.5 cm), and time points before scheduled abdominoplasty (1, 3, 7, or 28 days). During abdominoplasty, tissue was excised and preserved for histology. RESULTS All injection paradigms resulted in histological changes confined to the subcutaneous layer, which were more prominent at higher concentrations and independent of volume and spacing. Key features at Day 1 after injection were adipocytolysis, blood vessel injury, neutrophilic inflammation, and lysis of locally present neutrophils. At Day 3, inflammation was reduced versus Day 1, and hemorrhage and lipid lake formation (at higher concentrations) were observed. Day 7 samples exhibited prominent adipocytolysis, mild inflammation, lipid-laden macrophages in the septae, and repair of vascular injury. At Day 28, inflammation was largely resolved and prominent features were septal thickening, neovascularization, and atrophy of fat lobules. CONCLUSION Subcutaneous injection of ATX-101 induces adipocytolysis and local inflammation with septal thickening and resolution of inflammation by 28 days after injection.
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Jain M, Savage NE, Spiteri K, Snell BJ. A 3-Dimensional Quantitative Analysis of Volume Loss Following Submental Cryolipolysis. Aesthet Surg J 2020; 40:123-132. [PMID: 31099382 DOI: 10.1093/asj/sjz145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cryolipolysis is a proven and effective means of fat reduction; however, there are no standardized means of measuring volume reduction. OBJECTIVES We aim to assess the volume loss using a 3-dimensional (3D) analysis following submental cryolipolysis. METHODS A retrospective cohort study between April 2016 and August 2018 was performed. Thirty-five patients underwent a single 45-minute cycle of cryolipolysis to the submental region using the CoolSculpting System. A 3-fold analysis was performed employing an independent observer assessment of 2-dimensional photographs and 3D volumetric analysis utilizing the Vectra XT system, and patient satisfaction was measured with the FACE-Q questionnaire. RESULTS Our results suggested the mean (standard deviation) pretreatment volume (n = 35) was 104.12 cm3 (28.78). The 6-week mean posttreatment volume (n = 26) was 81.55 cm3 (21.29). The mean volume reduction found at 6 weeks posttreatment showed a reduction of 22.46 cm3 (19.10) (95% CI 14.74 to 30.17, P < 0.0001). The 12-week mean posttreatment volume (n = 24) was 82.24 cm3 (23.97). The 12-week posttreatment demonstrated a reduction of 22.30 cm3 (14.04) (95% CI 16.37 to 28.23, P < 0.0001). The mean percentage correct for each reviewer correctly identifying the pretreatment and posttreatment photograph was 76.33% (7.14). Patient satisfaction showed a mean FACE-Q score of 54.10 (20.41). CONCLUSIONS The study further affirms that submental cryolipolysis is an efficacious and safe, noninvasive method for reducing submental adiposity resulting in notable patient satisfaction rates. Furthermore, results suggest that patients can have a volume loss of about 20% on average, allowing them to be more confident and comfortable with their appearance. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mohit Jain
- Department of Plastics and Reconstructive Surgery, Bendigo Health, Bendigo, Australia
| | | | | | - Broughton J Snell
- Department of Plastics and Reconstructive Surgery, Bendigo Health, Bendigo, Australia
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18
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Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients. Dermatol Surg 2019; 45 Suppl 1:S2-S11. [DOI: 10.1097/dss.0000000000001993] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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La Padula S, Hersant B, Bompy L, Meningaud JP. In search of a universal and objective method to assess facial aging: The new face objective photo-numerical assessment scale. J Craniomaxillofac Surg 2019; 47:1209-1215. [DOI: 10.1016/j.jcms.2019.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 01/07/2023] Open
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21
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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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22
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Development of a Global Subjective Skin Aging Assessment score from the perspective of dermatologists. BMC Res Notes 2019; 12:364. [PMID: 31253172 PMCID: PMC6599371 DOI: 10.1186/s13104-019-4404-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Several skin aging assessment scales exist but no standard scale is widely used. Dermatologists may be the most appropriate persons for skin assessment but their perceptions regarding the signs of skin aging are unexplored. To develop a simple global skin aging assessment score from the perspective of dermatologists, an online questionnaire, the Thai Dermatologist Survey of Skin Aging Assessment, was conducted from October to December, 2016. Twenty-nine signs with published evidence of their relevancy to skin aging were included. Certified dermatologists were asked to score each sign using a 5-point Likert scale. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis. Results Of 213 randomly selected dermatologists, 145 responded to the survey. EFA revealed 3 important factors related to skin aging: Factor 1 comprised 8 signs related to atrophy (deep/superficial wrinkles, eye bags, lax appearance, etc.); Factor 2 comprised 7 signs related to discoloration (freckles, lentigines, melasma, etc.); and Factor 3 comprised 3 malignant skin lesions. The Global Subjective Skin Aging Assessment (GS2A2) score is a simple numerical score that can be used to evaluate the anti-aging effects of a cosmetic product or dermatologic intervention. This score should be tested further for validity and reliability. Electronic supplementary material The online version of this article (10.1186/s13104-019-4404-z) contains supplementary material, which is available to authorized users.
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Validation of a Photonumeric Assessment Scale for Grading the Slope of the Asian Forehead. Dermatol Surg 2019; 45 Suppl 1:S38-S45. [PMID: 31246870 DOI: 10.1097/dss.0000000000001997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the number of aesthetic treatments has grown, so have the number of photonumeric assessment scales used to compare the effectiveness of these aesthetic treatments in specific anatomical areas; however, these are primarily based on Caucasian features. OBJECTIVE To assess the validity of the first aesthetic scale for assessing the slope of the Asian forehead. A secondary objective was to correlate this scale with subject demographics and baseline characteristics. METHODS During 2 validation sessions, 13 raters assessed full frontal and lateral facial images of female (n = 28; 56.0%) and male (n = 22; 44%) subjects. For each subject, the severity of forehead sloping was graded from 0 (convex forehead, optimal forehead volume) to 4 (concave forehead, very severe sloping). Raters also assessed the age of each subject and the estimated aesthetic treatment effort required to treat each subject. RESULTS Inter-rater reliability was "substantial" with scores of 0.67 and 0.68 for the first and second validation sessions, indicating high reliability. BMI showed the highest correlation with the scale and was a significant predictor in the final regression model. CONCLUSION This photonumeric assessment scale will be useful for assessing the slope of the Asian forehead in both clinical and research settings.
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Abstract
BACKGROUND Clinical photonumeric scales have been developed and validated to objectively measure the effectiveness of aesthetic treatments in specific anatomical areas; however, these are based on the typical features of Caucasian patients. No clinical scale for Asian calf appearance currently exists. OBJECTIVE To develop and validate a calf assessment scale for use in the female Asian patient population. METHODS AND MATERIALS During 2 validation sessions, 13 raters assessed calf images of female Asian subjects (N = 35) viewed from behind with feet flat on the floor (at rest) and on tiptoes (dynamic). Images were rated from 0 (very slim, linear profile) to 4 (very severe convex profile). RESULTS Inter-rater and intra-rater reliability were "substantial" (≥0.6, intraclass correlation coefficient [ICC] and weighted kappa) for the calf-at rest, calf-dynamic, and calf summary score. Reliability was "substantial" for calf-at rest and calf-dynamic (≥0.6, ICC and weighted kappa) and "almost perfect" (0.85) for the calf summary score. BMI and calf circumference were highly correlated with scale ratings, and calf circumference was a significant predictor. CONCLUSION This new photonumeric assessment scale has value for assessing the female Asian calf, providing a standardized measure of calf appearance in clinical practice and clinical research settings.
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Wollina U, Brzezinski P. Aesthetic dermatology: What's new, what's true? Dermatol Ther 2018; 32:e12623. [PMID: 30182495 DOI: 10.1111/dth.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023]
Abstract
Aesthetic dermatology (AD) is a rapidly growing subspecialty of dermatology. The acceptance of AD in scientific community and the society is associated with its competence, efficiency, and seriousness. This review highlights some recent developments toward new tools, techniques, and understanding in the field of AD. Analyzing the specific needs of patients and assessing the effect by objective measurements is important for further progress. For long time ignored, white adipose tissue has gained increasing interest in biology and rejuvenation. Characterization of dermal and subcutaneous white adipose tissue has made progress. The interaction of hyaluronic acid and calcium hydroxyl apatite (CaHA) fillers with adipocytes could be responsible for clinical efficacy. New developments of oral collagen treatment and highly diluted CaHA to contour the body outside the face will be discussed. Submental contouring using purified desoxycholic acid is another new development.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
| | - Piotr Brzezinski
- Faculty of Mathematics and Natural Sciences, Institute of Biology and Environmental Protection, Pomeranian Academy, Slupsk, Poland.,Department of Dermatology, 6th Military Support Unit, Ustka, Poland
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Lipner SR. Cryolipolysis for the treatment of submental fat: Review of the literature. J Cosmet Dermatol 2018; 17:145-151. [PMID: 29345049 DOI: 10.1111/jocd.12495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Submental fat accumulation is a common cosmetic concern. Cryolipolysis utilizes noninvasive cooling to lyse adipocytes. A cryolipolysis device was recently approved for treatment of submental fat. OBJECTIVE This manuscript provides a review of the preclinical work and clinical trials related to cryolipolysis for the treatment of submental fat. Settings, efficacy, and side effects are also discussed. MATERIALS AND METHODS A literature search was performed through Pubmed, EMBASE, Web of Science, and CINAHL, using the search terms "cryolipolysis," "submental," and "paradoxical adipose hyperplasia". Additional sources from the original source bibliographies were used to further supplement this review. RESULTS There are 4 clinical trials and one case series (total 101 patients) that evaluated the use of cryolipolysis for treatment of submental fat. In these studies, there was a statistically significant reduction in submental fat and patients expressed high satisfaction with the treatment. Adverse effects were mild and transient. CONCLUSIONS Cryolipolysis is a noninvasive cooling technique that is safe and effective for treatment of submental fat. To date, there are no reports of marginal mandibular nerve injury or paradoxical adipose hyperplasia following treatment with this device.
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Affiliation(s)
- Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Garg S, Khan N, Makadia S. Proposed global drooping and wrinkles classification and scoring system for aging face with validation and experience on 54 Indian subjects. Indian J Dermatol Venereol Leprol 2018; 84:672-677. [DOI: 10.4103/ijdvl.ijdvl_418_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rauso R. Deoxycholate (ATX-101) Mixed with Lidocaine to Minimize Pain/Discomfort in Nonsurgical Treatment of Submental Fullness Appearance. J Cutan Aesthet Surg 2018; 11:229-233. [PMID: 30886478 PMCID: PMC6371728 DOI: 10.4103/jcas.jcas_9_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the present study pain/discomfort reduction in submental fullness treatment with the injections of a DC based drug (ATX-101, Allergan, Dublin, Ireland) premixed with lidocaine 2% on a sample of 12 patients retrospectively evaluated has been performed All patients indicated improvement in skin tightening from the 2nd month postinjection. Three patients had minor ecchymoses at the injection sites, which resolved spontaneously within 10 days posttreatment. One patient experienced dysesthesia of the treated area, which lasted approximately 40 days and resolved spontaneously. No other complications—such as nerve paresis or alopecia—were recorded. No patient required analgesic drugs postinjection.
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Affiliation(s)
- Raffaele Rauso
- Department of Maxillo-Facial Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Leal Silva H, Carmona Hernandez E, Grijalva Vazquez M, Leal Delgado S, Perez Blanco A. Noninvasive submental fat reduction using colder cryolipolysis. J Cosmet Dermatol 2017; 16:460-465. [PMID: 28901051 DOI: 10.1111/jocd.12383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.
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Affiliation(s)
| | | | | | | | - Angel Perez Blanco
- Universidad Autonoma de Nuevo Leon, San Nicolas de los Garza, Nuevo León, Mexico
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Early Experience in 100 Consecutive Patients With Injection Adipocytolysis for Neck Contouring With ATX-101 (Deoxycholic Acid). Dermatol Surg 2017; 43:950-958. [PMID: 28448317 PMCID: PMC5491226 DOI: 10.1097/dss.0000000000001133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Deoxycholic acid (DCA) is approved for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat. OBJECTIVE To assess early treatment experience with DCA injection in a clinical practice setting. MATERIALS AND METHODS In this single-center, prospective, single-arm, observational study, 100 consecutive patients seeking to decrease submental fullness received subcutaneous DCA (2 mg/cm) injections in the submental area (maximum of 6 sessions at ≥1 month intervals). Treatment response was assessed 1 and 5 to 7 weeks posttreatment using the clinician-reported submental fat rating scale (CR-SMFRS) and retrospective independent photograph review by 2 physicians. RESULTS Overall, 100 patients had 152 treatment sessions (58, 33, 8, and 1 patients had 1, 2, 3, and 4 sessions, respectively). CR-SMFRS score improved by ≥1 point from baseline in 88 (88%) patients; of these, 46, 33, 8, and 1 patients had 1, 2, 3, and 4 sessions, respectively. Local edema, numbness, and tenderness were reported for a mean (SD) of 7.7 (5.3), 28.5 (11.4), and 3.5 (3.5) days, respectively. Two patients experienced marginal mandibular nerve paresis. CONCLUSION Deoxycholic acid injection, a minimally invasive procedure for neck contouring, was effective and generally well tolerated in the private practice setting.
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Niforos F, Liew S, Acquilla R, Ogilvie P, Safa M, Signorini M, Jones D, Hawthorn J, Collins C, Kerson G, Sithamparanathan M. Creation and Validation of a Photonumeric Scale to Assess Volume Deficiency in the Infraorbital Region. Dermatol Surg 2017; 43:684-691. [PMID: 28375974 DOI: 10.1097/dss.0000000000001088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The eyes are particularly important aesthetic features of the face and revitalization of the infraorbital region has become a focus of aesthetic treatments. Published infraorbital scales to date have limitations in that they have been descriptive, subjective, or have used computer-generated images. Thus, there is an unmet need for a validated scale based on actual images. OBJECTIVE To develop a practical photonumeric scale that respects the complex anatomy and age-related changes occurring in the orbital area. METHODS AND MATERIALS The Allergan Infra-oRbital Scale (AIRS) was developed through a multistep process in collaboration with 16 physicians (plastic surgeons, dermatologists, and aesthetic physicians). Scale development involved both online photographs and live assessments of subjects. Interrater and intrarater reliability was assessed using intraclass correlation coefficients (ICCs). RESULTS The final AIRS showed intrarater and interrater ICCs of 0.78 to 0.86 and 0.91 to 0.98 for live validation and 0.76 to 0.82 and 0.86 to 0.91 for online validation, respectively, demonstrating robust validity. CONCLUSION The AIRS can be considered a photonumeric scale that accurately describes volume loss in the infraorbital region. It has been validated and is appropriate for use in research or for everyday clinical use for both live and photographic assessment.
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Affiliation(s)
- François Niforos
- *Centre Chirurgical Niforos, Lyon, France; †Shape Clinic, Sydney, Australia; ‡The Gatehouse, Cheshire, United Kingdom; §Skin Concept, Munich, Germany; ‖La Jouvence, Neuchâtel, Switzerland; ¶Private Practice, Milano, Italy; #Division of Dermatology, University of California at Los Angeles, Los Angeles, California; **Collins Therapeutic Consulting Ltd, Gloucestershire, United Kingdom; ††Surrey, United Kingdom; ‡‡Allergan plc, Marlow, United Kingdom
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Georgesen C, Lipner SR. The development, evidence, and current use of ATX-101 for the treatment of submental fat. J Cosmet Dermatol 2017; 16:174-179. [DOI: 10.1111/jocd.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Corey Georgesen
- Department of Dermatology; Weill Cornell Medicine; New York NY USA
| | - Shari R. Lipner
- Department of Dermatology; Weill Cornell Medicine; New York NY USA
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La Padula S, Hersant B, SidAhmed M, Niddam J, Meningaud JP. Objective estimation of patient age through a new composite scale for facial aging assessment: The face – Objective assessment scale. J Craniomaxillofac Surg 2016; 44:775-82. [DOI: 10.1016/j.jcms.2016.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/02/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022] Open
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Cohen JL, Carruthers A, Jones DH, Narurkar VA, Wong M, Cheskin LN, Trout JR, Howell DJ. A Randomized, Blinded Study to Validate the Merz Hand Grading Scale for Use in Live Assessments. Dermatol Surg 2016; 41 Suppl 1:S384-8. [PMID: 26618469 DOI: 10.1097/dss.0000000000000553] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Merz Hand Grading Scale (MHGS) is a 5-point scale used to grade appearance of the dorsum of the hand. The MHGS has been previously validated for assessment of photographed hands but not for live assessment. OBJECTIVE The purpose of this randomized, blinded study was to validate the MHGS for live assessment of the hands in the clinical setting. METHODS Three physician raters completed a scale qualification program that included MHGS training, ratings of standardized hand photographs, and statistical analysis for reliability. Eighty-four subjects (28 males, 30% Fitzpatrick skin Types IV-VI, mean age of 42 years), randomized to 2 live assessment sessions for independent and blinded observation of dorsa of their right hands, completed the study. RESULTS Overall MHGS intrarater weighted Kappa value was 0.74 (0.68-0.79 [CI 95%]). First- and second-time hand-rating agreement scores ranged from 64% to 75%. Interrater weighed Kappa values ranged from 0.59 to 0.71, representing between-rater paired results of each combination of raters. CONCLUSION High-weighted Kappa values and agreements demonstrate that consistency at different time points can be achieved individually and by different raters for live assessments. The MHGS is a suitable instrument for live assessment in the clinical setting.
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Affiliation(s)
- Joel L Cohen
- *AboutSkin Dermatology and DermSurgery, Englewood, Colorado, and Department of Dermatology, University of Colorado, Aurora, Colorado; †Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada; ‡Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California; §Bay Area Laser Institute, San Francisco, California; ‖Merz North America, Raleigh, North Carolina; ¶Yardley, Pennsylvania; #San Francisco, California
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Abstract
UNLABELLED Despite the expert execution of the most sophisticated techniques, a precise descriptive guide of the treated areas to produce clinical records is lacking. The aim of our study was to develop a method of facial analysis to get a classification of areas that have to be treated for precise records. Our aim was to find an easy and original method for positioning and recording facial filler quantities and results. METHODS We studied this method of analysis on 300 nonsmoker patients aged between 25 and 55 years. It involves the use of vertical and horizontal lines to divide the middle lower third into areas. It is this grid-like framework of perpendicular lines that gives rise to the name selected for the method. RESULTS Postsurgical analysis with FAFI GRID (Facial Filler Grid) indicated a satisfactory outcome, and it proved useful for precise records. DISCUSSION FAFI GRID allows us to treat precise facial points that are treated in steps: (1) malar, (2) nose, (3) lower third. The method thus provides an easy way to position and orient facial fillers in the entire face.
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Randag A, Graaff R, Dreise M, Vierkötter A, Werker P, Stenekes M. Body mass index, chronological age and hormonal status are better predictors of biological skin age than arm skin autofluorescence in healthy women who have never smoked. Br J Dermatol 2015. [DOI: 10.1111/bjd.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A.C. Randag
- Department of Plastic Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - R. Graaff
- Department of Endocrinology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - M.M. Dreise
- Department of Plastic Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - A. Vierkötter
- IUF - Leibniz Research Institute for Environmental Medicine; Düsseldorf Germany
| | - P.M.N. Werker
- Department of Plastic Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - M.W. Stenekes
- Department of Plastic Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
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Dobos G, Lichterfeld A, Blume-Peytavi U, Kottner J. Evaluation of skin ageing: a systematic review of clinical scales. Br J Dermatol 2015; 172:1249-61. [PMID: 25363020 DOI: 10.1111/bjd.13509] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 01/18/2023]
Abstract
Clinical scales are widely used in anti-ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty-two scales were evaluated for their test-retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses-testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the 'best' to improve clinical research and practice.
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Affiliation(s)
- G Dobos
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A Lichterfeld
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - U Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - J Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Guerrrerosantos J, Carlos Eduardo PG, Mateos Arriola J, Villa Manzano AI, Villarán-Muñoz B, García Benavides L, Vazquez MG. Effectiveness of botulinum toxin (type-A) administered by the fixed-site dosing approach versus the muscle area identification. Aesthetic Plast Surg 2015; 39:243-51. [PMID: 25673569 DOI: 10.1007/s00266-014-0445-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Botulinum toxin is widely used in glabellar musculature. The authors express the need to individualize the approach by means of muscular identification to improve effectiveness. Despite these guidelines, the fixed-point technique is still used. OBJECTIVE Comparison of effectiveness of botulinum toxin administration in the glabellar zone by using fixed-site application versus objective-muscle-identification. MATERIALS AND METHODS Prolective dynamic cohort study. Patients (after previous informed consent) were assessed on their facial expressions, level of satisfaction, re-interventions, adverse effects, dosage, dilution, and number of injections. All patients who experienced either of both techniques of botulinum toxin administration (fixed-site or objective-muscle-identification) were subjected to followup by the following parameters: statistical analysis: student's t Test (inter-group mean comparisons), paired student's t test (intra-group mean comparisons), χ (2) with Fisher exact text. RESULTS Sixty-two patients were evaluated (31 fixed-site approach, 31 objective-muscle-identification). No patient abandoned the trial during followup. Fixed-site injections required larger doses (16 vs 12 U, p = 0.001), greater volume (0.48 vs. 0.37 ml, p = 0.001), and more application sites (4 vs 2, p = 0.001), compared to the objective-muscle-identification approach. Under the objective-muscle-identification technique, facial expressions were better attenuated (52 vs 65%, p = 0.001), with a higher initial satisfaction level (6 vs 9, p = 0.001) and final satisfaction level (9 vs 9.9, p = 0.001). CONCLUSIONS Botulinum toxin application is more effective when administered through the objective-muscle-identification approach (less frowning, lower doses, less fixed sites injected, and patients more satisfied at the end). 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)
- Jose Guerrrerosantos
- Plastic Surgery Division of University of Guadalajara, Medical School, Calzada Federalismo 2022, Guadalajara, Jalisco, Mexico,
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Hamer MA, Jacobs LC, Lall JS, Wollstein A, Hollestein LM, Rae AR, Gossage KW, Hofman A, Liu F, Kayser M, Nijsten T, Gunn DA. Validation of image analysis techniques to measure skin aging features from facial photographs. Skin Res Technol 2015; 21:392-402. [DOI: 10.1111/srt.12205] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 12/31/2022]
Affiliation(s)
- M. A. Hamer
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
- Netherlands Genomics Initiative (NGI) - sponsored Netherlands Consortium for Healthy Aging (NCHA); Leiden The Netherlands
| | - L. C. Jacobs
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
- Netherlands Genomics Initiative (NGI) - sponsored Netherlands Consortium for Healthy Aging (NCHA); Leiden The Netherlands
| | - J. S. Lall
- Unilever Research and Development; Colworth Science Park; Sharnbrook UK
| | - A. Wollstein
- Section of Evolutionary Biology; Department of Biology II; University of Munich; Planegg-Martinsried Germany
| | - L. M. Hollestein
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
| | | | | | - A. Hofman
- Department of Epidemiology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
| | - F. Liu
- Department of Forensic Molecular Biology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
| | - M. Kayser
- Department of Forensic Molecular Biology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
| | - T. Nijsten
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; Rotterdam The Netherlands
- Netherlands Genomics Initiative (NGI) - sponsored Netherlands Consortium for Healthy Aging (NCHA); Leiden The Netherlands
| | - D. A. Gunn
- Unilever Research and Development; Colworth Science Park; Sharnbrook UK
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Tan SL, Brandt MG, Yeung JC, Doyle PC, Moore CC. The Aesthetic Unit Principle of Facial Aging. JAMA FACIAL PLAST SU 2015; 17:33-8. [DOI: 10.1001/jamafacial.2014.789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan L. Tan
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Michael G. Brandt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Jeffrey C. Yeung
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip C. Doyle
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, Ontario, Canada
- Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Corey C. Moore
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, St Joseph’s Health Care London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Rzany B, Griffiths T, Walker P, Lippert S, McDiarmid J, Havlickova B. Reduction of unwanted submental fat with ATX-101 (deoxycholic acid), an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study. Br J Dermatol 2014; 170:445-53. [PMID: 24147933 PMCID: PMC4232897 DOI: 10.1111/bjd.12695] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 12/01/2022]
Abstract
Summary What's already known about this topic? What does this study add?
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Affiliation(s)
- B Rzany
- Division of Evidence-Based Medicine in Dermatology, Charité-Universitätsmedizin, and RZANY & HUND, Privatpraxis und klinisches Studienzentrum für Dermatologie, Berlin, Germany
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Camargo CP, Costa CS, Gemperli R, Tatini MDC, Bulsara MK, Riera R. Botulinum toxin for facial wrinkles. Hippokratia 2014. [DOI: 10.1002/14651858.cd011301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Caroline S Costa
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Rolf Gemperli
- Universidade de São Paulo; Department of Surgery; Rua Pedroso Alvarenja 1046 2 Andar São Paulo Brazil 04531-004
| | - Maria DC Tatini
- A103, King's Meadow Campus; The University of Nottingham; Lenton Lane Nottingham UK NG7 2NR
| | - Max K Bulsara
- The University of Notre Dame Australia; Institute for Health Research; 19 Mouat Street PO Box 1125 Fremantle WA Australia 6959
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
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Ascher B, Hoffmann K, Walker P, Lippert S, Wollina U, Havlickova B. Efficacy, patient-reported outcomes and safety profile of ATX-101 (deoxycholic acid), an injectable drug for the reduction of unwanted submental fat: results from a phase III, randomized, placebo-controlled study. J Eur Acad Dermatol Venereol 2014; 28:1707-15. [PMID: 24605812 PMCID: PMC4263247 DOI: 10.1111/jdv.12377] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
Background Unwanted submental fat (SMF) may result in an unattractive chin profile and dissatisfaction with appearance. An approved and rigorously tested non-surgical method for SMF reduction is lacking. Objective To evaluate the efficacy and safety of ATX-101 for the pharmacological reduction of unwanted SMF in a phase III randomized, double-blind, placebo-controlled study. Methods Patients (n = 360) with moderate or severe SMF were randomized to receive ATX-101 1 or 2 mg/cm2 or placebo injected into their SMF for up to four treatments ∼28 days apart, with a 12-week follow-up. Coprimary efficacy endpoints were the proportions of treatment responders, defined as a ≥1-point reduction in SMF on the Clinician-Reported Submental Fat Rating Scale (CR-SMFRS), and those satisfied with their appearance in association with their face and chin after treatment on the Subject Self-Rating Scale (SSRS score ≥4). Secondary efficacy endpoints included a ≥1-point improvement in SMF on the Patient-Reported Submental Fat Rating Scale (PR-SMFRS) and changes in the Patient-Reported Submental Fat Impact Scale (PR-SMFIS). Additional patient-reported outcomes and changes in the Skin Laxity Rating Scale were recorded. Adverse events (AEs) and laboratory test results were monitored. Results Compared with placebo, a greater proportion of patients treated with ATX-101 1 and 2 mg/cm2 showed a ≥1-point improvement in CR-SMFRS (58.3% and 62.3%, respectively, vs. 34.5% with placebo; P < 0.001) and patient satisfaction (SSRS score ≥4) with the appearance of their face and chin (68.3% and 64.8%, respectively, vs. 29.3%; P < 0.001). Patient-reported secondary efficacy endpoints showed significant improvements in SMF severity (PR-SMFRS; P = 0.009 for ATX-101 1 mg/cm2, P < 0.001 for ATX-101 2 mg/cm2 vs. placebo) and emotions and perceived self-image (PR-SMFIS; P < 0.001). No overall worsening of skin laxity was observed. AEs were mostly transient, mild to moderate in intensity and localized to the treatment area. Conclusion ATX-101 was effective and well tolerated, and may be an alternative to surgery for patients desiring improvement of their submental profile.
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Affiliation(s)
- B Ascher
- Clinic of Aesthetic Surgery IENA, Paris, France
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Geister TL, Bleßmann-Gurk B, Rzany B, Harrington L, Görtelmeyer R, Pooth R. Validated assessment scale for platysmal bands. Dermatol Surg 2013; 39:1217-25. [PMID: 23650974 DOI: 10.1111/dsu.12240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Marked platysmal bands in the neck are an unwelcome sign of aging. Botulinum neurotoxin type A has been used successfully to treat this indication, but there is a need for a validated tool for accurate assessment of dynamic platysmal bands to evaluate treatment efficacy objectively. OBJECTIVE To develop a scale for objective assessment of dynamic platysmal bands and to validate its use in the clinical setting. METHODS A new 5-point photonumeric assessment scale for platysmal bands was developed. Ten experts experienced in aesthetic dermatology used the scale to rate frontal and lateral neck photographs of 50 subjects in two separate validation cycles. Inter- and intrarater reliability of the scale was assessed. RESULTS The scale comprises five ratings of platysmal band severity ranging from 0 (no relevant prominence of platysmal bands) to 4 (very severe prominence of platysmal bands). Interrater reliability was "almost perfect," with intraclass correlation coefficients of 0.81 for the first validation cycle and 0.82 for the second. Mean intrarater reliability was also high (0.89), with Pearson correlation coefficients ranging between 0.87 and 0.91. CONCLUSION The new 5-point dynamic platysmal band photonumeric assessment scale is a valuable tool for use in the aesthetic clinical setting.
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Affiliation(s)
- Thorin L Geister
- Research and Development HQ, MERZ Pharmaceuticals GmbH, Frankfurt, Germany.
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Carruthers J, Fournier N, Kerscher M, Ruiz-Avila J, Trindade de Almeida AR, Kaeuper G. The Convergence of Medicine and Neurotoxins: A Focus on Botulinum Toxin Type A and Its Application in Aesthetic Medicine—A Global, Evidence-Based Botulinum Toxin Consensus Education Initiative. Dermatol Surg 2013; 39:510-25. [DOI: 10.1111/dsu.12148] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Visscher MO, Pan BS. Update on techniques for the quantitation of facial skin characteristics. Facial Plast Surg Clin North Am 2013; 21:7-19. [PMID: 23369585 DOI: 10.1016/j.fsc.2012.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article is to review the strategies and methods for quantifying treatment outcomes, perhaps defined by the consumer/patient as a "decrease in perceived age." The demand for the rejuvenation of facial skin is expected to increase as the population ages and seeks optimal outcomes from the array of available treatment modalities. This information will be of value to the plastic surgeon in collaborating with patients on evaluation and treatment strategies.
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Affiliation(s)
- Marty O Visscher
- Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Geister TL, Görtelmeyer R, Carruthers A, Carruthers J. Letter: Re: Greg Goodman on Special Issue on Advances in Aesthetic Scales. Dermatol Surg 2012. [DOI: 10.1111/j.1524-4725.2012.02508.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Narins RS, Carruthers J, Flynn TC, Geister TL, Görtelmeyer R, Hardas B, Himmrich S, Jones D, Kerscher M, de Maio M, Mohrmann C, Pooth R, Rzany B, Sattler G, Buchner L, Benter U, Breitscheidel L, Carruthers A. Validated Assessment Scales for the Lower Face. Dermatol Surg 2012; 38:333-42. [DOI: 10.1111/j.1524-4725.2011.02247.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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