Rejuvenation of periocular region in Koreans: A multimodal approach combining botulinum toxin, fillers, and micro-focused ultrasound with visualization for optimal results.

Periorbital aging involves all layers of the skin, fat, and the bony orbit. Therefore, a multimodal approach is necessary. Twenty Korean subjects who required periorbital rejuvenation were enrolled in this study. First, micro-focused ultrasound with visualization (MFU-V) was performed across the supra-brow area, lateral canthus, and the infraorbital area. Next, the filler was injected into the sunken upper eyelid, lateral eyebrow, and the infraorbital area. Lastly, botulinum toxin was administered into the forehead, glabella, crow's feet, and the lateral orbital rim below the brow on the same day. Photographs were taken at baseline; immediately after treatment; and at 1, 4, and 12 weeks of follow-up. The average eyebrow height was increased by 3.5 mm, and the maximum height was elevated by 3.9 mm at week 12. Physician visual analogue scale (VAS) scores regarding the whole periorbital area and eyebrow ptosis were continuously improved throughout the observation period. Physician VAS scores for infraorbital hollow and superior sulcus deformity improved immediately after the procedure and were maintained at week 12. Adverse events were mild and transient. We believe that a multimodal approach combining MFU-V, fillers, and botulinum toxin results in significant periocular rejuvenation.

Air Pollution, Autophagy, and Skin Aging: Impact of Particulate Matter (PM10) on Human Dermal Fibroblasts.

A World Health Organization (WHO) report from 2016 states that over 3 million people die annually from air pollution, which places air pollution as the world's largest single environmental health risk factor. Particulate matter (PM) is one of the main components of air pollution, and there is increasing evidence that PM exposure exerts negative effects on the human skin. To see the impact of air pollution on skin aging, we analyzed the effect of PM exposure on human dermal fibroblasts (HDFs) with Western blot, enzyme-linked immunosorbent assay (ELISA), and gene analysis. Cultured HDFs were exposed to PM10 at a concentration of 30 µg/cm² for 24 h, and their gene/protein expression of inflammatory cytokines, fibroblast chemical mediators, and autophagy were assessed. A total of 1977 genes were found to be differentially expressed following PM exposure. We observed a significantly increased expression of pro-inflammatory genes interleukin (IL)-1ß, IL-6, IL-8 and IL-33 in dermal fibroblasts exposed to PM10. Protein expression of IL-6 and IL-8 also significantly increased, which complemented our gene analysis results. In addition, there was a significant increase in cytochrome P450 (CYP1A1, CYP1B1), matrix metalloproteinase (MMP-1, MMP-3) mRNA expression, and significant decrease in transforming growth factor (TGF)-ß, collagen type I alpha chain (COL1A1, COL1A2), and elastin (ELN) mRNA expression in PM-exposed dermal fibroblasts. Protein expression of MMP-1 was significantly increased and that of TGF-ß and procollagen profoundly decreased, similar to the gene analysis results. Autophagy, an integrated cellular stress response, was also increased while transmission electron microscopy (TEM) analysis provided evidence of PM internalization in the autolysosomes. Taken together, our results demonstrate that PM10 contributes to skin inflammation and skin aging via impaired collagen synthesis. Increased autophagy in our study suggests a reparative role of autophagy in HDFs stressed with PM, but its biological significance requires further research.

Vertical Lifting: A New Optimal Thread Lifting Technique for Asians.

BACKGROUND: With the evolution of facial rejuvenation methods, thread lifts have gained popularity among patients who seek cosmetic improvement. Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available, and they are extremely popular in the aesthetic clinics in Korea. In case of midface and mandibular jowl lift, threads are most often inserted in an oblique manner with vectors of rejuvenation directed toward the temple. However, specific characteristics of skeletal anatomy should be considered when deciding which technique to use in Asians. Herein, the authors introduce a vertical lifting technique most suitable for Asians, in which short (6 cm in length), wedge-shaped PDO sutures are inserted vertically downward in the anterior malar and submalar areas. OBJECTIVE: To describe a novel technique adopted to counteract the descent and laxity of the Asian face. The authors also aimed to assess the overall safety and efficacy of wedge-shaped PDO thread lift in facial rejuvenation. METHODS: A retrospective chart review was performed on cases of facial laxity treated with vertical thread lifting. A total of 39 Korean patients were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the patients' satisfaction scores. Complications were also recorded. RESULTS: Most patients (89.7%) considered the results satisfactory. Consensus ratings by 2 independent dermatologists showed that the objective outcomes at the 6-month follow-up were largely categorized as very much improved (10.3%), much improved (43.6%), and improved (33.3%). The incidence of complications was low, and the complications were minor. CONCLUSION: Thread lifting with short, wedge-shaped PDO sutures is safe and effective for facial rejuvenation. The authors' vertical lifting technique has several advantages over the current approaches. First, the vectors directly oppose the vertical sagging of the face, which makes the technique highly efficient. The technique also carries a lower risk of accentuating the cheekbones, a feature which most Asians do not prefer.

Potential Role of the Microbiome in Acne: A Comprehensive Review.

Acne is a highly prevalent inflammatory skin condition involving sebaceous sties. Although it clearly develops from an interplay of multiple factors, the exact cause of acne remains elusive. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Cutibacterium acnes (C. acnes; formerly called Propionibacterium acnes) is commonly found in sebum-rich areas and its over-proliferation has long been thought to contribute to the disease. However, information provided by advanced metagenomic sequencing has indicated that the cutaneous microbiota in acne patients and acne-free individuals differ at the virulent-specific lineage level. Acne also has close connections with the gastrointestinal tract, and many argue that the gut microbiota could be involved in the pathogenic process of acne. The emotions of stress (e.g., depression and anxiety), for instance, have been hypothesized to aggravate acne by altering the gut microbiota and increasing intestinal permeability, potentially contributing to skin inflammation. Over the years, an expanding body of research has highlighted the presence of a gut-brain-skin axis that connects gut microbes, oral probiotics, and diet, currently an area of intense scrutiny, to acne severity. This review concentrates on the skin and gut microbes in acne, the role that the gut-brain-skin axis plays in the immunobiology of acne, and newly emerging microbiome-based therapies that can be applied to treat acne.

Suboptimal vitamin D status in Korean adolescents: a nationwide study on its prevalence, risk factors including cotinine-verified smoking status and association with atopic dermatitis and asthma.

OBJECTIVE: To determine the prevalence and risk factors for suboptimal vitamin D status in Korean adolescents and to assess its relationship with atopic dermatitis (AD) and asthma at a national level. DESIGN: This is a cross-sectional study with data from the Korean National Health and Nutrition Examination Survey. Information regarding socioeconomic characteristics, clinical data and environmental factors was collected. Blood and urine samples were taken for vitamin D and cotinine, respectively. Descriptive and multivariable logistic regression was performed on the data. SETTING: South Korea (nationwide). PARTICIPANTS: 2515 individuals aged 10-18 years who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2011. MAIN OUTCOME MEASURES: Vitamin D status was determined through measurement of serum 25-hydroxyvitamin D (25OHD). Smoking status was classified based on the urine cotinine level. Physician diagnosed with AD and asthma were assessed using a questionnaire. RESULTS: Overall, 73.3% of the subjects were vitamin D deficient (25OHD <20 ng/mL) and 24.4% of the subjects were vitamin D insufficient (25OHD, 20-29.9 ng/mL). Older age (p<0.001), female gender (p<0.001), urban residence (p=0.019), higher body mass index (p=0.003) and sampling in winter months (November-March) (p<0.001) were independently associated with low serum 25OHD levels. With cotinine verification, 18.2% of the participants were classified as active smokers, and 43.4% were classified as passive smokers. After adjusting for potential confounders, serum 25OHD status showed no association with AD or asthma. CONCLUSION: Vitamin D deficiency is highly prevalent in Korean adolescents. Cotinine-verified prevalence of smoking was also high, but its relationship with vitamin D deficiency was not confirmed in our study. Above all, our results provide epidemiological evidence against the association of vitamin D status with AD and asthma at the national level among Korean adolescents.

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.