Thread Lifts: A Critical Analysis of Treatment Modalities.

Background: Thread lifting procedure was developed to reverse the aging process and restore youthful appearance by retightening and lifting the skin. Different models of absorbable and non-absorbable threads are universally available and promise quick results with minimum downtime. Objectives: To evaluate the efficacy, safety, and cost effectiveness of the commonly used threads for facial lifting and rejuvenation using an evidence-based review. Methods: A comprehensive search of the literature was done using numerous databases (including Cochrane Collaboration, PubMed, Ovid, and Google Scholar). Thread lift for non-aesthetic purpose, open surgical procedure, animals or cadaver studies were excluded. 16 relevant studies were included. The extracted data included significant details related to the review question. Results: Several types of threads with different designs and properties are available for facial rejuvenation, provided by many companies all over the world. Higher quality evidence was found for Contour thread (III). Available studies for the other various threads were level IV. Thread lifting procedure was found to be safe and effective, with minor and mostly self-limited complications. The longevity of results varied from months to years, with more focus related to the technique and patient selection rather than the type of thread. Conclusion: Comparatively high quality long-term multicentre standardized studies are required to help aesthetic doctors to choose the appropriate thread type based on optimum aesthetic outcomes. J Drugs Dermatol. 2020;19(4):413-417. doi:10.36849/JDD.2020.3646.

A Randomized, Controlled, Split-Face Study of the Efficacy of a Picosecond Laser in the Treatment of Melasma

Introduction: Melasma is a common disorder where patients develop hyperpigmented macules and patches on the face and is thought to be the result of sun exposure and hormonal contributions, although the pathogenesis is not completely understood. Lasers have been used for melasma treatment with varying degrees of success. Objectives: The objective of this study was to examine the safety and efficacy of a novel picosecond laser for the treatment of melasma. Materials and Methods: Ten subjects received nine weekly laser treatments with a picosecond laser to a randomized half of their face. A lightening cream was applied to the entire face to serve as a control. The primary outcome measure was clinical efficacy measured by a patient-reported outcome survey, the Melasma Quality of Life (MELASQOL) questionnaire, and physician assessment with the Global Aesthetic Improvement Scale (GAIS). The secondary outcome measure was safety, which was assessed by monitoring for adverse events. Photos were taken before every treatment and at a 1-week follow-up. Results: Ninety percent of subjects rated their melasma as at least slightly better, and 90% percent of subjects would recommend this laser treatment to others with melasma. MELASQoL questionnaire scores improved by an average of 5.7 points after laser treatment. Assessments by two board-certified dermatologists using the GAIS revealed an overall improvement in 80% of patients on the laser treatment side versus 20% on the control side. Side effects, including erythema and discomfort, were minimal and transient post-treatment. Conclusions: This study suggests that picosecond laser treatments are a safe and efficacious way to treat melasma. J Drugs Dermatol. 2019;18(11):1104-1107.

Re-pigmentation of Hypopigmentation: Fractional Lasers vs Laser-Assisted Delivery of Bimatoprost vs Epidermal Melanocyte Harvesting System

Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted. Methods & Materials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system. Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser). Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation. J Drugs Dermatol. 2019;18(11):1090-1096.

Rosacea causing unilateral Morbihan syndrome.

Morbihan syndrome is a rare entity causing woody induration of the face. There are numerous case reports of bilateral Morbihan syndrome. We present a case of a 46-year-old man with right infra-orbital cheek swelling and symptoms of rosacea who had histology consistent with granulomatous rosacea following debulking surgery. His clinical presentation and investigation findings support a diagnosis of rosacea causing unilateral Morbihan syndrome.

Cutaneous Nodular Amyloidosis: A Disfiguring Aspect of the Face.

Primary localized cutaneous nodular amyloidosis is a rare plasma cell dyscrasia in which an amorphous material consisting of light chain amyloid is produced and deposited in the dermis, with varied clinical presentation. We describe the case with unusual and tumor lush clinical presentation in the face with no progression to systemic disease and no evidence of extracutaneous commitment.

A Prospective Study in the Treatment of Lentigines in Asian Skin Using 532 nm Picosecond Nd:YAG Laser.

BACKGROUND AND OBJECTIVE: To evaluate safety and efficacy of treatment with the picosecond Nd:YAG 532 nm for lentigines in Asian skin. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, open-label cohort study, using a novel picosecond 532-nm laser for the treatment of facial lentigines. Subjects received up to three laser treatments every 4-6 weeks and were assessed at 4 and 12 weeks after final treatment. Primary endpoint was degree of improvement in lentigines at 12 weeks after the final treatment, assessed by treating investigator based on Physicians Global Assessment. Secondary end-points included degree of improvement in lentigines at 12 weeks after final treatment, assessed by subject (Subject's Global Assessment), and change in mean relative Melanin index (MI) value at 3 months after final treatment as compared to baseline as assessed by mexameter measurement. RESULTS: A total of 20 patients (3 male, and 17 female) of Asian-descent with Fitzpatrick skin type III and IV, with lentigines on the face were included in this study. A total of 89 lesions were treated with the laser setting of 532-nm, 750 picoseconds, fluence of 0.2-0.5 J/cm 2 , and spot size of 4 mm. One hundred and thirty-seven treatment sessions were given in total. Eighteen patients (90%) achieved a moderate to significant improvement at 12-week follow-up based on a 5-grade physician global assessment scale. The improvement rate of relative MI (MI in the lesion minus normal skin) was 33.30 ± 18.71 and 37.63 ± 19.25% at 4- and 12-week follow-up. Post-inflammatory hyperpigmentation (PIH) occurred in 14 of 137 sessions (10.2%), and hypopigmentation occurred in one patient with five lesions (3.6%). CONCLUSION: This study demonstrates that using picosecond Nd:YAG laser 532 nm for removal of solar lentigines in darker skin type appears to be safe and effective. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc. LIMITATIONS: Small study group.

Final Data from the Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR)

Perceptions of attractiveness can be negatively affected by submental fullness. Patients seeking to improve their submental contour have a variety of treatment options including surgical procedures, energy-based devices, and injectable treatment. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to provide insights into the treatment of submental fat (SMF) in clinical practice. CONTOUR was a prospective observational study that enrolled 1029 adults at 91 sites in the United States and Canada. Patients were followed until treatment completion, discontinuation, or 1 year elapsed from enrollment without treatment. Final data from CONTOUR are reported here. Of the 676 patients who underwent treatment, 570 were treated with ATX-101 (deoxycholic acid injection), 77 with energy-based devices, 23 with surgical liposuction, 5 with laser liposuction, and 9 with other treatments. The majority of treated patients were facial aesthetic treatment naive. A markedly greater percentage of patients with mild or moderate SMF at baseline received treatment with ATX-101 or energy-based devices, whereas the majority of patients undergoing liposuction had severe or extreme SMF. Physicians most frequently cited a preference for a noninvasive/minimally invasive procedure as the reason for choosing either ATX-101 or energy-based devices. The majority of patients were at least partially satisfied with results, regardless of the chosen treatment. Data from CONTOUR indicate that cost is the most important factor in a patient's decision to undergo treatment, that choice of treatment method is most influenced by SMF severity and preference for nonsurgical versus surgical intervention, and that the availability of noninvasive/minimally invasive options has made SMF treatment an attractive first procedure for patients who have not undergone previous facial aesthetic treatments. ClinicalTrials.gov identifier: NCT02438813. J Drugs Dermatol. 2019;18(1):40-48.

Effectiveness of Combining High-Intensity Focused Radiofrequency and Non-Ablative Fractional Laser for Improving the Appearance of the Aging Face and Neck

Background: The safety and effectiveness of high-intensity precision radiofrequency (RF) for rejuvenating the aging neck and face, and of fractional laser therapy for treating photodamaged skin have each been previously demonstrated. Objective: To assess the effects of combining high-intensity precision RF and fractional laser therapy for treating the aging face and neck. Methods and Materials: Subjects (N=19) with Fitzpatrick skin types I to VI and mild-to-moderate solar elastosis and sun or age-related pigmentation on the face and/or neck were sequentially treated with high-intensity precision RF and fractionated laser devices during the same session. Three sessions were completed 30 days apart. Assessments were made 90 days after the last treatment. Results: Both Clinician and Subject Global Assessment of Improvement scores indicated clinical improvement (n=16, 84%) or no change (n=3, 16%) in skin quality. Clinical improvement was also observed in 16 subjects (68%) in masked assessment. Most subjects (90%) noted improved skin quality and 74% expressed at least some satisfaction with their treatment results. The most common adverse events were erythema (n=57, 45%) and edema (n=45, 35%). Conclusion: The results of this study establish the safety and effectiveness of combined treatment with a 1927 nm thulium laser and a high-intensity precision RF device. ClinicalTrials.gov Identifier: NCT03409965. J Drugs Dermatol. 2019;18(1):59-64.

Fractional 532-nm KTP diode laser and 595-nm pulsed dye laser in treatment of facial telangiectatic erythema.

BACKGROUND: A 595-nm pulsed dye laser (PDL) and the fractional 532-nm potassium titanyl phosphate (KTP) laser have also been demonstrated to be effective for facial telangiectasias. OBJECTIVE: To compare the clinical therapeutic effects of a fractional 532-nm KTP laser with those of a 595-nm pulsed dye laser (PDL) for treating facial erythematous skin lesions. METHODS: Twenty healthy adults with facial erythematous skin lesions were treated using a fractional 532-nm KTP laser on one side of the face and a 595-nm PDL on the other cheek. Three treatments were administered at 4-week intervals. The degree of improvement in facial telangiectasias was evaluated by colorimeter analysis, a physician's assessment using clinical photographs, and the subject's self-assessment. RESULTS: In the physician's assessment with clinical photography, a significant improvement was observed from baseline to posttreatment in both groups. As measured by a colorimeter, the a* value decreased from 16.23 (±2.81) to 12.22 (±2.75) in the 595-nm PDL group and from 16.02 (±2.93) to 12.77 (±2.77) in the fractional 532-nm KTP laser group. The a* value showed a significant reduction in both groups (P < .0001). There was no significant difference in efficacy between the two groups. In the subjective self-assessment, scores improved by 1.68 (±0.95) in the fractional 532-nm KTP laser group and by 1.78 (±0.92) in the 595-nm PDL group. CONCLUSION: A fractional 532-nm KTP laser is a valid option for the treatment of facial erythematous skin lesions with telangiectasia.

The rapid effect of pulsed dye laser on demodex density of facial skin.

BACKGROUND: Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques. MATERIAL AND METHODS: Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated. RESULTS AND DISCUSSION: The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.

Hybrid Fractional Laser: A Multi-Center Trial on the Safety and Efficacy for Photorejuvenation

BACKGROUND: Laser skin resurfacing has continued to evolve over the past two decades. One of the most recent advances included a hybrid fractional laser resurfacing system that can sequentially utilize two wavelengths in its delivery, non-ablative coagulation with 1470 nm, and ablative vaporization with 2940 nm. The 1470 nm laser wavelength is absorbed by water, which is ideal for creating controlled zones of coagulation to chosen depths into the dermis up to 700 micrometers. The 2940 nm laser wavelength has a large water absorption coefficient, which results in precise ablation as desired in the epidermis up to 110 micrometers. This combination allows for fractionated non-ablative and ablative skin resurfacing simultaneously resulting in a cosmetic improvement in pigmentation, tone, texture of skin as well as other effects of photoaging. METHODS: Open-label prospective, multi-center study in which 34 female subjects were enrolled with Fitzpatrick skin types I-IV, mean age of 52 ± 14 years. Each subject underwent two treatments, spaced 4-6 weeks apart. Follow up visits at 1 week, 2 weeks, and 1, 2, and 3 months after the first treatment. Photographs, numeric pain scores during treatment, and subject satisfaction survey questionnaires were evaluated. Photographs were analyzed by six blinded evaluators. The primary endpoint was to evaluate safety and efficacy of hybrid laser treatments for photodamage and dyschromia. The secondary endpoints included evaluating the tolerability of the treatment using the Wong Baker Face scale and patient satisfaction survey results. RESULTS: Of the 29 subjects completing the study, 80% showed significant skin improvement on photographic analysis. Average numeric pain score was a 4 on a 0-10 scale. Survey results showed 100% satisfaction with treatment and achieved results. Two patients experienced post-inflammatory hyperpigmentation that resolved within 90 days. No other adverse events were reported. CONCLUSION: The non-ablative and ablative hybrid fractional laser can be used to safely and efficaciously treat photodamaged skin with high patient satisfaction and minimal adverse events. J Drugs Dermatol. 2018;17(11):1164-1168.

The Safety of Laser Skin Resurfacing With the Microablative Carbon Dioxide Laser and Review of the Literature

OBJECTIVE: The aim of this study was to evaluate the incidence of adverse effects following laser skin resurfacing with the microablative carbon dioxide (CO2) laser system (SmartXide DOT; DEKA, Calenzano, Italy). METHODS: A retrospective chart review was performed. Data was collected for DOT laser procedures performed at three clinical centers from 2008-2014. Results: Of the 1,081 DOT laser procedures, there were 13 complications (1.3% of all cases), which included eleven cases of prolonged erythema and two cases of post-inflammatory hyperpigmentation. Of note, there were no cases of scarring. LIMITATIONS: This was a retrospective chart review. Data was collected from laser case logs. However, all patients with complications were evaluated clinically by a physician. CONCLUSION: Microablative fractional resurfacing with the DOT laser enables treatment of a diversity of skin conditions with short post-procedure recovery time and an extremely low incidence of adverse side effects. J Drugs Dermatol. 2018;17(11):1157-1162.

Comparison of novel dual mode vs conventional single pass of a 1450-nm diode laser in the treatment of acne vulgaris for Korean patients: A 20-week prospective, randomized, split-face study.

BACKGROUND: Although a 1450-nm diode laser has been shown to be effective for acne, the conventional high-energy stamp-only regimen is often associated with pain and hyperpigmentation, especially for dark-skinned individuals. AIMS: To evaluate whether the novel dual regimen has clinical advantages for acne treatments compared with conventional regimen in Asian patients. PATIENTS AND METHODS: Twenty-four Korean patients with facial acne were treated with a 1450-nm diode laser through a 20-week, randomized, split-face study. The patients were treated with three consecutive sessions at 4-week intervals. One half of the face received a dual regimen consisting of low-fluence stamping mode (5-6 J/cm2 ) for inflammatory acne lesions only, followed by 4-5 passes of moving mode for the full face. The other side received a single-pass treatment of conventional high-fluence stamp mode (14-15 J/cm2 ). Evaluations for acne, sebum secretion measurements, and safety profiles were performed. RESULTS: At the final 12-week follow-up evaluations, the dual-mode side demonstrated better improvements in both inflammatory and noninflammatory lesion counts, acne severity assessments, and reduction in sebum secretion compared with stamp-only side. Subjective satisfaction for the improvement for acne, seborrhea, and texture correlated well with objective assessments. In addition, degrees of pain and treatment-related side effects were remarkably decreased in the novel dual mode. CONCLUSION: This novel dual regimen of the 1450-nm laser demonstrated improved efficacies for acne and seborrhea with satisfactory safety profiles. Therefore, this regimen would be a viable option for acne treatments either as monotherapy or as combination therapy.

Plasma Exeresis Treatment for Epidermoid Cysts: A Minimal Scarring Technique.

BACKGROUND: Epidermoid cysts are cutaneous benign tumors commonly seen in young or middle-aged adults. Plasma exeresis is an innovative technique for several skin conditions: it causes ionization of the atmospheric gas between the proximal tip of the device and the tissue to be treated, creating sublimation of the tissue. OBJECTIVE: To remove the cyst with a novel technique that allows a good cosmetic result. MATERIALS AND METHODS: Patients with clinical diagnosis of at least one epidermal cyst, aged between 18 and 70 years were enrolled. A standardized procedure was used. After administration of topical and sometimes local anesthesia (for cysts bigger than 1 cm), a tiny hole was created with plasma exeresis. The content of the cyst was then extruded and Micro Hartman Alligator Ear Forceps pulled out the loosened capsule. RESULTS: Twenty patients aged between 18 and 68 years were enrolled: 11 males (55%) and 9 females (45%). Twenty-eight cysts were successfully removed. The diameter ranged from 3 to 24 mm. No side effects were observed. The scar measured not more than 3 mm. CONCLUSION: This study suggests that plasma exeresis could represent a good and safe option to remove noninfected cysts on cosmetic areas, although further study is required.