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Mariwalla K, Shamban A, Green JB, Gross TM, Brown J, Gallagher CJ. Clinical Benefits of DaxibotulinumtoxinA for Injection: Beyond Glabellar Line Effacement? Dermatol Surg 2024; 50:S18-S23. [PMID: 39196829 DOI: 10.1097/dss.0000000000004332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) is standard of care for glabellar lines ameliorization. DaxibotulinumtoxinA for Injection (DAXI) is a new BoNTA with a unique formulation representing the latest advancement in BoNTA technology. There is an unmet need for patients to understand the full potential of BoNTA treatment and new technologies. OBJECTIVE To update clinical data supporting the use of DAXI for glabellar lines within the context of clinical experience. MATERIALS AND METHODS A narrative review of the literature and summary of clinical experience with DAXI. RESULTS The DAXI clinical trial program reflects clinical experience post-FDA approval, with DAXI demonstrating rapid onset, high patient response rates, and extended treatment duration versus conventional BoNTAs. Clinical observations suggest that DAXI has limited diffusion from the injection site, enabling more localized control of muscle activity and greater improvements in wrinkle severity. DAXI enables practitioners to exert greater finesse in their injections and in predicting changes to eyebrow shape and position and achieve improvement in skin quality. CONCLUSION Advances in BoNTA technology can provide patients with greater options for treatment outcomes. The potential for enhanced localized effects with DAXI may contribute to more precise and targeted effects on muscle activity and additional aesthetic benefits to patients.
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Affiliation(s)
| | | | - Jeremy B Green
- Skin Associates of South Florida/Skin Research Institute, Coral Gables, Florida
| | - Todd M Gross
- Revance Therapeutics, Inc., Nashville, Tennessee
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Goodman GJ, Bagatin E. Photoaging and cosmeceutical solutions in sun-overexposed countries: The experience of Australia and Brazil. J Eur Acad Dermatol Venereol 2024; 38 Suppl 4:36-44. [PMID: 38881450 DOI: 10.1111/jdv.19867] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/31/2024] [Indexed: 06/18/2024]
Abstract
Skin aging is the result of physiological changes determined by genetically driven processes and intrinsic factors, and exacerbated by a combination of multiple environmental factors, the main one being sun exposure. The effects of photoaging are particularly apparent on the face, where the appearance of aging signs can have a significant impact on the emotions conveyed and well-being. Photoprotection and facial skin care for managing photoaging signs are thus of particular importance for both physical and mental health. Countries, like Australia and Brazil, where the level of sun exposure is high and the populations have predominantly outdoor lifestyles, are particularly aware of the harms of photoaging and have implemented several measures to help reduce the risk of skin cancer in their populations. However, sun-seeking behaviours are difficult to change, and it takes time before interventions provide perceptible results. Australia still has some of the highest skin cancer incidence and mortality rates in the world. Solutions that target individuals can also be used for minimizing the clinical signs of facial aging and for improving skin quality, with the ultimate aim being not only to improve the appearance of the skin but also to mitigate the occurrence of pre-malignant and malignant lesions. This review summarizes the features of facial skin photoaging in photo-exposed populations, based on evidence gained from studies of Australian individuals, and discusses the various available solutions for skin photoaging, in particular those that are most popular in Brazil, which is a country with many years of experience in managing photoaged skin.
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Affiliation(s)
- Greg J Goodman
- Monash University, Clayton, Victoria, Australia
- University College of London, London, UK
| | - Edileia Bagatin
- Department of Dermatology, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil
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Gold M, Lorenc ZP, Bass LS, Bank D, Downie J, Bellia G, Giori A, Grimolizzi F. Development and Validation of a Composite Skin Quality Scale. Aesthet Surg J Open Forum 2024; 6:ojae038. [PMID: 38912092 PMCID: PMC11192058 DOI: 10.1093/asjof/ojae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices. Objectives To develop and validate a 5-point photonumeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness. Methods The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed through intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs. Results Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side) and an ICC of 0.903 for both sides, indicating an almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853 and ICCs between 0.657 and 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established. Conclusions Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products. Level of Evidence 3
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Affiliation(s)
- Michael Gold
- Corresponding Author: Dr Michael Gold, 2000 Richard Jones Rd #220, Nashville, TN 37215, USA. E-mail:
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Hennessy K, Dayan S, Somenek M, Bay S, Witfill K, Fabi S. Aesthetic Considerations for Treating Lesbian, Gay, and Bisexual Patients: A Review and Our Experience. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:34-39. [PMID: 38779371 PMCID: PMC11107904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Objectvie The population of the United States continues to grow in diversity, particularly within sex and gender. In recent years, there has been a surge in aesthetic procedures in the Lesbian, Gay, Bisexual (LGB) community. Herein, we discuss a tailored approach to these patient populations and offer guidance to address their concerns both safely and effectively based on a comprehensive review of the literature as well as a roundtable series focusing on diversity in aesthetics. Methods A literature search was conducted on PubMed using the following terms: "aesthetics," "cosmetics," "lesbian," "gay," and "bisexual." Additionally, an eight-part roundtable series focusing on diversity in aesthetics was conducted from August 2021 to August 2022. Results The results of the literature search as well as the discussion from the roundtable series addressing the LGB community are reviewed within. Limitations We are limited by the paucity of data available in the existing literature. We also acknowledge differences within LGB subgroups and a need for individualization. Conclusion A tailored approach to the LGB patient with regards to fillers, neuromodulators, and energy-based devices may offer improved patient satisfaction and safety.
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Affiliation(s)
- Kerry Hennessy
- Dr. Hennessy is with University of South Florida Department of Dermatology and Cutaneous Surgery in Tampa, Florida
| | - Steve Dayan
- Dr. Dayan is with the Division of Facial Plastic and Reconstructive Surgery in Department of Otolaryngology at University of Illinois at Chicago in Chicago, Illinois
| | - Michael Somenek
- Dr. Somenek is with Somenek and Pittman MD: Advanced Plastic Surgery in Washington, DC
| | - Shino Bay
- Dr. Bay is with Shino Bay Cosmetic Dermatology and Laser Institute in Fort Lauderdale, Florida
| | - Kristin Witfill
- Dr. Witfill is with HCA Florida Largo at Hospital in Largo, Florida
| | - Sabrina Fabi
- Dr. Fabi is with Cosmetic Laser Dermatology in San Diego, California
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Tobar MDPB, Clemann S, Hagens R, Pagel‐Wolff S, Hoppe S, Behm P, Engelhard F, Langhals M, Gallinat S, Zhavoronkov A, Georgievskaya A, Kiselev K, Tlyachev T, Jaspers S. Skinly: A novel handheld IoT device for validating biophysical skin characteristics. Skin Res Technol 2024; 30:e13613. [PMID: 38419420 PMCID: PMC10902616 DOI: 10.1111/srt.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Recent advancements in artificial intelligence have revolutionized dermatological diagnostics. These technologies, particularly machine learning (ML), including deep learning (DL), have shown accuracy equivalent or even superior to human experts in diagnosing skin conditions like melanoma. With the integration of ML, including DL, the development of at home skin analysis devices has become feasible. To this end, we introduced the Skinly system, a handheld device capable of evaluating various personal skin characteristics noninvasively. MATERIALS AND METHODS Equipped with a moisture sensor and a multi-light-source camera, Skinly can assess age-related skin parameters and specific skin properties. Utilizing state-of-the-art DL, Skinly processed vast amounts of images efficiently. The Skinly system's efficacy was validated both in the lab and at home, comparing its results to established "gold standard" methods. RESULTS Our findings revealed that the Skinly device can accurately measure age-associated parameters, that is, facial age, skin evenness, and wrinkles. Furthermore, Skinly produced data consistent with established devices for parameters like glossiness, skin tone, redness, and porphyrin levels. A separate study was conducted to evaluate the effects of two moisturizing formulations on skin hydration in laboratory studies with standard instrumentation and at home with Skinly. CONCLUSION Thanks to its capability for multi-parameter measurements, the Skinly device, combined with its smartphone application, holds the potential to replace more expensive, time-consuming diagnostic tools. Collectively, the Skinly device opens new avenues in dermatological research, offering a reliable, versatile tool for comprehensive skin analysis.
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Affiliation(s)
| | - Sven Clemann
- Research and DevelopmentBeiersdorf AGHamburgGermany
| | - Ralf Hagens
- Research and DevelopmentBeiersdorf AGHamburgGermany
| | | | - Stefan Hoppe
- Research and DevelopmentBeiersdorf AGHamburgGermany
| | - Peter Behm
- Research and DevelopmentBeiersdorf AGHamburgGermany
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Cattelan L, Dayan S, Aguilera SB, Viscomi B, Fabi SG. A Review of Aesthetic Considerations for Treating the Transgender Patient. Dermatol Surg 2024:00042728-990000000-00673. [PMID: 38349851 DOI: 10.1097/dss.0000000000004112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques. OBJECTIVE The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population. METHODS A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques. RESULTS The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy. CONCLUSION The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.
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Affiliation(s)
- Leila Cattelan
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Steven Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois
| | - Shino Bay Aguilera
- Shino Bay Cosmetic Dermatology & Laser Institute, Fort Lauderdale, Florida
| | - Bianca Viscomi
- Bianca Viscomi Dermatologia Private Practice, São Paulo, Brazil
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Lim TS, Liew S, Tee XJ, Chong I, Lo FJ, Ho MJ, Ong K, Cavallini M. Polynucleotides HPT for Asian Skin Regeneration and Rejuvenation. Clin Cosmet Investig Dermatol 2024; 17:417-431. [PMID: 38371328 PMCID: PMC10874187 DOI: 10.2147/ccid.s437942] [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: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
Introduction Even lightly compromised skin may impact self-esteem and social behaviour. After intradermal infiltration, natural-origin Polynucleotides High Purification Technology (PN HPT) promote new collagen and extracellular matrix production, translating into a physiological correction of the ageing skin. The study aimed to explore the benefits of intradermal PN HPT on the four perceptual skin quality categories "Skin Tone Evenness", "Skin Surface Evenness", "Skin Firmness", and "Skin Glow" in a representative sample of 30 Asian subjects (mean age 40.2± 11.4 years old). Methods Study protocol: three intradermal injections of a PN HPT-based Class III CE-marked medical device at T0 (baseline assessment and first treatment session), T1 (four weeks after baseline), and T2 (eight weeks after baseline), with efficacy and safety evaluations at T1, T2, T3 (four months after baseline) and T4 (six months after baseline). Quantitative and qualitative assessments: 3D skin analysis system QuantifiCare and Global Aesthetic Improvement Scale (GAIS, Investigator and Patient subscales). Results PN HPT treatment led to a meaningful and statistically significant improvement of the skin surface, firmness, pigmentation, and radiance, with no early- or late-onset adverse events and benefits persisting up to the sixth-month visit in all subjects. At T4, 33% and 43% of treated subjects felt "Much Improved" and "Very Much Improved" (optimal result); 56% and 44% of treated subjects felt "Satisfied" or "Very Satisfied". At T4, the mean Investigator GAIS scores were 3.33 out of 5.0 for the "Skin Tone Evenness" skin quality perceptual category, 3.46 for the "Skin Surface Evenness" category, 3.61 for "Skin Firmness", and 3.45 per for the radiance determinant of the "Skin Glow" category. Conclusion Intradermal treatment with the PN HPT-based medical device led to a meaningful improvement of the skin surface, firmness, pigmentation, and radiance with complete safety. The aesthetic benefits persisted up to the sixth-month visit in all subjects.
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Affiliation(s)
| | | | | | - Ian Chong
- Clique Clinic, Petaling Jaya, Selangor, Malaysia
| | - Fui Jun Lo
- Clique Clinic, Petaling Jaya, Selangor, Malaysia
| | - Meng Jun Ho
- Clique Clinic, Petaling Jaya, Selangor, Malaysia
| | - KuokTjun Ong
- Clique Clinic, Petaling Jaya, Selangor, Malaysia
| | - Maurizio Cavallini
- Dermatology and Dermatosurgery Department, CDI Centro Diagnostico Italiano, Milan, Italy
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Draelos ZD, Grimes PE, Watchmaker J, Nelson DB. A Multi-center Trial Evaluating a Serum Comprised of Plant-based Adaptogens Targeting Skin Quality. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:15-19. [PMID: 38444422 PMCID: PMC10911267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Objective The ability of the skin to maintain homeostasis declines with age. Adaptogens support the capacity of the skin to respond to stress. We sought to evaluate the efficacy of a novel serum comprised of plant-based adaptogens for improving photoaged skin following twice-daily application. Methods A multi-center, 12-week trial was conducted in participants aged 45 to 65 years, Fitzpatrick Skin Type (FST) I to VI, with mild-to-severe photoaging based on a 10-point grading scale (3 [Minimum] to 7 [Maximum]). Visible improvements were assessed in erythema, pore size, skin dullness, skin texture, and uneven pigmentation utilizing a six-point grading scale (0=None to 5=Severe). Global skin quality was measured utilizing our Global Skin Quality Index (GSQI). Sebum measurements were obtained in a subset of participants. Patient satisfaction and tolerability were recorded throughout the study. Results Fifty-three participants were enrolled and completed the study. Mean age was 56 years and 66 percent were White, 17 percent were Black, 8 percent were Hispanic, 6 percent were Asian/Pacific Islander, and 81 percent had moderate photodamage. At Week 12, significant mean percent improvements from baseline were demonstrated in erythema (50%), dullness (44%), texture (52%), pore size (23%), and uneven pigmentation (21%; all p<.0001). Significant GSQI improvements from baseline were observed at Week 12 (39%; p<0.0001). Significant mean reductions from baseline in skin surface sebum were demonstrated at Week 12 (-38%; p<0.0001). All adverse events (AEs) were mild and transient. Conclusion A novel serum comprised of plant-based adaptogens, demonstrated improvements from baseline in the appearance of erythema, dullness, texture, pore size, uneven pigmentation, and global skin quality over 12 weeks. Participants reported high levels of satisfaction, with mild, transient AEs reported.
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Affiliation(s)
- Zoe Diana Draelos
- Dr. Draelos is with Dermatology Consulting Services PLLC in High Point, North Carolina
| | - Pearl E. Grimes
- Dr. Grimes is with The Grimes Center of Medical and Aesthetic Dermatology and the Vitiligo and Pigmentation Institute of Southern California in Los Angeles, California
| | | | - Diane B. Nelson
- Ms. Nelson is with Skinbetter Science, a Dermatological Beauty brand of L'Oréal USA, Inc., in Phoenix, Arizona
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Alcotzer I, Liassidou A, Hexsel D, Tsur Shenhav L, Artzi O. Optimal Changes Seen in Patients After Treatment With Poly- l -Lactic Acid: A Retrospective Descriptive Study. Dermatol Surg 2024; 50:69-74. [PMID: 37910604 DOI: 10.1097/dss.0000000000003993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poly- l -lactic acid (PLLA) is a biostimulator that enhances collagen production and leads to volume restoration. It became popular because of its improvement of facial wrinkles and long-lasting effect, although the specific visible changes it causes in the facial area are not fully described. OBJECTIVE To identify and characterize the visible changes resulting from injecting PLLA into the facial area. METHODS A list of 678 patients who underwent 2 to 3 treatments with PLLA injections in this center between 2021 and 2022 were retrieved. After 2 rounds of evaluations, 31 independent international evaluators described the 3 main changes they observed in the before-and-after images (taken approximately 7 months after the last injection session) of the 12 patients with the most significant improvement. RESULTS A total of 1,015 descriptions were received. They were divided into categories based upon similarity. The main detected changes were better contouring and enhancement of the lateral face, a lifting effect and secondary impact on the nasolabial fold, and improvement of skin texture and skin firmness. CONCLUSION Poly- l -lactic acid injections were judged to be effective for contouring, lifting, and improving skin texture in the facial area. Further research is needed to validate these results and create an assessment scale for PLLA injections.
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Affiliation(s)
- Inbar Alcotzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aspasia Liassidou
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Doris Hexsel
- Hexsel Dermatologic Clinic and Research Center, Porto Alegre, RS, Brazil
| | - Leah Tsur Shenhav
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Israel
| | - Ofir Artzi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Goodman GJ, Armour K, Ong D, Tienthavorn T, Wu Y, Chen PC, Tam E, Ong A, Messiha G, Telfer T, Avelar LET. An absence of imperfections: A proposed framework for defining, assessing, and achieving skin glow. J Cosmet Dermatol 2024; 23:161-171. [PMID: 37929650 DOI: 10.1111/jocd.16063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Skin glow is a subcomponent of skin quality. It has become entrenched in the cosmeceuticals and aesthetics lexicons as a synonym for health and youth, but is not well-defined as a scientific metric. AIMS To examine the concept of skin glow and determine if it is an objective concept that can be defined and quantified. METHODS Literature review was used to develop a survey on current concepts relating to skin quality. The survey results were analyzed descriptively and presented to a focus group comprising five dermatologists and four aesthetic physicians. This group then discussed the concept of skin glow, how to define it and what metrics could be used to assess it. RESULTS Surveyed practitioners (n = 38) ranked skin quality as the fourth most important factor related to a person's overall aesthetic first impression. Almost all (95%) respondents reported routinely assessing skin quality, citing serial photography (83%), and visual inspection (67%) as the main means of achieving this. The focus group defined skin glow as even reflectance from an unaffected papillary and reticular dermal collagen layer, which is created only when skin does not exhibit any characteristics that detract from this even reflectance. Due to its complexity, the focus group proposed a hierarchal framework for assessment, encompassing patient self-rating, practitioner severity rating, and supplemental use of validated measurement devices. CONCLUSIONS Skin glow can be defined and quantified. More work is warranted to develop a practical skin glow assessment tool suitable for use in the clinic setting.
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Affiliation(s)
- Greg J Goodman
- Monash University, Clayton, Victoria, Australia
- University College of London, London, UK
| | - Katherine Armour
- Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
| | - David Ong
- Sydney Day Hospital, Sydney, New South Wales, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Tanongkiet Tienthavorn
- Division of Dermatosurgery, Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Yan Wu
- Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
| | | | - Elias Tam
- University College of London, London, UK
- EHA Clinic, Singapore, Singapore
| | - Amanda Ong
- Bioscor International, East Oakleigh, Victoria, Australia
| | - Gina Messiha
- Ocean Village Medical Centre and Ocean Cosmetics, Perth, Western Australia, Australia
| | - Tara Telfer
- Galderma Australia Pty Ltd, North Sydney, New South Wales, Australia
| | - Luiz E T Avelar
- Department of Plastic Surgery, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Park JY, Youn S, Hong W, Lee KC, Kim I. Treatment Protocol on Using Microfocused Ultrasound with Visualization for Skin Quality Improvement: The Korean Experience. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5029. [PMID: 37250837 PMCID: PMC10219723 DOI: 10.1097/gox.0000000000005029] [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: 07/25/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023]
Abstract
Facial skin quality profoundly influences an individual's perceived appearance and is an important aspect of facial rejuvenation. Facial pore enlargement is one of the most common concerns among Asian individuals that adversely impacts perceived skin surface evenness and affects overall skin quality. One of the major causes of enlarged pores is facial skin laxity. Microfocused ultrasound with visualization (MFU-V; Ultherapy; Merz North America, Inc., Raleigh, N.C.) is indicated for lifting and tightening of the face and neck, and improving the appearance of wrinkles on the décolletage. In addition, it is useful for addressing several aspects of facial rejuvenation, including facial pores, skin laxity, skin unevenness, etc., but there is limited literature on these applications. Thus, we present our proposed MFU-V treatment protocol for achieving a harmonious outcome for attractive skin, along with practical strategies for its application, illustrated in patients presenting with enlarged pores as their main concern. Drawing on our collective experience in using MFU-V for facial rejuvenation and the recently published skin quality framework that advocates addressing interrelated attributes of skin quality for optimal outcomes, we developed a treatment protocol for improving skin quality using MFU-V. This MFU-V treatment protocol reliably improves overall skin quality in patients presenting with enlarged pores, through MFU-V's effects on skin lifting and tightening, and consequent improvement in facial pores and skin texture. This treatment protocol can be readily used as part of a multimodal layering approach to yield successful outcomes in patients with various facial skin concerns.
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Affiliation(s)
- Je-Young Park
- From the Apkoo-Jung Oracle Dermatology Clinic, Seoul, Republic of Korea
| | - Seongjae Youn
- Apgujung Leaders Dermatology Clinic, Seoul, Republic of Korea
| | - Wonkyu Hong
- Human Dermatology Clinic, Incheon, Republic of Korea
| | - Kyou Chae Lee
- Hwanggeum Dermatology Clinic, Daegu, Republic of Korea
| | - Inyong Kim
- Prive Plastic Surgery & Dermatology Clinic, Daegu, Republic of Korea
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Belvedere R, Novizio N, Eletto D, Porta A, Di Maio U, Petrella A. The Protecting Activity of RIPACUT ®: A New Therapeutic Approach Preserving Epithelial Health Based on the Combination of Iceland Lichen Extract, Silver Salt, and Sodium Hyaluronate. Life (Basel) 2023; 13:life13051088. [PMID: 37240732 DOI: 10.3390/life13051088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Epithelial integrity and function must be maintained in a dynamic healthy equilibrium, keeping unaltered the oxidative and inflammatory conditions and the microbiome of the cutaneous layers. Beside the skin, other mucous membranes can be injured, such as the nasal and anal ones, because of the contact with the external environment. Here, we detected the effects of RIPACUT®, a combination of Iceland lichen extract, silver salt and sodium hyaluronate that individually act in diverse biological ways. The findings we obtained on keratinocytes, nasal and intestinal epithelial cells reveal that this combination showed a marked antioxidant activity, further assessed by the DPPH assay. Additionally, by analyzing the release of the IL-1β, TNF-α and IL-6 cytokines, we proved the anti-inflammatory effect of RIPACUT®. In both cases, the main preserving action was due to Iceland lichen. We also observed a notable antimicrobial activity mediated by the silver compound. These data suggest that RIPACUT® could signify the basis for an attractive pharmacological approach to maintaining healthy epithelial conditions. Interestingly, this may be extended to the nasal and anal areas where it protects against oxidative, inflammatory and infectious insults. Thus, these outcomes encourage the creation of sprays or creams for which sodium hyaluronate can guarantee a surface film-forming effect.
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Affiliation(s)
- Raffaella Belvedere
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
| | - Nunzia Novizio
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
| | - Daniela Eletto
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
| | - Amalia Porta
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
| | - Umberto Di Maio
- Shedir Pharma Group Spa, Via Bagnulo 95, 80063 Piano di Sorrento, Italy
| | - Antonello Petrella
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
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Rongthong A, Wanitphakdeedecha R, Maiprasert M, Cembrano KAG, Voravutinon N, Rakchart S, Sermswan K, Koonngam P. Efficacy and safety of hyaluronic acid filler on the treatment of horizontal neck lines. J Cosmet Dermatol 2023; 22:433-438. [PMID: 36575878 DOI: 10.1111/jocd.15539] [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: 07/25/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Injection of hyaluronic acid fillers (HA) fillers for horizontal neck line correction and rejuvenation has gained popularity in recent years despite conflicting reports on its efficacy and safety. Most published reports are retrospective studies that commonly use the sharp needle technique. In this prospective study, we therefore aimed to determine the efficacy and safety of an HA filler (Belotero Balance®, Merz Aesthetics) on the treatment of horizontal neck lines by blunt cannula injection technique. MATERIALS AND METHODS Thirty subjects were enrolled and treated with HA filler injections on the neck region using a blunt cannula injection technique into the deep dermis. Standardized photographic documentation was done at baseline, immediately after injection, and at 2-week, 1-, 3-, and 6-month follow-up after treatment. The rejuvenation effect was graded by the patients themselves and two blinded dermatologists using comparative photographs. Side effects were likewise recorded at each follow-up visit. RESULTS All 30 subjects completed treatment and attended every follow-up visit. The study participants comprised both females and males aged 20-69 years with mild, moderate, and severe neck lines based on the Horizontal Neck Wrinkle Severity Scale (HNWS) (Plast Reconstr Surg Glob Open, 2019, 7, 2366). All patients received approximately 3 ml of HA fillers for the entire treatment area. Both patient and physician ratings revealed peak benefits at 1-month post-treatment, with a significant decline at 3 months, which was sustained until 6 months after the procedure. Only one patient developed bruising related to the treatment, which resolved spontaneously without any additional medication. CONCLUSION The study demonstrated efficacy in improving the appearance of horizontal neck lines after one session of HA filler injection. The results showed peak improvement at 1 month, but with sustained rejuvenation effects up to 6 months after injection.
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Affiliation(s)
- Awika Rongthong
- Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok, Thailand
| | | | - Mart Maiprasert
- Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok, Thailand
| | | | | | - Sarawalai Rakchart
- Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok, Thailand.,Innovative Skin and Laser Surgery (iSKY) Center, Bangkok, Thailand
| | - Kanchana Sermswan
- Bangkok Skin and Aesthetic Center, Bangkok Hospital, Bangkok, Thailand
| | - Pongsiri Koonngam
- Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok, Thailand
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Viscomi B. From Anatomical Modifications to Skin Quality: Case Series of Botulinum Toxin and Facial Fillers for Facial Feminization in Transgender Women. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1333-1345. [PMID: 35860607 PMCID: PMC9293247 DOI: 10.2147/ccid.s363882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
A transgender individual is someone who does not identify with his or her biological sex1. During the transgender transition process, minimally invasive procedures (MIP) provide a versatile tool in the clinician’s therapeutic armamentarium, since the changes can be impactful for the patient, yet reversible, especially for the patient who is unsure about proceeding with a definite surgery. We report 5 cases of facial feminization of transgender women, illustrating the use of minimally invasive facial remodeling procedures for male-to-female transitioning patients. ![]()
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Affiliation(s)
- Bianca Viscomi
- Dermatology, Private Practice, São Paulo, São Paulo, Brazil
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15
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Kleine‐Börger L, Hofmann M, Kerscher M. Microinjections with hyaluronic acid in combination with glycerol: How do they influence biophysical viscoelastic skin properties? Skin Res Technol 2022; 28:633-642. [PMID: 35643988 PMCID: PMC9907673 DOI: 10.1111/srt.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin quality improvement with hyaluronic acid microinjections is increasing as a clinical treatment indication and as a scientific issue. This present study assessed changes in biomechanical viscoelastic skin properties after microinjections with the skin quality booster CPM-HA20G (Belotero Revive). MATERIALS AND METHODS Fifteen subjects have been randomized in a 2:1 ratio to receive either three treatments (total 3 ml per side) or a single-dose treatment (total 1.5 ml per side) with CPM-HA20G at dermal level into the lower cheeks via microinjections. Treatments were provided 4 weeks apart. Biophysical measurements were performed describing the viscoelastic skin properties and the underlying skin structure. The measurements were performed before injection (week 0) and on follow-up visits 4, 8, 16, 24, and 36 weeks after the last injection treatment. RESULTS One (p = 0.028) as well as three (p = 0.003) consecutive treatments with CPM-HA20G improved statistically significant skin firmness (R0). For the multiple-treatment group improved significant differences were observed for skin fatigue (R3; p = 0.007) and skin density (p = 0.017) with stable skin thickness levels (p > 0.05), too. There were zero-to-weak correlations between skin thickness and biomechanical skin properties (R0, rs = 0.084; R3, rs = 0.093). CONCLUSION Overall, microinjections with CPM-HA20G improved biomechanical viscoelastic skin properties with a stronger and more pronounced effect in the multiple-treatment group. The observed changes may explain some of the skin quality improvements observed after treatment with CPM-HA20G.
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Affiliation(s)
- Linda Kleine‐Börger
- Cosmetic ScienceInstitute of Biochemistry and Molecular BiologyUniversity of HamburgHamburgGermany
| | | | - Martina Kerscher
- Cosmetic ScienceInstitute of Biochemistry and Molecular BiologyUniversity of HamburgHamburgGermany
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Park JY, Chen JF, Choi H, Ho WWS, Lesthari NNI, Lim JTE, Lim TS, Lowe S, Ong-Amoranto B, Vachiramon V, Wanitphakdeedecha R, Kerscher M. Insights on Skin Quality and Clinical Practice Trends in Asia Pacific and a Practical Guide to Good Skin Quality from the Inside Out. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:10-21. [PMID: 35783570 PMCID: PMC9239129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We sought to examine the current skin quality trends and gaps in clinical practice in the Asia Pacific region and develop a practical guide to improve skin quality. METHODS Medical practitioners from 11 countries in the Asia Pacific region completed an online survey on current trends in skin quality treatment. A panel of 12 leading experts convened for a virtual meeting to develop a practical guide for skin quality improvement. RESULTS A total of 153 practitioners completed the survey. The four most common skin quality issues were uneven skin tone, skin surface unevenness, skin laxity, and sebaceous gland hyperactivity and enlarged pores. Most practitioners reported using a combination of treatment modalities for each skin quality issue. It was also observed that each treatment modality could be used to treat several skin quality issues. A multimodal approach targeting different interrelated issues across the tissue planes was recommended for balanced results. The panel developed a practical guide for the appropriate combinations and sequence of treatments, and created treatment protocols for specific skin quality outcome goals. The guide employed an "inside-out" approach, treating the deeper tissue planes prior to the superficial layers to achieve harmonious results. LIMITATIONS Future studies are needed to support the recommended treatment protocols for skin quality improvement. CONCLUSION These findings provide valuable insights on current skin quality trends and gaps in clinical practice. The practical guide provides a framework for practitioners to customize their treatment plan according to each patient's needs.
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Affiliation(s)
- Je-Young Park
- Dr. Park is with the Apkoo-Jung Oracle Dermatology Clinic in Seoul, South Korea
| | - Jeng-Feng Chen
- Dr. Chen is with Beauté J'adore Dermatology and Esthetic Medicine in Taipei, Taiwan
| | - Hosung Choi
- Dr. Choi is with the Piena Clinic in Seoul, South Korea
| | - Wilson W S Ho
- Dr. Ho is with The Specialists: Lasers, Aesthetic & Plastic Surgery in Hong Kong
| | | | - Joyce Teng Ee Lim
- Dr. Teng Ee Lim is with Joyce Lim Skin and Laser Clinic in Singapore
| | - Ting Song Lim
- Dr. Ting Song Lim is with the Clique Clinic in Kuala Lumpur, Malaysia
| | - Stephen Lowe
- Dr. Lowe is with MUSE Clinic in Sydney, Australia
| | - Beverly Ong-Amoranto
- Dr. Ong-Amoranto is with the Department of Dermatology at Asian Hospital and Medical Center in Metro Manila, Philippines
| | - Vasanop Vachiramon
- Dr. Vachiramon is with the Division of Dermatology, Faculty of Medicine Ramathibodi Hospital at Mahidol University in Bangkok, Thailand
| | - Rungsima Wanitphakdeedecha
- Dr. Wanitphakdeedecha is with the Department of Dermatology, Faculty of Medicine at Siriraj Hospital, Mahidol University in Bangkok, Thailand
| | - Martina Kerscher
- Dr. Kerscher is with the Division of Cosmetic Science and Aesthetics at the University of Hamburg in Hamburg, Germany
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17
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Haykal D. Pilot prospective study evaluating the anti aging efficacy, tolerability, and improvement of skin quality by hyaluronic acid injections for mid and lower face. J Cosmet Dermatol 2022; 21:5259-5260. [PMID: 35218302 DOI: 10.1111/jocd.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
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18
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Facial Skin Revitalization with Cohesive Polydensified Matrix-HA20G: Results from a Randomized Multicenter Clinical Study. Plast Reconstr Surg Glob Open 2022; 9:e3973. [PMID: 35070607 PMCID: PMC8769088 DOI: 10.1097/gox.0000000000003973] [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: 07/09/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
Background: There is a growing interest in the application of hyaluronic acid (HA) derivatives in skin quality improvement. The aim of this study was to confirm safety and effectiveness of cohesive polydensified matrix-hyaluronic acid + glycerol (CPM-HA20G; Belotero Revive) in revitalization of early-onset photodamaged facial skin. Methods: A total of 159 subjects with early signs of facial photodamaged skin were randomized in a 2:1 ratio to multiple- or single-dose treatment with CPMHA20G. Effectiveness assessments included biophysical measurements of skin hydration; elasticity, firmness, and roughness; investigator- and subject-assessed Global Aesthetic Improvement Scales; and FACE-Q Skin Changes and Treatment Satisfaction questionnaires. Results: In both treatment groups, skin hydration improved from baseline to all follow-up visits in subjects with dry or very dry skin. This improvement was significant at week 16 after initial treatment in the multiple-dose group (P = 0.0013). Investigator- and subject-reported outcomes showed that the majority of subjects across all skin hydration types benefited from treatment, with higher satisfaction rates observed in the multiple-dose group. According to investigator-assessed Global Aesthetic Improvement Scale, 90.7% of subjects at week 12 in the multiple-dose and 74.6% of subjects at week 4 in the single-dose group were rated as at least “improved.” All related treatment-emergent adverse events were transient, expected injection-site reactions of mild to moderate intensity. Conclusions: Effectiveness of CPM-HA20G for skin hydration in subjects with dry or very dry skin was demonstrated up to 9 months after last injection. Overall, CPM-HA20G demonstrated effective and safe use in facial skin revitalization among subjects with early-onset photodamaged skin.
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Lim T, Frank K, Hadjab B. Target-Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology. J Cosmet Dermatol 2021; 21:207-219. [PMID: 34255904 DOI: 10.1111/jocd.14342] [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: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian-specific strategies that correct underlying structural deficiencies and cumulative age-related changes. The presented Target-Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians. A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment. With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling. Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption-induced volume loss.
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