A Practical Algorithm Integrating Skin Care With Nonenergy and Injectable Dermatologic Procedures to Improve Patient Outcomes and Satisfaction

BACKGROUND

The most rapidly increasing medical aesthetic procedures for facial antiaging comprise nonenergy and injectable treatments. Currently, standards for skin care before, during, and after nonenergy and injectable treatments are lacking. The algorithm on supportive skin care for facial antiaging nonenergy and injectable treatments aims to stimulate healing, reduce downtime, and improve comfort and treatment outcomes.  Methods: A panel of 7 global physicians employed a modified Delphi method and reached a consensus on an algorithm for supportive skin care for nonenergy and injectable antiaging treatments based on the best available evidence and the panel members’ clinical experiences and opinions.

RESULTS

The algorithm has a pretreatment (starts 2 – 4 weeks before the procedure) and treatment or ongoing (day of treatment) section, followed by care after the procedure (0 – 7 days) and follow-up care (1 – 4 weeks after the procedure). Applying a broad-spectrum sunscreen with an SPF 30 or higher, combined with protective measures, such as wearing a wide-brimmed hat and sunglasses, is recommended to protect the face from sun exposure. Dyschromia is a significant concern for those with richly pigmented skin. Clinicians may recommend skin care using a gentle cleanser and moisturizer containing vitamins C and E, retinoid, or other ingredients, such as niacinamide, kojic acid, licorice root extract, azelaic acid, and tranexamic acid, depending on the patient's facial skin condition.

CONCLUSION

Nonenergy and injectable procedures combined with skin care or topical treatments may improve outcomes and patient satisfaction. Topical antioxidants and free radical quenchers can combat photodamage and may offer a safe alternative to topical hydroquinone.    J Drugs Dermatol. 2024;23(4):     doi:10.36849/JDD.7918.

Update: Cellulite Therapies and Optimizing Treatment Combinations

Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens.

LEVEL OF EVIDENCE: 5

Treatment of acne in the aesthetic patient: A round table update

BACKGROUND

The popularity of social media appears to be increasing the acceptance of cosmetic treatments, prompting more consumers to seek cosmetic treatments. As the estimated prevalence of acne vulgaris among adult women may be as high as 54%, acne is commonly observed among patients presenting for cosmetic treatments. Concomitant treatment of acne in the aesthetic patient population will improve overall clinical outcomes.

AIMS

The goal of this work was to deliver a high-quality ethical and evidence-based educational program to physicians and adjunctive health care providers to advance patient care.

METHODS

This paper is based on a webcam presentation with roundtable discussion by several notable experts in their field.

RESULTS

A range of topical medications, injectable products, chemical peels, and energy-based devices are available for treating acne vulgaris. In most instances, these are compatible with rejuvenation procedures in the aesthetic patient.

CONCLUSION

The growth of social media is raising awareness of aesthetic procedures and appears to be increasing the number of patients seeking aesthetic treatment. Educating patients about the importance of treating acne vulgaris can improve overall treatment outcomes. In most instances, the presence of acne is not a barrier to aesthetic care.

Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars: A Roundtable on Integrating Intradermal Botulinum Toxin Type A Microdoses Into Clinical Practice

BACKGROUND

In aesthetic clinical practice, botulinum toxin type A (BoNT-A) is best known for its use as a neuromodulator for the treatment of dynamic facial lines; however, when injected intradermally as microdroplets, BoNT-A can improve skin quality and overall skin appearance.

OBJECTIVES

To discuss key aspects of microtoxin use in clinical practice and provide expert guidance on utilization.

METHODS

As part of a continuing medical education lecture series and roundtable, the authors discussed key aspects of microtoxin patient selection, injection technique, and safety.

RESULTS

The experiences of expert faculty are shared here. Clinical experience is consistent with reported data. Microtoxin can be used to reduce pore size, sebum production, rosacea, acne, and fine lines, and to improve jawline and neck definition. Intradermal injection can also be employed for the improvement of transverse neck lines as well as for the safe prevention and management of scars and keloids.

CONCLUSIONS

Expanding the use of BoNT-A, a predictable, minimally invasive, and affordable treatment to address commonly encountered complaints is appealing. The authors have found that making patients aware of microtoxin as a treatment option results in an increased interest in and utilization of BoNT-A, and high satisfaction among appropriately selected patients.

Aesthetic considerations for treating the Asian patient: Thriving in diversity international roundtable series

BACKGROUND

The unique anatomy of the Asian face, along with the influence of cultural forces and regional preferences, has led to the development of specialized approaches to rejuvenation and beautification that are applicable to the aesthetic practice within Asia as well as those who serve these patients internationally.

AIMS

To discuss similarities and differences in anatomy and treatment preferences of Asian patients and explore how these differences may influence aesthetic practices.

PATIENTS/METHODS

In support of clinicians who wish to serve a diverse patient population, a six-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022.

RESULTS

The results of the sixth and final roundtable in the series, the Asian Patient, are described here. Anatomical differences and their influence on treatment preferences are discussed, and specific procedural information provided for management of facial shape and projection, including advanced injection techniques for the eyelid-forehead complex.

CONCLUSIONS

The continued exchange of ideas and treatment techniques support not only optimal aesthetic outcomes for a diverse range of patients within a given practice, but also the evolution of aesthetic medicine. The expert approaches detailed here may be used to inform treatment plans tailored to the Asian population.

Aesthetic considerations for treating the Middle Eastern patient: Thriving in Diversity international roundtable series

BACKGROUND

The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment.

AIMS

The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices.

PATIENTS/METHODS

In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022.

RESULTS

The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for  commonly treated areas in this population (forehead, infraorbital area, and jawline).

CONCLUSIONS

Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice.

Aesthetic considerations when treating the Latin American patient: Thriving in diversity international roundtable series

BACKGROUND

The Hispanic/Latin American population is the fastest growing non-Caucasian group in the United States. Within this group, demand for aesthetic procedures is on the rise. High ethnic variability among these patients influences treatment approaches and patient priorities. Understanding these ethnic differences is central to providing optimal care.

AIMS

To discuss similarities and differences in anatomy and treatment preferences of Hispanic/Latin American patients both within the United States and internationally and explore how these differences may influence or inform aesthetic practices.

PATIENTS/METHODS

In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. In this roundtable, held in Medellin, Columbia, expert clinicians from across Latin America and the United States were invited to contribute and share best practices.

RESULTS

The results of the second roundtable in the series, the Latin American Patient, are described here. A special emphasis is placed on procedures that address the most commonly encountered concerns in these patients.

CONCLUSIONS

Hispanic and Latino patients represent a broad demographic with unique anatomical features, aesthetic preferences, and treatment priorities. Clinicians should consider these differences when treating this patient population.

Aesthetic considerations for treating the North American multi-ethnic patient: Thriving in diversity international roundtable series

BACKGROUND

The United States is becoming increasingly diverse, and between 2016 and 2019, an increase of 945 832 aesthetic procedures was recorded for Hispanic, African American, and Asian American patients combined. In aesthetics, where outcomes are technique dependent and tied to the clinician's ability to tailor treatment to the needs of individual patients, a knowledge of ethnic differences in anatomy and how aesthetic issues can be safely and effectively addressed in different groups is paramount.

AIMS

To discuss similarities and difference in anatomy and treatment preferences of patients from a variety of ethnic and racial backgrounds and how these differences may influence the products or techniques utilized to achieve natural-looking results and minimize side effects.

PATIENTS/METHODS

In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022.

RESULTS

The results of the first roundtable in the series, the North American Multiethnic Patient, are described here.

CONCLUSIONS

A diverse range of patients can benefit from the tailored use of fillers, fat transfer, neuromodulators, lasers, and energy-based devices, as long as differences in structural support, skin, and aging patterns, are appreciated.

High-Dose Neuromodulators: A Roundtable on Making Sense of the Data in Real-World Clinical Practice

BACKGROUND

For aesthetic treatment with botulinum neurotoxin type A (BoNTA), interest in maximizing treatment duration and efficacy has prompted study of doses higher than those used in registration studies. As data emerge, it is important that physicians understand how to apply study findings to their own practice so that patient demand is satisfied.

OBJECTIVES

To bring together leading experts in neuromodulators for a roundtable discussion on the implications of high-dose BoNTA studies for patient care.

METHODS

The authors reviewed and discussed recent data from high-dose BoNTA studies for abobotulinum toxin A, incobotulinum toxin A, and Oonobotulinumtoxin A.

RESULTS

Discussion focused on the challenges of data interpretation and extrapolation of study findings for real-world patient care. The authors participated in a candid discussion of whether the observed improvements in treatment duration and patient satisfaction warrant treatment with high-dose regimens delivered as high-concentration injections. Safety was also discussed, as well as economic considerations for both practices and patients. Of note, for BoNTA products, the registration dose, when administered in a smaller total volume, appears to give rise to more durable results than those observed in pivotal trials, implicating product concentration as an important consideration. Importantly, at higher doses, extended duration of effect does not appear to be at the expense of natural-looking results.

CONCLUSIONS

While the authors provide considerations for the development of individual clinical practice, there is no one-size-fits-all recommendation. It may be that "high-dose" BoNTA is in reality the optimal dose; however, important economic considerations may prevent rapid uptake for all patients.

Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications

Background

As the treatment indications for the Cohesive Polydensified Matrix^® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.

Methods

An international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.

Results

Consensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.

Conclusion

The recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.

Aesthetic Delusions: An Investigation into the Role of Rapid Visual Adaptation in Aesthetic Practice

Background

To date, the process of adaptation in the setting of aesthetic medicine has not been investigated. The combination of complex advanced feedback in the current intense social media milieu, in conjunction with easily accessible and effective aesthetic treatments, has produced pockets of overtreated patients and over-zealous practitioners. We examine whether aesthetic assessments of attractiveness and what appears natural can be distorted by the cognitive process of adaptation.

Methods

Forty-eight female participants were exposed to photographs of female faces in whom lip fullness had been strongly under- or over-exaggerated, while remaining within the bounds of natural appearing lips. Before and after evaluation of the exaggerated images, participants were asked to rate an alternative set of faces in terms of attractiveness (reflecting direct assessment of effective beauty impression) and naturalness (reflecting indirect assessment of beauty norms). The evaluation set consisted of six base faces that had been digitally altered to create a systematically varying 11 step set of lip sizes from extremely thin, to the original version, to very full.

Results

Second-order polynomial fits indicated clear shifts of the subjects’ facial aesthetic assessments towards the specific lip fullness of the adaptors. In contrast, such adaptions were not found for ratings of face naturalness. In contrast to research demonstrating mathematical foundations and unchanging rules governing perceptions of beauty, we show that simple viewing of exaggerated feature morphologies can rapidly result in recalibration of a person’s assessment of attractiveness.

Conclusion

This paper provides evidence that facial attractiveness is fluid, and that there are psychological mechanisms that cause an aesthetic bias. Over-exposure to exaggerated features can lead to significant changes to a person’s ideas of attractiveness.

Skin Quality - A Holistic 360° View: Consensus Results

Introduction

Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened.

Methods

A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement.

Results

There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy.

Conclusion

This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.

The perception bias of aesthetic providers

Since there is no universal standard of beauty, each aesthetic provider's definition may shape his/her practice of aesthetic procedures. Beauty and attractiveness are commonly defined by both mathematical and cultural influences and are shaped by our surroundings and what is most familiar to us. Therefore, we thoroughly explored the literature to better elucidate these variables and biases that affect the perception of beauty, in order to better provide appropriate and customized aesthetic procedures that preserve each individuals' own unique beauty. Understanding how each provider's own bias and aesthetic preferences differs from that of his/her patients may go a long way to improving communication in the consultation process and patient satisfaction with the outcomes achieved. We know that clinicians many times superimpose their biases onto their patients, so it is important that each practitioner accounts for bias in aesthetic medicine when consulting with patients and colleagues.

Efficacy and safety of ATX-101 as a treatment for submental fullness: A retrospective analysis of two aesthetic practices

BACKGROUND

Submental fullness (SMF) is a common cosmetic concern that can have negative impact on one's self-esteem. ATX-101 has shown promise as a minimally invasive treatment for SMF correction in clinical trials.

AIMS

To assess the safety and efficacy of ATX-101 for SMF correction.

PATIENTS/METHODS

This was a retrospective review of 90 patients from two aesthetic practices who received ATX-101 injections for SMF (January 2016-August 2017). There were no exclusion criteria. Initial SMF severity was assigned using standardized photographs and a validated 5-point scale. Eighty one patients subsequently answered questionnaires regarding improvement, satisfaction, and adverse effects. Degree of SMF correction was also evaluated by the investigator and a blinded reviewer.

RESULTS

Eighty one patients (mean initial submental fullness severity 1.6) received a mean of 1.84 ATX-101 treatment sessions using a median of 2.0 vials per treatment (mean 3.02, range 1-9). Mean Physician Global Aesthetic Improvement Scale scores were 2.73 and 2.25, after the first and second treatments, respectively (P = .04). Mean Subject Goal Aesthetic Improvement Scale scores were 2.7 and 2.25 after the first and second treatments, respectively (P = .01). Sixty-seven percentage of patients were "somewhat" or "very" satisfied. Adverse events were transient and limited to the treatment area.

CONCLUSION

Patients achieved progressive improvement in SMF after the 1st and 2nd treatments, as judged by patients themselves, investigators, and blinded evaluators. These results of SMF correction suggest that significant benefit can be obtained with proper dosing at the initial visit. These data support the efficacy and safety profile of ATX-101 use for SMF correction.

Communication Concepts for Prevention and Early Intervention in Aesthetic Medicine: Consensus and Literature Review

BACKGROUND

Communication concepts relating to prevention and early intervention (P&E) within aesthetic medicine are poorly understood and highly underexplored. However, effective communication is a key criterion for successful outcomes.

OBJECTIVES

To introduce the framework for P&E communication strategies within a younger population and explore the barriers that may be encountered.

METHODS

A literature review on P&E communication strategies in aesthetic medicine and related topics of interest was conducted and used to construct a working framework that may be applied in clinical practice.

RESULTS

Examination of existing literature revealed a need for a more structured communication framework for P&E encompassing up-to-date evidence-based learning and educational marketing that is tailored to individual needs and target populations. Message framing-the way in which a message is presented-is an important consideration in the dissemination of information to promote changes in health behaviour. A structured consultation is key to optimising patient engagement and ensures a tailored approach to understanding and catering to the specific needs of each patient.

CONCLUSION

This is the first paper to discuss the communication concepts behind P&E within aesthetic medicine and paves the way for further research and focus in this significant field. <p><em>J Drugs Dermatol. 2017;16(9):859-864.</em></p>.

First Consensus on Primary Prevention and Early Intervention in Aesthetic Medicine

BACKGROUND

Facial aging is a complex interplay of extrinsic and intrinsic factors leading to progressive changes in the skin, subcutaneous tissue, and bone. Clinical experience suggests that early aesthetic intervention may slow the signs of aging, but treatment in the absence of symptoms or with minimal signs of aging has not yet been properly addressed.

OBJECTIVES

To provide treatment recommendations for primary prevention and early intervention in individuals with no or minimal signs of aging.

METHODS

Fourteen specialists in aesthetic medicine convened over a full-day meeting under the guidance of a certified moderator.

RESULTS

Tailored treatment recommendations have been provided for prevention and early intervention of fine wrinkles, static lines and folds, irregular pigmentation, laxity, and subcutaneous volume loss by protecting the epidermis, stimulating neocollagenesis, reducing hyperkinetic musculature, and reinforcing supporting structures.

CONCLUSION

Preventive measures and early therapeutic interventions that may alter the course of facial aging were defined. Further studies are needed to support these recommendations with the best possible evidence. <p><em>J Drugs Dermatol. 2017;16(9):846-854.</em></p>.

PAN-ASIAN CONSENSUS-Key Recommendations for Adapting the World Congress of Dermatology Consensus on Combination Treatment with Injectable Fillers, Toxins, and Ultrasound Devices in Asian Patients

BACKGROUND. The demand for minimally invasive aesthetic procedures has driven requests by physicians for guidance on their use in Asian patients, who have unique cultural preferences, social trends, and anatomy. However, few guidelines exist, particularly on combination treatment strategies for different facial shapes or indications such as the modification of face shapes to the "oval ideal."Physicians must, therefore, apply Caucasian patient-optimized guidelines to their Asian patients. METHODS. Eleven specialists developed a consensus on the use of botulinum toxin A (BoNT-A), calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, and microfocused ultrasound with visualization (MFU-V) devices in Asian patients on upper-, middle-, and lower-face indications, including strategies to modify different facial shapes to the oval shape. Approval from 70 to 90 percent of all participants led to moderate consensus, while 90 percent agreement denoted a strong consensus. RESULTS. For early intervention/enhancement and restoration, most combination strategies are similar between Asian and Caucasian patients. Compared to Caucasian patients, however, beautification is a more common focus in Asian patients. The "ideal" oval facial shape can be created using different interventions depending on the patient's baseline characteristics. CONCLUSIONS. Although treatments and treatment sequences for early intervention/enhancement and restoration for beautification in Asian patients are similar to those in Caucasian patients, different treatment strategies may be required.

Treating the Young Aesthetic Patient: Evidence-Based Recommendations

<p>BACKGROUND: There is growing demand for cosmetic treatments in the younger population, yet counseling and treating this age group can be difficult to justify.</p> <p>OBJECTIVE: Chronologic changes that cause noticeable signs of aging are discussed within each age group. Age-appropriate cosmetic preventions and interventions are therefore recommended.</p> <p>METHODS: A PubMed search was performed for high quality trials and evidence based reviews on the basic science of aging, as well as on cosmetic modalities and their histological, biochemical, and clinical effects.</p> <p>RESULTS AND CONCLUSIONS: Specific age-related changes occur with each decade of life. A complete understanding of when these physiologic changes occur helps determine age-appropriate cosmetic counseling, preventions, and interventions.</p> <p><em>J Drugs Dermatol. 2017;16(6 Suppl):s81-83.</em></p>.

Combination therapy in skin of color including injectables, laser, and light devices

With the rapid increase in patients seeking cosmetic treatments, the variation in responses of lightly pigmented skin versus darkly pigmented skin has become increasingly apparent. Despite extensive treatment options in patients with skin of color, there is a paucity of well-designed studies performed on this patient population. The lack of research is concerning, as it is well documented that patients with darker skin types are at an increased risk of adverse events when treated with many of the available modalities used in cosmetic procedures. Fortunately, by combining a variety of treatments, these risks may be abrogated, and combination treatments may be a promising regimen for a wide variety of cosmetic complaints. An overview and evaluation of the research of combination therapy in skin of color is presented.

Clinical Efficacy and Safety of a Monopolar Radiofrequency Device With Comfort Pulse Technology for the Treatment of Facial and Neck Laxity in Men

The objective of this study was to demonstrate the efficacy and safety of a monopolar radiofrequency treatment for facial and neck laxity in men. Twelve men received one treatment of the face and upper portion of the neck using an RF system with comfort pulsed technology. Standardized photographs were taken at baseline and at 1, 3, and 6 months of follow-up. Study investigators evaluated facial and neck laxity at baseline and all follow-up visits using the Fasil Laxity Scale. Patents and investigators assessed skin texture and overall appearance using the Quartile Improvement Scale. Average improvement in treated areas was statistically significant at 1-month (P<.01), 3-month (P=.02), and 6-month (P=.05) follow-up visits compared with baseline. Investigators rated greatest improvement in skin texture and overall appearance (mild to moderate) at the 3-month follow-up. Patient assessments demonstrated moderate improvement in skin laxity, skin texture, and overall appearance maintained out to 6 months after treatment. A total of 64% of patients were satisfied to very satisfied with treatment at the 6-month follow-up. One RF treatment of the face and neck yielded 20% reduction in facial laxity 1 month after treatment, with maintained improvement out to 6 months (15% reduction).

Noninvasive skin tightening: focus on new ultrasound techniques

Microfocused ultrasound (MFU) has been recently developed to meet the ever-growing public demand for achieving significant, noninvasive skin lifting and tightening. MFU can be focused on subcutaneous tissue where the temperature briefly reaches greater than 60°C, producing small (<1 mm³) thermal coagulation points to a depth of up to 5 mm within the mid-to-deep reticular layer of the dermis and subdermis. The intervening papillary dermal and epidermal layers of skin remain unaffected. The application of heat at these discrete thermal coagulation points causes collagen fibers in the facial planes such as the superficial musculoaponeurotic system and platysma, as well as the deep reticular dermis, to become denatured, contracting and stimulating de novo collagen. A commercially available device combines MFU with high-resolution ultrasound imaging (MFU-V), which enables visualization of tissue planes to a depth of 8 mm and allows the user to see where the MFU energy will be applied (Ultherapy^®; Ulthera Inc., Mesa, AZ, USA). Using different transducers, MFU-V treatment can be customized to meet the unique physical characteristics of each patient by adjusting energy and focal depth of the emitted ultrasound. By targeting the facial superficial musculoaponeurotic system, noninvasive tightening and lifting of sagging facial and neck skin and improvements in the appearance of wrinkles can be achieved. MFU-V can also improve lines and wrinkles of the décolleté. Treatment protocols for the use of MFU-V continue to be refined, and its use in combination with other rejuvenation techniques has been demonstrated. Brief discomfort that often occurs during treatment can be minimized with oral nonsteroidal anti-inflammatory drugs. Other treatment-related adverse events include transient erythema, edema, and occasional bruising. MFU-V is best suited for patients with mild-to-moderate skin and soft tissue laxity. For older patients with severe skin laxity and marked platysmal banding, surgical treatment should be considered.

The Effects of Filtrate of the Secretion of the Cryptomphalus Aspersa on Photoaged Skin

BACKGROUND

Growth factors (GFs) are chemical messengers that regulate specific cellular activities such as cell proliferation and formation of the extracellular matrix. GFs may be derived from a variety of sources, including animals.

OBJECTIVE

Evaluate the safety and efficacy of a topical antiphotoaging product containing secretions of the snail Cryptomphalus aspersa (SCA) for the improvement of facial rhytides.

MATERIALS AND METHODS

This was a 2-center, double-blind, randomized, 14-week study in which 25 patients with moderate to severe facial photodamage were treated with an emulsion (with 8% SCA) and liquid serum (with 40% SCA) on one side of the face and placebo on the contralateral side for 12 weeks. Silicone skin impressions of periocular rhytides were performed at baseline and after 12 weeks of treatment. Patient and physician assessments were also performed at 8, 12, and 14 weeks.

RESULTS

Periocular rhytides on the active ingredient side showed significant improvement after 12 weeks (P=.03) and improved texture to a greater degree than placebo at 8 and 12 weeks, as well as 2 weeks after discontinuing the product (14 weeks).

CONCLUSION

Daily application of topical products containing SCA proved effective and well tolerated for improvement in coarse periocular rhytides and fine facial rhytides. Subjects noted a significant degree of improvement in fines lines at the 8-week time point on the SCA-treated side (P≤.05) but did not report a significant difference in the quality of their skin.

Frequency of thromboembolic events associated with thalidomide in the non-cancer setting: a case report and review of the literature

Thalidomide is increasingly being used due to its effectiveness in the treatment of a variety of dermatologic conditions refractory to other treatments. Although thalidomide's side effects have been well-documented in the literature since its entry in the 1950s, some of the risks associated with its use are still being discovered. Recently, increased incidence of venous thrombosis following thalidomide use has been reported in the treatment of diseases with disease-related thrombotic risks, such as malignancy and lupus with antiphospholipid antibody syndrome, as well as concomitant therapy with chemotherapy and/or systemic corticosteroids. We report a case of deep venous thrombosis (DVT) and pulmonary embolus (PE) following thalidomide use in a patient with leprosy (erythema nodosum leprosum, ENL) who was concurrently treated with prednisone, as well as a review of relevant literature. Our findings substantiate an increase in risk for thrombosis following thalidomide use in the dermatology and non-cancer clinical setting.