Skin boosters: Definitions and varied classifications.

BACKGROUND: The concept of "skin boosters" has evolved, marking a shift from traditional uses of hyaluronic acid (HA) fillers primarily for augmenting skin volume to a more diverse application aimed at improving dermal conditions. Restylane Vital and other HA fillers have been repurposed to combat skin aging and wrinkles by delivering HA directly to the dermis. OBJECTIVES: This review aims to define the term "skin booster" and to discuss the various components that constitute skin boosters. It seeks to provide a comprehensive overview of the different ingredients used in skin boosters, their roles, and their impact on enhancing dermal conditions. METHODS: A comprehensive review was conducted, focusing on representative skin booster ingredients. The approach involved analyzing the different elements used in skin boosters and their specific roles in enhancing dermal improvement. RESULTS: The findings indicate that skin boosters, encompassing a range of ingredients, are effective in improving the condition of the skin's dermis. The review identifies key ingredients in skin boosters and their specific benefits, including hydration, elasticity improvement, and wrinkle reduction. CONCLUSIONS: Skin boosters represent a significant development in dermatological treatments, offering diverse benefits beyond traditional HA fillers. This review provides valuable insights into the constituents of skin boosters and their effectiveness, aiding readers in making informed decisions about these treatments. The potential of skin boosters in dermatological practice is considerable, warranting further research and application.

Ultrasonographic Study of the Submandibular Gland for Botulinum Neurotoxin Injection.

BACKGROUND: Hypertrophied submandibular glands provide a bulky contour to the lower face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, no studies have suggested injection points because of the lack of delicate anatomical information on the submandibular gland. OBJECTIVE: The aim of this study was to determine the optimal injection site for botulinum neurotoxin injections in the submandibular gland. MATERIALS AND METHODS: Anatomical considerations when injecting botulinum neurotoxin into the submandibular gland were determined using ultrasonography. The thickness of the submandibular gland, its depth from the skin surface, and the location of the vascular bundle were observed bilaterally in 42 participants. Two cadavers were dissected to measure the location of the submandibular gland corresponding to the ultrasonographic observation. RESULTS: The thickest part of the submandibular gland measured 11.12 ± 2.46 in width with a depth of 4.63 ± 0.76. At the point where it crosses the line of the lateral canthus, it measured 5.53 ± 1.83 in width and 8.73 ± 1.64 in depth. CONCLUSION: The authors suggest optimal injection sites based on external anatomical landmarks. These guidelines aim to maximize the effects of botulinum neurotoxin therapy by minimizing its deleterious effects, which can be useful in clinical settings.

Observation on cadavers and through ultrasonography using a 2 mm needle length for intradermal injections.

BACKGROUND: An intradermal injection is a medical procedure that involves administering a small amount of medication or substance into the dermal layer of the skin. This research focused on identifying the most suitable injection needle for precise intradermal administration of skin boosters. METHODS: The study involved conducting intradermal injections on four cadavers and participants using a 2 mm length, 34-gauge needle (N-Finders, Inc., South Korea). During the cadaveric study, the polynucleotide prefilled syringe was dyed green, and an anatomist performed dissections, removing only the skin layer. Ultrasonographic observations were carried out to ensure accurate intradermal injection placement. RESULTS: In all four cadavers, the facial injections at the anterior cheek region were precisely administered intradermally at a 30-degree injection angle. However, the 90-degree injection was found just below the dermal layer upon skin layer removal. DISCUSSION: The findings suggest that using a 2 mm needle length allows for easy and convenient intradermal injections.

Legal vs. illegal injectable fillers: The adverse effects comparison study.

BACKGROUND: Over the past decades, soft-tissue filler injections have become an essential part of cosmetic practice worldwide. Due to the increasing demand, unlicensed practitioners venture in performing this minimally invasive procedure, injecting illegal fillers that pose serious complications. OBJECTIVES: To compare the adverse effects of legal and illegal soft-tissue fillers injected by licensed and unlicensed practitioners. MATERIALS AND METHODS: A 10-year retrospective, descriptive, single-center study conducted at the outpatient dermatology department and skin laser center at Siriraj Hospital from January 2009 to December 2019. Patients were identified as having treatment-related complications. Their demographic data, clinical history, and injection history were reviewed. RESULTS: Forty patients with mean age of 37 years old were included in the study. Thirty-five of them (87.5%) were female. Illegal soft-tissue fillers were used in 28 patients (70%) and were performed by unlicensed practitioners (18 cases, 64.3%, P = .001). Adverse effects from illegal fillers (26 cases, 92.9%) developed longer than legal fillers (7 cases, 58.3%) (P = .017). Symptoms significantly lasted longer in patients injected with illegal fillers, 10 (0.07-288) weeks, as compared to patients injected with legal fillers 0.75 (0.14-72) weeks (P = .01). Injections from illegal fillers resulted to foreign body reaction (22 cases, 78.6%) and infections (6 cases, 21.4%). Vascular complications were identified in legal fillers injections (5 cases, 41.7%). CONCLUSIONS: The incidence of adverse effects and complications from soft-tissue filler injections are superior when performed by novice injectors and unlicensed practitioners using illegal fillers. Proper training of filler injections, selection of appropriate fillers, and early recognition of adverse effects are critically important to the success of treatments.