Treatment of Rhinophyma With Fractional CO2 Laser Resurfacing in a Woman of Color: Case Report and Review of the Literature.

Rhinophyma is a disfiguring disorder that is characterized by an erythematous, hypertrophied, and inflamed lower two-thirds of the nose. Widely accepted as the severe form of acne rosacea, rhinophyma can result in functional, aesthetic, and psychosocial concerns that require treatment in a cosmetic fashion. Rosacea should be treated in its earliest manifestations to mitigate the progression towards rhinophyma; therefore, early detection and intervention is a crucial part of treatment. Little has been written on this subject in people of color. We present the first reported case of rhinophyma in a 62-year-old Fitzpatrick V female patient who was successfully treated with one session of fractional CO2 laser resurfacing. This case highlights the successful use of the fractional CO2 laser to treat rhinophyma in darker skin types (Fitzpatrick IV–VI) and underscores the potential for future use among patients of color. J Drugs Dermatol. 2021;20(7):772-775. doi:10.36849/JDD.C702.

Global Recommendations on COVID-19 Vaccines and Soft Tissue Filler Reactions: A Survey-Based Investigation in Cooperation With the International Society for Dermatologic and Aesthetic Surgery (ISDS).

BACKGROUND: Recent reports have surfaced from the United States Food and Drug Administration hearings in December 2020 regarding the COVID-19 vaccines and study participants who developed facial and/or lip swelling after receiving the newly developed drug. Despite an incidence rate of 0.02% in the vaccine arm of the Moderna mRNA-1273 trial, concerns have been expressed about the association of adverse reactions following soft tissue filler injections and the COVID-19 vaccines. The International Society for Dermatologic and Aesthetic Surgery (ISDS) understands these concerns and has designed the following study. METHODS: A global survey was designed to capture the incidence of adverse events related to: (1) previous soft tissue filler injections, (2) soft tissue filler injections during positive testing for COVID-19, and (3) soft tissue filler injections during and after receiving any of the COVID-19 vaccines globally available. RESULTS: The information of 106 survey participants from 18 different countries was analyzed. 80.2% (n=85) never experienced any adverse reaction following their soft tissue filler injection whereas 15.1% (n=16) experienced swelling and 4.7% (n=5) experienced pain that lasted longer than two days. Of those who received at least one dose of the COVID-19 vaccine (n=78), 94.9% reported not to have experienced any adverse reaction related to their previous soft tissue filler injection, whereas 5.1% (n=4) reported to have perceived pain that lasted longer than two days. CONCLUSION: The data collected does not support the concern for an increased risk of developing adverse reactions following soft tissue filler injections associated with the COVID-19 vaccines compared to that risk associated with other previously described triggers or the default risk following soft tissue filler injections. J Drugs Dermatol. 20(4):374-378. doi:10.36849/JDD.2021.6041.

Controversy: Mohs and Close.

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Bimatoprost-induced chemical blepharoplasty.

We report significant changes in the appearance of the periorbital area, beyond eyelash enhancement, induced by the topical application of bimatoprost ophthalmic solution, 0.03% (Latisse®, Allergan, Inc., Irvine, CA). To our knowledge, this is the first report in the dermatology or plastic surgery literature describing the rejuvenating effect and overall improvement in the appearance of the periorbital area resulting from applying Latisse to the upper eyelid margins. To date, reports in the literature discuss side-effects and potential complications of topical bimatoprost therapy causing a constellation of findings known as PAP (prostaglandin-associated periorbitopathy). While periorbitopathy implies pathology or a state of disease, we report changes that can be perceived as an improvement in the overall appearance of the periorbital area. We, therefore, propose a name change from PAP to PAPS - prostaglandin- associated periorbital syndrome. This better describes the beneficial, as well as the possible negative effects of topical bimatoprost. Although there is a risk for periorbital disfigurement, when used bilaterally, in properly selected candidates and titrated appropriately, bimatoprost can be beneficial. The striking improvement in the appearance of some individuals warrants further research into the potential use of topical bimatoprost to achieve a "chemical blepharoplasty."

ACELIFT: a minimally invasive alternative to a facelift.

BACKGROUND: Cervicofacial aging is often characterized by a combination of skin and subcutaneous tissue laxity, midfacial deflation, an accumulation of excess submental fat, an obtuse cervicomental angle, jowls, and rhytides of the face and neck. Traditional treatment, and the "gold standard" against which other treatments are compared, is a facelift. OBJECTIVE: To demonstrate that a combination technique called ACELIFT - an acronym for the Augmentation of Collagen and Elastin using Lasers, Injectable neurotoxins, Fillers, and Topicals - in selected patients, is a viable, safe, and effective alternative to a facelift. METHODS: Ten healthy women, ages 50 to 62 (mean age = 58), with cervical and facial stigmata of aging were enrolled in a prospective study conducted in the authors' private practice. Patients underwent a two-step procedure; the first step was laser lipolysis of the submental and anterior cervical areas with a pulsed 1440 nm Nd:YAG laser with a side-firing fiber (PrecisionTx, Cynosure, Westford, MA). Three months later, the patients were treated in a single session that combined injectable neurotoxin, fillers, and fractional (Fx) CO2 laser resurfacing delivered in a novel "hammock" distribution. After two weeks, following complete re-epithelialization, the patients were started on a topical regimen that included daily use of sunscreen and antioxidants and nightly use of retinoids and peptides. This regimen was continued for a period of six months when all patients returned for final evaluation. RESULTS: Nine months following the initiation of treatment, all patients were evaluated by the following: Global Aesthetic Improvement Scale, cervicomental angle scale, physician, and subject evaluation. Clinical improvement was evident, and often marked, for all subjects. Both physician and subject satisfaction scores were high, indicating overall satisfaction with the procedure and the outcomes. Side-effects were mild and transient; there were no incidents of adverse scarring, thermal injuries, permanent nerve injury, or dyschromia, hematomas, seromas, or infection. Subjects were likely to recommend the procedure to a friend. CONCLUSIONS: In properly selected patients, the ACELIFT proved to be a safe and effective, minimally invasive alternative to a facelift. There was little downtime and high patient satisfaction.

A preliminary study on the safety and efficacy of a novel fractional CO2 laser with synchronous radiofrequency delivery.

Building upon the fractional CO2 technology incorporated into the first generation SmartXide DOT (DEKA / ElEn, SpA, Calenzano, Italy) introduced in the U.S. in 2008, a second generation SmartXide Quadro has recently been introduced. This is a versatile device that has the ability to combine fractional CO2 laser output for skin resurfacing with the synchronous delivery of bipolar radiofrequency (RF) energy for deeper, more diffuse heating. A pilot study was undertaken to demonstrate the safety and efficacy of the SmartXide Quadro, employing both fractional CO2 laser output combined with the synchronous delivery of radiofrequency energy for the treatment of facial rhytides and acne scars. Ten patients, all women, six with facial rhytides and four with acne scarring, were treated with the SmartXide Quadro, a variably pulsed CO2 laser with Pulse Shape Design® technology, a microablative DOT scanner and synchronized bipolar RF emission. Each patient was treated with a single fractional CO2 laser-RF treatment; laser and RF parameters varied according to the severity of the rhytides or acne scars and were based upon both manufacturer-recommended settings and surgeon experience. Follow-up was at three days, one week, 2 weeks, and one month, three months, and six months after treatment. Results were judged by comparison of preoperative and post-operative photos evaluated by independent physicians, preoperative and post-operative grading by treating physicians, subjective evaluation of results by the patients themselves, and tabulation and categorization of adverse events (AEs). The SmartXide Quadro variably pulsed CO2 laser with a microablative DOT scanner, with synchronous delivery of bipolar RF energy emission, proved to be both safe and effective in the treatment of facial rhytides and acne scars. The single treatment protocol was well tolerated and recovery was similar to fractional CO2 laser skin resurfacing alone. The AEs were minimal and no significant complications occurred.

Evaluation of the safety and efficacy of a novel 1440nm Nd:YAG laser for neck contouring and skin tightening without liposuction.

BACKGROUND: Laser lipolysis is a less invasive approach to neck rejuvenation than open surgery or liposuction. Wavelengths utilized for lipolysis liquefy fat and induce collagen remodeling, which tightens skin. A new Nd:YAG device has recently been developed that emits energy at a wavelength of 1440nm; this wavelength is more highly absorbed by adipose tissue and water than other wavelengths currently available. OBJECTIVE: To test the safety and efficacy of a pulsed 1440nm Nd:YAG wavelength and side-firing fiber for the treatment of subcutaneous fat and skin laxity associated with the aging neck. METHODS: Twenty-four subjects aged 40 to 65 years underwent laser lipolysis of the submental and anterior cervical areas. An average of 1205J per 5 x 5 cm square was delivered, with a maximum internal temperature setting of 47 degrees C. Cervicomental Angle Score (CAS), Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and safety were assessed. RESULTS: At six months post-treatment, 79% of subjects had a significant improvement in the CAS (P<.001) and 79% demonstrated an improvement on the GAIS. Clinical improvement was marked and evident for all but one subject, with physician and patient satisfaction scores indicating overall satisfaction with the procedure and outcomes. Adverse events were mild and transient with no incidence of burns, seromas, hematomas, infection, or nerve damage. CONCLUSION: The 1440nm Nd:YAG device with the side-firing fiber was safe and effective for the treatment of subcutaneous fat and skin laxity in the neck. This device offers an alternative to selected individuals aged 40 and over who do not wish to undergo rhytidectomy.

Six steps to the "perfect" lip.

Full lips have always been associated with youth and beauty. Because of this, lip enhancement is one of the most frequently requested procedures in a cosmetic practice. For novice injectors, we recommend hyaluronic acid (HA) as the filler of choice. There is no skin test required; it is an easily obtainable, "off-the-shelf" product that is natural feeling when skillfully implanted in the soft tissues. Hyaluronic acid is easily reversible with hyaluronidase and, therefore, has an excellent safety profile. While Restylane® is the only FDA-approved HA filler with a specific indication for lip augmentation, one can use the following HA products off-label: Juvéderm® Ultra, Juvéderm Ultra Plus, Juvéderm Ultra XC, Juvéderm Ultra PLUS XC, Restylane-L®, Perlane®, Perlane-L®, and Belotero®. We present our six steps to achieve aesthetically pleasing augmented lips. While there is no single prescription for a "perfect" lip, nor a "one size fits all" approach for lip augmentation, these 6 steps can be used as a basic template for achieving a natural look. For more comprehensive, global perioral rejuvenation, our 6-step technique can be combined with the injection of neuromodulating agents and fractional laser skin resurfacing during the same treatment session.