A Study on the Alterations in Skin Viscoelasticity before and after an Intradermal Administration of Growth Factor

A Single Intradermal Injection of Autologous Adipose-Tissue-Derived Stem Cells Rejuvenates Aged Skin and Sharpens Double Eyelids

Facial skin aging is the most visible manifestation of aging in the body. In this study, we aimed to rejuvenate aging skin via a one-time intradermal injection of autologous adipose-derived stem cells (ADSCs). Eight patients were enrolled for study. Photographs of patients taken immediately before and 1, 3, 6, and 12 months after ADSC injections were comparatively evaluated for visible skin manifestations. ADSCs were cultured from the abdominal-skin-derived subcutaneous fat tissue, and 1 × 108 cultured ADSCs were injected intradermally into the facial skin. Cultured myoblasts were incubated with the supernatant derived from ADSCs, and the effect was evaluated via glucose consumption and lactic acid production in the medium. Eight cases showed the shallowing and disappearance of wrinkles, including those of the glabella, lower eyelids, crow`s feet, and forehead and nasolabial grooves, a month to several months after treatment. Double eyelids became prominent, and facial pores significantly reduced in size. These effects lasted for over one year. Myoblasts cultured in the presence of an ADSC-derived exosome were activated compared to that of ADSCs cultured without supernatant. The result supports the role of muscle in ADSC skin rejuvenation. The present study first reports that a single intradermal administration of cultured ADSCs rejuvenates aged facial skin over the course of one year. Further, patients exhibited definite double eyelids and pore shrinkage, strongly indicating the active involvement of muscle, which was supported by an in vitro study. Our study also suggested the important role of biological factors delivered from injected stem cells, although the detailed mechanism of rejuvenation effects of ADSC skin injection remains to be clarified.

Granulomatous Reaction to Dermal Injection of Growth Factors from Umbilical Cord Blood-Derived Mesenchymal Stem Cells: A Case Report

Use of stem cells to treat various diseases in dermatology has been of interest. Conditioned media with the growth factors secreted from stem cells has been used as a topical agent. We report a case of foreign body granulomas that appeared days after dermal injection of the conditioned media mimicking scars at all injection sites.

Defining Skin Quality: Clinical Relevance, Terminology, and Assessment

BACKGROUND

Flawless skin is one of the most universally desired features, and demand for improvements in skin quality is growing rapidly. Skin quality has been shown to substantially impact emotional health, quality of life, self-perception, and interactions with others. Although skin quality improvements are a common end point in studies of cosmeceuticals, they are rarely assessed in clinical studies of other aesthetic treatments and products. Descriptive terminology for skin quality parameters also varies considerably within the aesthetic field, relying on a range of redundant and occasionally contradictory descriptors. In short, skin quality has not been clearly defined.

OBJECTIVE

The goal of this review is to highlight the importance of skin quality to patients and physicians, explore known and unknown factors comprising skin quality, and provide clarity regarding terminology, descriptors, and evaluation tools for assessing skin quality.

MATERIALS AND METHODS

A review of the literature on skin quality was performed without limitation on publication date. Relevant articles are presented.

RESULTS AND CONCLUSION

We propose a framework of attributes contributing to skin quality rooted in 3 fundamental categories-visible, mechanical, and topographical-with the aim to provide information to help guide clinicians and inform future clinical studies.

Comparative Study on the Outcome of Periorbital Wrinkles Treated with Laser-Assisted Delivery of Vitamin C or Vitamin C Plus Growth Factors: A Randomized, Double-blind, Clinical Trial

Background

Despite promising results, laser-assisted drug delivery (LADD) is not yet considered as standard therapies and published data rely mainly on laboratory tests, animal experiments or cadaver skin.

Objectives

This double-blind, prospective, randomized clinical trial investigates the impact in topical application of vitamin C and a cosmeceutical containing growth factors (GFs) on periorbital wrinkles primarily treated with laser skin resurfacing.

Material and Methods

In total, 149 female patients with periorbital wrinkles were consented and randomized into two study groups, R-C (receiving vitamin C only) and R-CGF (receiving vitamin C and a cosmeceutical containing growth factors). The statistical analysis evaluated the efficacy of each treatment regimen using software readouts provided by a three-dimensional stereophotogrammetry system prior to treatment and three months after the procedure. Results were compared to confirm if there was a significant change in the skin roughness and the average depth of the wrinkles between the two groups after treatment.

Results

There was a significant reduction in both skin roughness and average depth of the wrinkles in the group treated with vitamin C and growth factors (p <0.01) than those treated with LADD followed by topical application of vitamin C alone. There were no cutaneous reactions or adverse systemic reactions observed in this study related to LADD with vitamin C and GFs.

Conclusion

Controlled laser application might have a great potential to facilitate the absorption of exogenous macromolecules by the skin. Periorbital wrinkles were reduced in both groups, but LADD using vitamin C and GFs provided significantly better results.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Healing and Angiogenic Properties of Collagen/Chitosan Scaffolds Enriched with Hyperstable FGF2-STAB® Protein: In Vitro, Ex Ovo and In Vivo Comprehensive Evaluation

Wound healing is a process regulated by a complex interaction of multiple growth factors including fibroblast growth factor 2 (FGF2). Although FGF2 appears in several tissue engineered studies, its applications are limited due to its low stability both in vitro and in vivo. Here, this shortcoming is overcome by a unique nine-point mutant of the low molecular weight isoform FGF2 retaining full biological activity even after twenty days at 37 °C. Crosslinked freeze-dried 3D porous collagen/chitosan scaffolds enriched with this hyper stable recombinant human protein named FGF2-STAB® were tested for in vitro biocompatibility and cytotoxicity using murine 3T3-A31 fibroblasts, for angiogenic potential using an ex ovo chick chorioallantoic membrane assay and for wound healing in vivo with 3-month old white New Zealand rabbits. Metabolic activity assays indicated the positive effect of FGF2-STAB® already at very low concentrations (0.01 µg/mL). The angiogenic properties examined ex ovo showed enhanced vascularization of the tested scaffolds. Histological evaluation and gene expression analysis by RT-qPCR proved newly formed granulation tissue at the place of a previous skin defect without significant inflammation infiltration in vivo. This work highlights the safety and biocompatibility of newly developed crosslinked collagen/chitosan scaffolds involving FGF2-STAB® protein. Moreover, these sponges could be used as scaffolds for growing cells for dermis replacement, where neovascularization is a crucial parameter for successful skin regeneration.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33–63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

Management patterns for skin aging among Saudi dermatologists: A questionnaire-based study

Background:

Skin aging is a complicated process affected by intrinsic, chronological, and extrinsic, environmental, determinants, and it is affected, to a large extent, by exposure to ultraviolet radiation (UVR). The present study aims to assess the antiaging treatment strategies in a real-world setting in Saudi Arabia.

Materials and Methods:

We conducted an online cross-sectional survey that was conducted from May 2020 to October 2020, involving all eligible dermatologists working at different academic, governmental, and private sectors in Saudi Arabia.

Results:

A total of 200 dermatologists were included in this study, of them, 33% were aged between 24–35 years. 28.5%, 25.5%, 24.5%, and 21.5% of the participants had 7–10, 4–6, >10, and 0–3 years of practice, respectively. Generally, 80 (40%) of the dermatologists reported that 10–20% of their patients consulting for antiaging, while 50 (25%) reported that 41–60% of their patients consulted for antiaging treatment. Cream products were preferred by 105 (52.5%) of the users. In general, 158 (79%) prescribe growth factors Post-procedures, while 29 (14.5), 24 (12%), and 22 (11%) prescribe them for under-eye dark circles, acne scars, and aging skin, respectively. 124 (62%) prefer to use it in combination with retinoids.

Conclusion:

The results of this survey indicate the fact that female patients and the age group 31-40 years old are more likely to seek skincare and antiaging therapy. Most dermatologists prescribed growth factors together with retinoids and only a small proportion of them used growth factors are antiaging modalities.

The Effects of Facial Lipografting on Skin Quality: A Systematic Review

BACKGROUND

Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue-derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this "skin rejuvenation" effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality.

METHODS

The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications.

RESULTS

Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue-derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported.

CONCLUSION

Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue-derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.

Management of aging skin: A questionnaire-based study among Indian dermatologists

INTRODUCTION

With increased life expectancy, the desire to look younger has increased. Hence, many patients approach dermatologists for antiaging treatment. However, data regarding management of skin aging in India are scarce.

AIMS

To understand management patterns for skin aging among dermatologists in India.

METHODS

Overall, 147 Indian dermatologists were administered a questionnaire-based survey about patient characteristics, signs of skin aging, treatment options, and cost.

RESULTS

Among all the patients coming for dermatologists' consultation, 10%-40% were for antiaging treatment. About 70% dermatologists opined that majority of patients aged 30-40 years consulted for antiaging treatment, and the male to female ratio was 3:7. Approximately 46% of dermatologists felt that antiaging treatment should be initiated by the age of 30. Common signs of aging were wrinkles, pigmentation, dull skin or complexion, and dry skin. Based on patient's age and sex, dermatologists prescribed a combination of 2-4 products, which included antioxidants, retinoids, growth factors, and moisturizers. Improvement was assessed by photographic and clinical evaluation, and by patients' satisfaction (55%). Effect of the antiaging products was evident within 4-6 months. Earliest improvement was noted in dry skin and dull complexion. Average extent of improvement noted by 6 months was approximately 20%-30%. The average monthly expenditure on antiaging treatments was 2000-4000 INR.

CONCLUSION

Both men and women seek clinical treatment for skin aging in India. Dermatologists prescribe a combination of 2-4 products, including antioxidants, retinoids, growth factors, and moisturizers. Available antiaging therapies show an average improvement of up to 30% by 6 months.

Fibroblast Growth Factors: A Controlling Mechanism of Skin Aging

Cutaneous aging is a complex and continuous biological process characterized by cellular and molecular alterations, with progressive reduction of the body's capacity to maintain the homeostasis, senescence, and/or apoptosis of the dermal cells. Fibroblast growth factors (FGF) have elicited studies to evaluate their role of repair and remodeling of the dermis during the skin anti-aging process, since they are regulatory proteins that mediate important signaling pathways and act on cell regeneration and repair processes. FGF acts primarily through binding to tyrosine kinase receptors through the autophosphorylation of their residues, promoting the phosphorylation of serine, threonine, and tyrosine residues of specific target proteins such as Raf-1, MAPK/Erk kinase, and extracellular signal-regulated kinase-1, which are part of the cascade of MAP kinases (mitogen-activated protein kinase). Then, FGF initiate signaling cascades inside the cell, where each kinase activates the following by phosphorylation, resulting in alterations of cellular functions. In addition, the FGF has a relevant role in anti-aging therapy because it is related to collagen and elastin synthesis activation responsible for skin resistance and elasticity, characteristics that are diminished with skin aging. Thus, the present article aims to review several scientific studies that demonstrated the cell signaling involved with the action of FGF on skin aging.

Nonablative fractional laser treatment for the skin in the eye area - clinical and cutometric analysis

OBJECTIVE

The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area using a 1410-nm nonablative fractional laser treatment, cutometric measurements and photographic documentation.

MATERIAL AND METHODS

This study included 24 patients (21 women, three men), aged 33-50 years (the average age was 44.6) with Fitzpatrick skin type II and III. They received five successive treatment sessions with a 1410-nm nonablative fractional laser in 2-week intervals. Biomechanical properties of the skin were measured by using Cutometer (Courage+Khazaka electronic). Measurements of skin elasticity were made in three places of the eye area. A photographic documentation was used to compare changes after the series of treatment sessions. Additionally, the patients filled in a survey in which they were asked to make a self-evaluation of the administered procedure.

RESULTS

Cutometric analysis showed a significant improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The analysis of clinical results of the therapy, using photographic documentation, showed a 47% decrease in the quantity and depth of wrinkles in the eye area.

CONCLUSIONS

A 1410-nm nonablative fractional laser treatment seems to be an effective method aiming at reducing wrinkles in the eye area and improving tightness. Cutometric measurements provide invaluable help in the objective evaluation of the anti-aging treatment and the photographic documentation is an excellent addition to the clinical analysis.

The Skin Acts to Maintain Muscle Shear Modulus

It is not clear how the tissues covering the skeletal muscles affect the muscles' mechanical properties. The main purpose of this study was to examine changes in muscle shear modulus as a representative mechanical property of muscle with and without the covering tissues of skin and epimysium (fascia). Shear modulus of the medial gastrocnemius (MG) muscle was determined using ultrasound shear-wave elastography in the Thiel's embalmed cadavers under three different conditions: original (intact cadavers), removal of the skin on the MG and subsequent removal of the epimysium. Muscle shear modulus significantly decreased by 50% after removal of the skin, whereas no additional changes in shear modulus were observed after subsequent removal of the epimysium. This study suggests that the skin is a main contributor for maintaining the muscle mechanical properties among tissues covering the skeletal muscle.

The effects of platelet-rich plasma on recovery time and aesthetic outcome in facial rejuvenation: preliminary retrospective observations

BACKGROUND

This study focused on the possible effect of platelet-rich plasma (PRP) on recovery time and aesthetic outcome after facial rejuvenation. We conducted a retrospective analysis with regard to recovery time and the aesthetic improvement after treatment among four groups of patients: those treated with fat grafting only (Group I), those treated with fat grafting and PRP (Group II), those treated with a minimal access cranial suspension (MACS)-lift and fat grafting (Group III), and those treated with a MACS-lift, fat grafting, and PRP (Group IV).

METHODS

For the first part of this study, i.e., evaluation of recovery time after surgery, the following selection criteria were used: nonsmoking females, aged 35-65 years, with a complete documented follow-up. In total, 82 patients were included in the evaluation of patient-reported recovery time. For the second part of the study, i.e., evaluation of potential differences in aesthetic outcome, the records of these 82 patients were screened for the presence of pre- and postoperative standardized photographs in three views (AP, lateral, and oblique), leaving 37 patients to evaluate. A questionnaire was developed to evaluate the aesthetic outcome in all four groups of patients. This questionnaire was given to an expert panel that consisted of ten plastic surgeons.

RESULTS

The addition of PRP to a lipofilling procedure resulted in a significant drop in the number of days needed to recover before returning to work or to restart social activities [Group I (no PRP) took 18.9 days vs Group II (PRP) took 13.2 days, p = 0.019]. There seemed to be no effect when PRP was added to a MACS-lift + lipofilling procedure. Also, the aesthetic outcome of the lipofilling and MACS-lift + lipofilling groups that received PRP (Groups II and IV) was significantly better than the groups without PRP (Groups I and III).

CONCLUSIONS

Adding PRP to facial lipofilling reduces recovery time and improves the overall aesthetic outcome of a MACS-lift.

LEVEL OF EVIDENCE V

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 .

The effect of probe to skin contact force on Cutometer MPA 580 measurements

The purpose of this study is to test the hypothesis that increasing the force applied on the skin by the Cutometer MP580 probe will result in a decrease in the skin elasticity measures. Specifically, this study assessed the probe intrinsic weight plus the addition of a light mass (10 g and 20 g), a moderate mass (50 g and 100 g) and a high mass (200 g and 500 g) on skin elasticity measures. Primary outcome measures Uv, Ur, Uf, Ue and Ua, along with calculated measures Uv/Uf, Ua/Uf and Ur/Uf were assessed under each loading condition. A general linear model ANOVA with repeated measures was used to assess for differences in each outcome measure between each loading condition. Thirty-two patients were enrolled and all completed the testing. For all primary variables except Uv (p < 0.001), there was no statistically significant effect of adding a light mass to the probe. There was a significant effect of the addition of a moderate and heavy mass for all variables (p < 0.005) except Ue/Uf. These results suggest that the addition of a low mass results in no significant effect on outcome measures. However, if moderate-to-heavy additional force is applied to the probe, the outcome measures are significantly altered. Of all the variables, Ue/Uf appears to be influenced the least by alterations in force. Users should ensure light contact is made between the skin and probe during testing to avoid a false alteration in outcome measures of skin elasticity.