Treatment of abdominal striae distensae in Fitzpatrick skin types IV to V using a 1064-nm picosecond laser with a fractionated microlens array.

BACKGROUND: Striae distensae are atrophic dermal scars that can cause psychosocial distress among affected patients. Despite numerous available therapeutic modalities, no gold standard treatment has been established. OBJECTIVE: To evaluate the long-term efficacy and safety of a fractional 1064-nm picosecond laser for the treatment of striae alba in individuals with dark skin types. MATERIALS AND METHODS: Twenty volunteers with Fitzpatrick skin types IV-V who presented with striae alba were enrolled. Subjects were treated with a fractional 1064-nm picosecond laser for four sessions at 4-week intervals. The skin texture, average melanin index (MI), and melanin variation score were assessed using Antera 3D® before treatment, at 1 month after the second treatment, and at 1, 3, and 6 months after the last treatment. Two independent investigators evaluated clinical improvement by comparing pretreatment and posttreatment photographs. The patient satisfaction rates were likewise assessed. Adverse effects were recorded during the entire study period. RESULTS: Significant improvement of skin texture was seen at 1 month after the final treatment (p < 0.001) and continuously improved until the 6-month follow-up visit (p = 0.003). The average MI significantly increased at 1 month after the final treatment (p < 0.001), whereas the melanin variation score decreased throughout the follow-up period. Investigator assessment at the 6-month follow-up revealed that 90% of subjects had moderate to marked improvement of striae appearance. Only two of 20 subjects (10%) developed transient postinflammatory hyperpigmentation (PIH) after laser treatment. CONCLUSION: Fractional picosecond 1064-nm laser is effective and well-tolerated for the treatment of striae alba in dark-skinned individuals with a low incidence of PIH.

Hypertrophic Scar Outcomes in Fractional Laser Monotherapy Versus Fractional Laser-Assisted Topical Corticosteroid Delivery: A Randomized Clinical Trial.

Topical corticosteroid delivery following fractional laser treatment is an effective means of treating hypertrophic scars. However, the relative efficacy of adjuvant corticosteroid treatment vs fractional laser mono-therapy alone is unclear. The aim of this study was to compare the efficacy and safety of fractional laser-assisted topical corticosteroid delivery with fractional laser monotherapy in the treatment of hyper-trophic scars. In this randomized, comparative, split-scar trial of 19 subjects, a borderline significant reduction in scar thickness was observed at 3-month follow-up in the laser+steroid group compared with laser+petrolatum (p = 0.049). However, no significant long-term difference in scar flattening was observed between the 2 groups. Patient and Observer Scar Assessment Scale scores showed significant improvement in scar appearance from baseline without significant differences between treatment groups. In conclusion, fractional laser monotherapy is an effective treatment for hypertrophic scars, and the application of topical corticosteroid provides no long-term synergistic effect to fractional laser monotherapy.

Comparison between topical recombinant human epidermal growth factor and Aloe vera gel in combination with ablative fractional carbon dioxide laser as treatment for striae alba: A randomized double-blind trial.

OBJECTIVES: Striae distensae are linear atrophic dermal scars. Despite several currently available therapeutic modalities, no consistently effective therapies have been established. This study aimed to evaluate and compare the efficacy of topical recombinant human epidermal growth factor (rhEGF) and ablative fractional carbon dioxide (CO2 ) laser (AFXL) versus ablative fractional CO2 laser and topical Aloe vera gel in treating striae alba. METHODS: A total of 24 participants with striae alba were enrolled. Patients' striae were divided into the left and right sides. Participants were treated with fractional CO2 laser on both sides for three sessions at 4-week intervals. Immediately after the laser treatment, each side of the striae was randomly assigned to either rhEGF or Aloe vera gel treatment. Patients were required to apply the medication twice daily up to 1 month after the last laser treatment session. Texture, average melanin, and melanin variation were assessed at pretreatment, 1 month after the first, second, and third treatments, and 6 months after the last treatment. Participants were asked to complete a self-administered questionnaire. Nine participants underwent skin biopsies of the nontreated and treated striae, which were obtained from each treated side. RESULTS: Both sides of the treatment area showed significant improvement in texture starting from 1-month follow-up, which sustained up to 6 months after the final treatment, albeit without statistically significant difference between the rhEGF- and Aloe vera-treated sides (P < 0.001, 0.003, and 0.002 for the AFXL-rhEGF-treated side and P = 0.024, 0.001, and 0.001 for the AFXL-Aloe-treated side at 1 month after the first treatment, 1 month after the last treatment, and 6 months after the last treatment, respectively). Participants expressed satisfaction with the AFXL-rhEGF-treated side, which showed significantly greater marked improvement (at 50%) than the AFXL-Aloe-treated side at 6 months after the final treatment (P = 0.034). Post-inflammatory hyperpigmentation (PIH) occurred in 95.8% of participants, which decreased after 6 months compared with baseline. Both treatments improved melanin variation at 6 months after the final treatment, although without significant difference from pretreatment between both groups. Skin biopsy revealed a statistically significant increase in epidermal thickness and decrease in elastic fragmentation in both groups. CONCLUSION: AFXL-rhEGF and AFXL-Aloe significantly improved the striae surface texture. PIH was the most common side effect, which improved at 6 months. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

The effect of botulinum toxin type A in different dilution on the contraction of fibroblast-In vitro study.

BACKGROUND: Botulinum toxin type A (BoNT-A) may directly remodel dermal tissues or induce a loss of normal morphology and cytoplasmic retraction and spread. Intradermal injection was claimed to produce a dermo-lifting effect, including midface lifting by using low concentration with variable dilution. OBJECTIVE: To understand how intradermal BoNT-A achieves tissue lifting, we examined different type of BoNT-A and their effects on dermal fibroblast contraction. METHODS: Normal human dermal fibroblasts were treated with onabotulinumtoxin (ONA), abobotulinumtoxin (ABO), prabotulinumtoxinA (PRABO), incobotulinumtoxinA (INCO), and letibotulinumtoxin A (LETI) in dilutions used in real-world practice. Fifty fibroblasts per dilution were photographed and measured the length to demonstrate their contraction every 2 hours from baseline (0 hours) to 12 hours post-treatment. RESULTS: ONA did not significantly decrease fibroblast lengths, at any timepoint or dilution. At 1:7 dilution ratios, ABO decreased fibroblast lengths after 2 hours and significantly after 10-12 hours. At 1:7, 1:8, 1:9, and 1:10 dilution, PRABO decreased length, and most rapidly at 1:7 and 1:8. At 1:6, 1:8, 1:9, and 1:10 dilution, INCO decreased lengths almost immediately. At 1:6 dilution, INCO decreased lengths almost immediately. At 1:7 dilution, INCO decreased lengths after 2-4 hours, while at 1:8, 1:9, and 1:10 dilution, INCO decreased lenghts nearly imediately. LETI decreased lengths at all dilutions except 1:9, with near-immediate effects at 1:6, 1:7, 1:8, and 1:10. At 1:4 dilution, LETI decreased lengths from 1 hour. CONCLUSIONS: Different commercial preparations of BoNT-A toxins cause different fibroblast contractions in vitro. Product selection and dilution used may affect the clinical outcome of intradermal injection of BoNT-A for face lifting.

A pilot study comparing the efficacy of two formulations of botulinum toxin type A for muscular calves contouring.

BACKGROUND: Enlarged, hypertrophy calf muscles are common in Asian women and can cause psychological burden. Botulinum toxin A (BTA) has been widely used in treating masseteric muscle hypertrophy and it's efficacious as a noninvasive method for calf-contouring has been reported. Food and Drug Administration has approved onabotulinumtoxin A (ONA, Botox; Allergan Inc, Irvine, CA, USA) for upper face rejuvenation and it has off-label uses for calf-contouring. A recently introduced Prabotulinumtoxin A (NABOTA® , PRA; Daewoong Pharmaceutical, Seoul, Korea) demonstrated a comparable efficacy and safety to ONA for masseter reduction. OBJECTIVE: To compare the efficacy and safety of PRA and ONA gastrocnemius muscle reduction. METHODS: This is an experimental, randomized, controlled double-blind study. Twenty-two patients were randomized to receive 100 units PRA and ONA on each calf and were asked to come for follow-up visit for up to 6 months. Clinical photographic documentation, calf circumference measurement (upright position and tiptoe), isokinetic analysis, and ultrasonographic imaging were performed to evaluate the treatment result. In addition, patients' satisfaction and side effect were also recorded. RESULTS: All patients completed the study without serious side effect occurred during the whole study period. The mean calf circumference of the ONA- and PRA-treated patients in upright position at baseline was 35.42 ± 1.35 cm and 36.49 ± 2.98 cm, respectively (P = 0.137). The mean calf circumference in upright position decreased significantly as early as 2 weeks after treatment, both in ONA group and in PRA group (P = 0.004 and P = 0.003, respectively), and continued to decrease until 6 months after treatment (P = 0.002 and P < 0.001, respectively). There was no statistically significant difference in mean calf circumference when comparing between ONA and PRA group at any time of follow-up period. For the tiptoe position, only in the PRA group that showed significant reduction as early as two weeks and lasted up to 6 months of follow-up (P < 0.001). The isokinetic analysis showed no significant reduction on both maximum torque and average work value in two groups. The ultrasonographic imaging revealed that the mean thickness of the lateral head of the gastrocnemius showed significant only in PRA-treated group at 2-, 3-, and 6-months of follow-up; meanwhile, the mean thickness of the medial head showed significant reduction at 2- and 6-months, with a slight increase at 3-months follow-up in two groups. The patients' satisfaction rate and doctor's evaluation also showed no statistically significant difference between both groups. CONCLUSION: This study demonstrated that PRA and ONA provided comparable efficacy and safety in gastrocnemius muscle reduction.

The efficacy of two formulations of botulinum toxin type A for masseter reduction: a split-face comparison study.

BACKGROUND: Botulinum toxin type A (BTA) is now extensively used to address cosmetic concerns. OnabotulinumtoxinA (ONA, Botox; Allergan Inc., Irvine, CA) received FDA approval for upper face rejuvenation, including glabella frown lines and crow's-feet lines. The other off-label uses for lower face conditions have been utilized for contouring purposes, especially masseter hypertrophy. Recently, a new Daewoong BTA, (NABOTA®, NBT, Daewoong Pharmaceutical, Seoul, Korea), was recently introduced. OBJECTIVE: To compare efficacy and safety of ONA and NBT for masseter reduction. METHODS: Thirty-five subjects with masseter hypertrophy were randomly injected with 25 units of ONA on one side and 25 units of NBT on the other side into masseter. Standardized photographic documentation was obtained at baseline, 1, 3 and 6 months after treatment. The mean volume of masseter was acquired by using three-dimensional computed tomography (3-D CT) at baseline, 3-, and 6-month follow-up visits. In addition, patients' satisfaction and side effects were also record at every follow-up visits. RESULTS: The mean masseter volume on the sides treated with ONA and NBT at baseline were 21.20 ± 4.23 cm3 and 21.26 ± 4.58 cm3, respectively. There was no statistically significant difference in the mean volume of both sides (p= 0.827). The mean masseter volume at 3- and 6-month follow-up visits reduced significantly on both ONA and NBT sides (p< 0.001 and p< 0.001, respectively). However, there was no statistically significant difference in mean masseter volume when comparing between ONA and NBT sides at 3 and 6 months after treatment (p= 0.769 and p = 0.346, respectively). There was also no statistically significant difference in masseter reduction when compared between ONA and NBT sides evaluated by physicians and patients at each follow-up visit. No side effect on both sides was reported after injection. CONCLUSIONS: This study demonstrated that ONA and NBT provided comparable efficacy and safety for masseter reduction.

The comparison between intradermal injection of abobotulinumtoxinA and normal saline for face-lifting: a split-face randomized controlled trial.

BACKGROUND: Botulinum toxin type A (BTA) has been approved for the treatment of strabismus, blepharospasm, muscle spasm, cervical dystonia, pain syndrome, glabella wrinkles, and severe primary axillary hyperhidrosis. Intradermal injection of BTA has been used off-label by many clinicians for the purpose of face-lifting effect. Few studies on onabotulinumtoxinA (ONA) demonstrated no clinical efficacy on face-lifting effect when comparing to normal saline solution (NSS). So far, there is no split-face comparison study on face-lifting effect of abobotulinumtoxinA (ABO). OBJECTIVE: To determine the face-lifting effect of ABO intradermal injection and NSS. METHODS: Twenty-two subjects with symmetrical faces on both facial expression and expressionless were randomly injected with ABO at 1:7 cc dilution (500 unit or one vial in 7 cc of NSS) on one side and NSS on the other side using intradermal injection technique. Standardized photographic documentation was obtained at baseline, and at 2 weeks after treatment. The face-lifting effect was graded by two blinded dermatologists using photographic comparison and rated by the patients. Side effects were also recorded at the end of the study. RESULTS: Face-lifting effect was demonstrated in 40.9% and 4.5% of patients with ABO and NSS, respectively. There was a statistically significant difference in face-lifting effect when comparing between ABO and NSS (P = 0.021). The face-lifting was reported in 50.0% of patients receiving ABO injection. The patients with oval-face shape tended to respond better with ABO (P = 0.046). The odd of face-lifting effect for patients aged younger than 32 was higher than patients aged older than 32 with the odds ratio of 7.9 and 95% confidence interval of 1.1-56.1. Facial asymmetry was found in 22.7% of subjects. CONCLUSIONS: This study demonstrated the face-lifting effect of ABO intradermal injection. Patients with oval-face shape and aged younger than 32 tended to respond better. Therefore, patient selection should be emphasized to improve efficacy of this technique.