Skin rejuvenating effect of a combined triple-wavelength (755 nm, 810 nm, and 1064 nm) laser: a preliminary study.

With an increasing demand for noninvasive skin rejuvenation techniques, several light-based devices have been introduced. Due to its ability to deliver thermal energy from the superficial to deeper levels of the dermis, a combined triple-wavelength laser (755 nm, 810 nm, and 1064 nm) can be used for skin rejuvenation. The objective of this study was to assess the effectiveness and safety of a combined triple-wavelength laser for skin rejuvenation. A total of 28 female patients seeking skin rejuvenation treatment were included. All patients underwent five consecutive treatment sessions at a two-week interval. Clinical improvement of aging-related cutaneous change was noted by the treating dermatologists and patients. Biopsies were performed on the faces of consenting patients before and two weeks after the final treatment. Significant clinical improvements were observed by both patients and evaluating dermatologists. Based on the patient satisfaction questionnaire, 78% of patients reported a self-assessed improvement of more than 25%. Additionally, 86% of patients showed an improvement of more than 25% on objective assessment by dermatologists. Histopathological findings revealed increased collagen and elastic bundles throughout the dermis. Except for transient pain during treatment, no serious adverse effects were reported. The findings of this study suggest that the combined triple-wavelength laser may be an effective and safe nonablative option for skin rejuvenation.

Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans.

BACKGROUND: Facial wrinkles and sagging are the most visible signs of aging and can cause profound distress. Microneedle fractional radiofrequency (MFR) is a minimally invasive procedure, which utilizes both microneedling and radiofrequency energy to rejuvenate the skin. OBJECTIVE: To describe the safety and efficacy of a temperature-controlled MFR device on facial fine lines and laxity. PATIENTS AND METHODS: A retrospective chart & histology review was performed on individuals who received bipolar MFR for facial rejuvenation. A total of 15 Koreans with a median age of 46 years were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the participants' satisfaction scores. Histologic changes before, immediately after MFR and at 4 months follow-up was examined. Complications were also recorded. RESULTS: Partially denatured collagen fibers and dermal shrinkage was observed immediately after MFR whereas an increase in elastin and collagen was noted at 4 months follow-up. 86.7% of recipients considered the results satisfactory. Consensus ratings by two independent dermatologists on the objective outcomes at 4-month follow-up were very much improved (53.3%), much improved (26.7%) and improved (20%). Treatment was well tolerated and did not cause any significant long-lasting discomfort. CONCLUSION: Temperature-controlled bipolar MFR is a minimally invasive treatment option to consider for facial fine lines and laxity via neo-collagenesis and neo-elastogenesis. The procedure was safe and clinically effective.

Efficacy and safety of intense pulsed light using a dual-band filter for the treatment of facial acne vulgaris.

Intense pulsed light (IPL) devices have been used in acne treatment in combination with conventional topical and oral medications. This study aimed to evaluate the efficacy and safety of IPL treatment using a dual-band filter (400-600 nm and 800-1200 nm) in facial acne vulgaris treatment. Twenty-three acne vulgaris patients were enrolled in this study. The patients were treated on both sides of the face. The treatments were performed in 2-week intervals for a total of five sessions. The final visit for the clinical evaluation was 2 weeks after the fifth treatment session. The mean number of papules, pustules, and comedones, and the melanin index, was significantly decreased at the final visit. However, sebum production and the erythema index showed no statistically significant differences after treatment. IPL treatment using a dual-band filter can be an alternative for patients who are unfit for systemic acne medication. It can also be used with conventional acne treatment for better treatment results.

Can a radiofrequency device reduce the pore size?

A facial pore is an empty funnel-shaped structure filled with cornified cylindrical plugs that can be cosmetically bothersome to some patients. In the previous report, the new unipolar radiofrequency (RF) device with a vacuum showed excellent skin tightening and patient satisfaction with improved pores. This study aims to confirm the treatment's efficacy with the new unipolar RF device on facial dilated pores by measuring quantitative sebum production differences and doing a histologic examination of pore size. Twelve patients who visited the dermatologic clinic without other underlying inflammatory facial skin diseases were included, regardless of the patient's age or sex. All patients received five successive treatments at 2-week intervals. We assessed all changes in sebum production levels, melanin index, erythema index before and after treatment, along with overall improvement (reduction of pore size, skin tone, skin texture, and skin laxity). In the five patients who agreed in advance, a biopsy of the pore lesion was taken before and 1 month after the last treatment with hematoxylin and eosin (H&E) staining, Masson's trichrome (M-T) staining, and Victoria blue staining. We observed a significant reduction of sebum production and melanin index after using the new unipolar RF device with a vacuum (sebum production, p = 0.011; MI, p = 0.004). In evaluating patient satisfaction for four categories, the patients showed a moderate to the excellent improvement of more than 50% in their condition except for skin tones. The average pore size decreased by 41.7% in the histological examination, from 64.98 to 37.86 µm. Additionally, we observed an overall decreased sebaceous gland in the dermis and the proliferation of dermal collagen fiber. The number of elastic bundles in the D-E junction was increased after treatment. The nonablative unipolar RF devices with a vacuum can improve dilated pores with a dual mechanism (collagen regeneration and reduction of sebum production), with much less pain than other RF devices.

Photothermal therapy using gold nanoparticles for acne in Asian patients: A preliminary study.

Acne is a common skin disease that occurs in pilosebaceous units and is often prevalent in adolescence. There are many acne treatments, but they are associated with side effects, such as antibiotic resistance, teratogenicity, and irritation. Therefore, it is necessary to develop a more effective and safe alternative treatment for managing acne in patients of all ages. This study aimed to confirm the effect of gold photothermal therapy for acne. About 12 patients who visited the dermatologic clinic with moderate to severe acne vulgaris were included in the study, regardless of age or sex. All patients received three successive treatments at 1- to 2-week intervals with a photopneumatic device after applying the contents of a gold nanoparticle ample to the skin. Changes in the number of papules, pustules, and comedones before and after treatment, along with the overall improvement, were assessed. In four patients, a biopsy was taken before and 1 month after the last treatment. Significant reductions in acne lesions were observed after the use of gold photothermal therapy (papules, P = .001; pustules, P < .001; and comedones, P = .001). As noted in the Physician Global Assessment, the patients showed an average improvement of more than 50% in their condition. In the histopathological findings, a decrease in inflammatory cell infiltration and fibrotic changes of the dermis were observed after gold photothermal therapy. Gold photothermal therapy showed significant clinical and histological improvements in acne vulgaris in Asians without serious adverse effects.

Objective assessment of facial laxity changes after monopolar radiofrequency treatment by using moiré topography.

Radiofrequency (RF) has been widely used as a noninvasive technique for skin tightening and rejuvenation. Moiré is a type of interference pattern corresponding to the shape of the face. We aimed to objectively evaluate the effect of RF on facial skin laxity using moiré. Ten subjects participated and were treated with a monopolar RF on the face. Clinical photographs and moiré images were obtained at the baseline and after treatment. The periorbital angle from the upper third of the face, zygomatic length ratio (L1/L2), angle from the middle third, perioral perpendicular length, and angle from the lower third were analyzed. After one session of RF treatment, the mean zygomatic length ratio (L1/L2) from the middle third of the face significantly increased in the 4th week (by 49.68%, P = .047). The L1/L2 ratio increased to nearly one, which were not significant after 8 weeks. The mean perioral perpendicular length decreased to 282.25 ± 84.069 pixels (px) after 4 weeks, and to 281.38 ± 76.03 px after 24 weeks; these differences were statistically significant. The parameters of zygomatic length ratio and perioral perpendicular length extracted from illuminated moiré images can be useful for objectively assessing various facial tightening treatments in clinical settings.

Relationship between acne and the use of cosmetics: Results of a questionnaire study in 539 Korean individuals.

BACKGROUND: Acne vulgaris is one of the most common dermatological diseases, and it is known that various factors are related to triggering this condition in a patient. In particular, although the use of cosmetics is thought to be associated with the onset of a patient developing acne, there are few studies that have been conducted to date on this disease and its related factors. METHODS: To begin with, a total of 539 patients with acne vulgaris, who visited three dermatologic clinics in Korea, were asked to complete a questionnaire regarding their condition in relation to clinical features and exacerbating factors, including the use of cosmetics. The patients all provided an accurate acne treatment history as well. RESULTS: Among the respondents, 38.1% of patients who failed treatment answered that the condition of their acne was worsened by the continued use of cosmetics, which was significantly higher than 26.3% of the surveyed treatment-naive patients (P < .05). In this relation, double cleansing (cleansing twice using oil and water-based cleanser) and the number of cosmetics in use were also noted in higher numbers than in the treatment-failure patients. As noted, the liquid-type foundation and concealer were frequently used in this group. CONCLUSIONS: This study showed the influence of cosmetics, especially in acne patients with a history of treatment failures. These results also show differences according to specific cosmetic types and formulations. Therefore, overall dermatologists should consider advising about cosmetic use to acne patients along with medical treatment options for the patients with acne.

A survey on monopolar radiofrequency treatment: The latest update.

The aim of this questionnaire-based study was to measure the level of appreciation, practice patterns, and side effects of monopolar radiofrequency treatment among Korean dermatologists practicing the most updated monopolar radiofrequency device (Thermage FLX, Thermage Inc., Hayward, California). According to a total of 52 surveys analyzed, this latest device (Thermage FLX) was considered more effective (57.4%), faster with reduced treatment time (66.0%), and more painful (25.5%) compared with Thermage CPT. Asians in their 40s were considered to benefit most and skin thickness continued to be the most important determinant in terms of responsiveness to Thermage FLX. The interval between treatments was mainly 1 year (51.9%) with the 600 REP 4 cm2 new total tip being preferred by 86.5% of Thermage FLX users. The treatment energy and the complication rate of Thermage was lower than what we reported in 2017 and 2011 which is likely due to the optimized energy delivery of Thermage FLX and the subsequent gentle treatment. We hope our updated data enable dermatologists to better utilize monopolar radiofrequency in their practice.

Monopolar radiofrequency treatment for facial laxity: Histometric analysis.

BACKGROUND: A monopolar radiofrequency device can be used in facial tightening. The device targets the dermis and fibrous septae, and the treatment results in immediate collagen contraction and the induction of subsequent collagen remodeling. AIMS: We aimed to evaluate the histometric change of the subjects treated with a monopolar radiofrequency device using a novel tip. MATERIALS AND METHODS: Eleven subjects with skin types III and IV participated in the study. They received a single session of a monopolar radiofrequency on the face, and biopsies were performed before treatment, and 2 and 6 months after the treatment. Hematoxylin and eosin, Masson trichome, and Victoria blue stains were used. An image analysis was performed using the Image J software. The dermal density of collagen and elastic fiber, and the coherency of collagen fibers were assessed in the papillary, upper reticular, and lower reticular dermises, respectively. RESULTS: The monopolar radiofrequency treatments led to improvements in collagen fiber density and coherency. In the Masson trichome staining, the collagen fiber densities were 0.736 ± 0.06 and 0.652 ± 0.063 before treatment and increased to 0.773 ± 0.044 (P = .018) and 0.686 ± 0.05 (P = .045) in the papillary and lower reticular dermises, respectively. The density of the elastic fibers in all parts of the dermis showed a tendency to increase after treatment, though not statistically significantly. The mean coherency was higher after than before treatment. CONCLUSIONS: In this in vivo study, we found that the collagen and elastic fiber densities and architectural structures were improved after treatment.

Superficial intense focused ultrasound on periorbital wrinkle.

The periorbital wrinkles are easily perceived evidence of aging, so become a major concern for many patients. Various treatments have been attempted to improve periorbital wrinkles, but the need for new treatments that are less invasive and more effective is still high. In this study, we evaluated the safety, clinical and histological effects of intense focused ultrasound using only a 1.5 mm transducer in the management of periorbital wrinkles. Ten adult Korean females were enrolled. The treatment effect and safety profile were evaluated up to 3 months after 1 session of IFUS treatment on the periorbital wrinkles. The mean subjective satisfaction score was 3.2 ± 0.79 (mean ± standard deviation) by 5- point scale. The mean objective clinical improvement score was highest in the fine wrinkle on the crow's feet area and lowest in the deep wrinkles of the infraorbital and crow's feet area. Histometrically, increase of collagen and elastic fiber density was observed in the all layers of dermis. No serious side effects occurred after the treatment. In conclusion, intense focused ultrasound treatment using a 1.5-mm transducer alone can significantly improve periocular wrinkles after a single treatment with a good safety profile.

Double stacking cryolipolysis treatment of the abdominal fat with use of a novel contoured applicator.

Background: Cryolipolysis is a noninvasive method for the selective reduction of subcutaneous fat. The abdomen and flank area are most commonly treated sites and now the treatment efficacy became the important issue. Objectives: To evaluate the effectiveness and safety of double stacking cryolipolysis treatment with the novel contoured applicator for abdominal fat reduction. Materials and methods: 12 healthy Korean were treated using cryolipolysis contact device. The device was applied on participant's left lower abdomen. Performance was held for 35 minutes and immediately repeated the second performance. The right abdomen was left untreated. Participants were examined with high resolution ultrasound and the depth of subcutaneous fat layer was measured initially and 8 weeks after the sessions. Any adverse events were assessed during the entire study period. Results: The subjective reduction of abdominal fat was noted in most participants. No serious adverse events was reported. Reduction of subcutaneous fat layer depth was confirmed in high resolution ultrasound after 8 weeks of treatment. Conclusion: The results of this study indicate that abdominal fat can be reduced effectively by the novel cryolipolysis applicator. With subjective satisfaction of participants our study shows that double stacking treatment appears safe and well tolerated with enhanced treatment outcomes.

Comparative effects of various absorbable threads in a rat model.

BACKGROUND: Conventional procedures including botulinum toxin and filler injections have their limitations in improving deep wrinkles and decreasing tissue laxity, and possess the propensity for vascular accidents. Absorbable thread is a recently commercialized field, but there is little evidence on comparative superiority. OBJECTIVES: We observed the effects of polydiaxanone (PDO) threads with different number of strands in relation to collagen production and histopathology in a rat model. MATERIALS AND METHODS: Dorsal skin of rat was divided into five different compartments and four different PDO threads and monofilament poly-lactic acid (PLA) thread were inserted. Tissue samples were obtained at week 1, 2, and 12 after the procedure for histopathologic review and real-time PCR for quantification of collagen. RESULTS: Multiple PDO filaments produced more collagen at 2 weeks. Single-stranded PLA thread insertion resulted in more Col1α1 levels than the double PDO thread and also showed the most Col1α3 production at week 2. The amount of collagen showed a sharp decline at week 12. Histologic evaluation showed retained threads surrounded by fibrous capsule-like structure at week 12. CONCLUSION: We were able to observe more collagen production in multiple stranded PDO threads compared to a single strand and that increasing number of threads leads to more collagen synthesis.

Cryolipolysis for submental fat reduction in Asians.

BACKGROUND: Cryolipolysis is a noninvasive method for the selective reduction of fat, especially proven to be safe and effective in body contouring. There is a demand for reduction in submental fat, which is related not only with a favorable appearance but also with signs of aging. OBJECTIVE: This study evaluated the efficacy and safety of cryolipolysis for subcutaneous fat reduction in the submental area in Asians. MATERIALS AND METHODS: Ten healthy Koreans were treated using a cryolipolysis contact device (CoolMini applicator, Zeltiq Aesthetics). The device was applied on the participant's neck twice via two lateral approaches. Patient's body weight was measured, and photographs were taken at baseline and during the follow-up visit after 8 weeks. Participants were examined with ultrasound and the depth of the subcutaneous fat layer was measured. RESULTS: The subjective reduction of submental fat was noted in most of the participants. Reduction of the subcutaneous fat layer depth was confirmed by ultrasound after 8 weeks of treatment. CONCLUSION: The results of this study indicate that submental fat can be safely and effectively reduced with use of a cryolipolysis applicator. The present study shows that cryolipolysis can be an option for nonsurgical facial contouring.

A survey on monopolar radiofrequency treatment.

This questionnaire-based study was aimed to measure the level of appreciation, awareness of the special tips, and practice patterns of monopolar radiofrequency among Korean dermatologists practicing a specific monopolar radiofrequency device (Thermage® Inc., Hayward, CA). A total of 82 surveys were analyzed to show that the majority of participants (78.8%) were highly satisfied with the outcomes of monopolar radiofrequency treatment. All respondents were aware of the Eye Tip 0.25 cm2 , and the majority knew the difference between the Face tip (blue) and the Total tip (orange). Most (86.3%) agreed to the statement that 900 shots were appropriate for facial tightening in those between the ages of 35 and 65 years. 66.2% of participants reported to have perform monopolar radiofrequency to extra-facial sites within the past year. As for the tips, the Total tip was most popular for all body sties and the Big tip was favored for the abdomen, thighs and buttock. We hope our data allow dermatologists to better utilize monopolar radiofrequency.

Clinical efficacy and safety evaluation of a novel fractional unipolar radiofrequency device on facial tightening: A preliminary report.

BACKGROUND: Previous studies have shown that radiofrequency (RF) energy is safe and effective for improving skin laxity. Unlike monopolar and bipolar devices, little has been studied with the unipolar hand piece. OBJECTIVES: We sought to evaluate the safety and efficacy of a novel fractional unipolar RF device on facial tightening. PATIENTS AND METHODS: This was a retrospective, single-center study of 14 subjects with age-related facial laxity who underwent five sessions of fractional unipolar RF at an interval of 2 weeks, and then followed-up for 3 months. Standardized photos were taken at baseline and at 3-months follow-up, and were assessed by two independent dermatologists using a 4-point scale (0=no improvement, 1=mild improvement, 2=moderate improvement, 3=significant improvement). Punch biopsies (2 mm) were performed and a questionnaire was used to evaluate the patient's satisfaction and the incidence of adverse reactions. RESULTS: Fourteen subjects with mild to moderate age-related facial laxity were included in the study. The mean age of the subjects was 49.7 years (range 32-80). 35.7% of the subjects showed significant improvement, 50% moderate improvement, and 14.3% slight improvement of facial laxity in their follow-up photos. About 85.7% of the patients replied that they were either greatly satisfied or satisfied with the results at 3-months follow-up. Skin biopsies revealed an increase in collagen in the dermis. None of the subjects experienced any serious adverse events during or after the procedure. CONCLUSION: Our findings suggest that fractional Unipolar RF can be safely performed on the face and is effective in skin tightening. It has a great advantage over other forms of RF by being entirely painless.

Safety and efficacy of a non-contact radiofrequency device for body contouring in Asians.

BACKGROUND: The non-invasive reduction of subcutaneous abdominal fat became popular. Radiofrequency, non-contact, selective-field device Vanquish® has been developed to selectively induce deep fat tissue heating to reduce waist circumference. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of clinical, radiological results of the radiofrequency, non-contact, selective-field device treatment. METHODS: Twelve healthy individuals with no underlying medical problem were treated with five sessions of radiofrequency treatment to reduce abdominal subcutaneous fat. 45-minute sessions were performed with an 1-week interval. For efficacy evaluation, patient's abdominal circumferences and body weight were measured, and photographs were taken at baseline and each follow-up visit for 12 weeks. One subject was examined with computed tomography (CT) before the first session and six weeks after the first CT scan, and we measured the volume of subcutaneous fat layer. Any adverse effect was assessed during the entire study period. RESULTS: Reduction in abdominal circumferences was noted in most participants (10 of 12 patients). No serious adverse effect was reported. Volume reduction of abdominal subcutaneous fat layer was confirmed in a subject who took CT scan. CONCLUSIONS: Our study shows that the selective-field radiofrequency treatment seems to be safe and efficient for reduction of abdominal subcutaneous fat.

Intense focused ultrasound (IFUS) with a modified parameter on facial tightening: A study on its safety and efficacy.

BACKGROUND: Intense focused ultrasound (IFUS) is a novel treatment modality for skin laxity. The delivery of thermal energy to the deeper tissue layers effectively tightens the skin but can also cause significant fat atrophy, limiting its use in patients with a lean face. OBJECTIVES: We sought to evaluate the safety and efficacy of modified IFUS on facial rejuvenation. PATIENTS AND METHODS: This was a retrospective, single-center study of 28 subjects with age-related facial laxity who underwent 3 sessions of IFUS (UltraskinTM, WONTECH Co., Daejeon, Korea) at an interval of four weeks, and then followed up for three months. IFUS was first applied using a 4-MHZ, 4.5-mm transducer followed by a 7-MHZ, 3-mm transducer. Approximately 200-300 treatment lines were applied to the face during each session. Standardized photographs were taken at baseline and follow-ups and were assessed by two independent dermatologists. A questionnaire was used to evaluate patient satisfaction and the incidence of adverse reactions. RESULTS: Twenty-eight subjects with mild-to-moderate age-related facial laxity were included in the study. The mean age of the subjects was 48 (range 29-74) years. About 32.1% of the subjects showed significant improvement and 57.1% showed improvement of facial laxity in their follow-up photographs. All of them (100%) replied that they were either greatly satisfied or satisfied with the results at three-month follow-up. None of the subjects experienced any serious adverse events including fat atrophy after the procedure. CONCLUSION: Modified IFUS (three sessions, four weeks apart, 200-300 treatment lines per session) can be safely performed with good clinical results.