Relationship Between Midface Volume Deficits and the Appearance of Tear Troughs and Nasolabial Folds.

BACKGROUND: Understanding interrelationships among aging facial features is important in facial aesthetics as a global treatment approach becomes standard. OBJECTIVE: Examine empirical relationships between midface volume deficit and severity of tear troughs (TTs) and nasolabial folds (NLFs) in women and men of different racial/ethnic groups. METHODS: A web-based study was administered to health panel members (aged 18-75 years). Participants compared their midface volume, TTs, and NLFs against photonumeric scales depicting degrees of severity. Linear regressions were conducted to assess the relationship of midface volume on severity of TTs and NLFs, controlling for demographic factors. RESULTS: Of 4,086 participants (80.0% female), 3,553 had complete data. Increasing severity of midface volume deficit was associated with increasing severity of TTs and NLFs in both sexes (all p < .001). Race/ethnicity was associated with differences in severity in all 3 facial areas, although specific differences between races/ethnicities varied for women and men. Progression rates of severity differed between racial/ethnic groups. Correlations between midface volume deficit, TTs, and NLFs were positive and significant (all p < .001). CONCLUSION: Midface volume deficit was associated with severity of TT deformity and NLFs after controlling for age and other demographic variables.

Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada.

BACKGROUND/OBJECTIVES: Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA. METHODS: Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18-75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I-III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race. RESULTS: Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women. CONCLUSIONS: Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.

A Prospective, Open-Label, Observational, Postmarket Study Evaluating VYC-17.5L for the Correction of Moderate to Severe Nasolabial Folds Over 12 Months.

BACKGROUND: VYC-17.5L (17.5 mg/mL hyaluronic acid, 0.3% lidocaine) is a dermal filler intended for deep dermis injection for the treatment of skin depressions. OBJECTIVE: To evaluate 12-month effectiveness and safety of VYC-17.5L for the treatment of moderate/severe nasolabial folds (NLFs). METHODS: Subjects ≥18 years old with moderate/severe NLFs were recruited (N = 70). Injected volume was aimed at achieving optimum correction; top-up treatment was given at 2 weeks if needed. The primary endpoint was investigator-assessed change in NLF severity over 12 months using the validated photonumeric NLF Severity Scale. Secondary endpoints included investigator- and subject-assessed satisfaction and safety. Adverse events judged to be more severe or prolonged than routinely observed were recorded. RESULTS: Sixty-five subjects completed study requirements. Mean volume injected was 3.0 ± 1.0 mL for both NLFs combined. Significant improvement was maintained in investigator-assessed NLF severity at 12 months, and investigators and subjects reported high satisfaction with VYC-17.5L throughout the study. Two unexpected adverse events were reported: (1) redness, swelling, and decreased sensitivity (resolved after 4 days) and (2) swelling (resolved after 48 hours); neither event was serious or life threatening. CONCLUSION: VYC-17.5L is effective and well tolerated for the treatment of moderate to severe NLFs for 1 year.

Signs of Facial Aging in Men in a Diverse, Multinational Study: Timing and Preventive Behaviors.

BACKGROUND: Men are a growing patient population in aesthetic medicine and are increasingly seeking minimally invasive cosmetic procedures. OBJECTIVE: To examine differences in the timing of facial aging and in the prevalence of preventive facial aging behaviors in men by race/ethnicity. METHODS: Men aged 18 to 75 years in the United States, Canada, United Kingdom, and Australia rated their features using photonumeric rating scales for 10 facial aging characteristics. Impact of race/ethnicity (Caucasian, black, Asian, Hispanic) on severity of each feature was assessed. Subjects also reported the frequency of dermatologic facial product use. RESULTS: The study included 819 men. Glabellar lines, crow's feet lines, and nasolabial folds showed the greatest change with age. Caucasian men reported more severe signs of aging and earlier onset, by 10 to 20 years, compared with Asian, Hispanic, and, particularly, black men. In all racial/ethnic groups, most men did not regularly engage in basic, antiaging preventive behaviors, such as use of sunscreen. CONCLUSION: Findings from this study conducted in a globally diverse sample may guide clinical discussions with men about the prevention and treatment of signs of facial aging, to help men of all races/ethnicities achieve their desired aesthetic outcomes.

Repeated OnabotulinumtoxinA Treatment of Glabellar Lines at Rest Over Three Treatment Cycles.

BACKGROUND: OnabotulinumtoxinA has demonstrated the ability to eliminate mild glabellar lines at rest; however, less is known regarding the effect of repeat treatment on more severe lines at rest. OBJECTIVE: To assess the effect of repeated onabotulinumtoxinA treatment for reduction of glabellar lines at rest. METHODS: Subjects 18 to 75 years old with at least mild glabellar lines at rest, as assessed by the validated Facial Wrinkle Scale (FWS) with photonumeric guide (score ≥ 1), received 3 treatments of 20 U onabotulinumtoxinA 4 months apart (N = 225). "Response" was defined as elimination of glabellar lines at rest (FWS score = 0) at any time point (Days 7, 30, 60, 90, and 120). Effect of treatment cycle on response was analyzed using repeated measures logistic regressions (p < .05). RESULTS: Most subjects were female (85%) and white (88%) (age range: 35-54 years). The likelihood of significant response was as follows: for all subjects combined (odds ratio [OR]: 1.31), for subjects with mild resting lines at baseline (OR: 1.49), and for older women (≥55 years) with mild resting lines at baseline (OR: 2.22). Of all subjects, 76% responded after 1 treatment, and 45% responded in all 3 cycles. CONCLUSION: Subjects repeatedly treated with onabotulinumtoxinA showed progressive improvement in glabellar lines at rest.

Facial Treatment Preferences Among Aesthetically Oriented Men.

BACKGROUND: There is a paucity of data describing male attitudes toward age-related changes to their facial features and associated preferences for prioritizing treatment. METHODS: Injectable-naive but aesthetically oriented men aged 30 to 65 participated in an online study (N = 600). Respondents indicated how concerned they were by the appearance of 15 age-related facial features, and the Maximum Difference scaling system was used to explore which features were most likely to be prioritized for treatment. The correlation between the features of most concern and the areas of treatment priority was assessed. Other aspects regarding the male perspective on aesthetic procedures, such as awareness, motivating factors, and barriers, also were explored. RESULTS: Crow's feet and tear troughs were rated as the most likely to be treated first (80% of first preferences) followed by forehead lines (74%), double chin (70%), and glabellar lines (60%). The areas of most concern in order were tear troughs, double chin, crow's feet, and forehead lines. There was a strong correlation between the features of most concern and the areas of treatment priority (r = 0.81). CONCLUSION: The periorbital areas, in particular crow's feet and tear troughs, are of most concern and likely to be prioritized for treatment among aesthetically oriented men.

Influence of specific individual and environmental variables on the relationship between body mass index and health-related quality of life in overweight and obese adolescents.

PURPOSE: Overweight and obese adolescents are at risk for low health-related quality of life (HRQOL). We examined the role of individual- and environmental-level variables on the relationship between body mass index (BMI kg/m(2)) and HRQOL in adolescents. METHODS: Linear regressions were performed to conduct mediation and moderation analyses on the relationship between BMI and HRQOL in overweight and obese adolescents (N = 205). HRQOL was measured by the Pediatric Quality of Life Inventory. Hypothesized mediators included depression, measured by the Center for Epidemiologic Studies Depression Scale; body image, measured by the gender-specific body dissatisfaction subscale of the Eating Disorder Inventory; and self-esteem, measured by the Rosenberg Self-Esteem Scale. Mediation was assessed using Baron and Kenny's approach and Sobel's test of indirect effects. Anglo-acculturation, measured by the Short Acculturation Scale for Hispanics-Youth, and environmental perception, measured by parent-proxy report of the Neighborhood Environment Walkability Scale, were hypothesized moderators. RESULTS: Body image mediated the relationship between BMI and HRQOL (b = -0.34, SE = 0.17, adj R (2) = 0.19, p = .051), and self-esteem was a partial mediator (b = -0.37, SE = 0.17, adj R (2) = 0.24, p = .027). Sobel's test confirmed these results (p < .05). No significant moderation effects were found. CONCLUSIONS: The finding that individual-level factors, such as body image and self-esteem, influence the relationship between BMI and HRQOL while environmental factors, such as neighborhood environment and acculturation, do not extends previous research. The finding that body image and self-esteem partially mediate this relationship presents new areas to investigate in interventions that address BMI in youth.

HYC-24L Demonstrates Greater Effectiveness With Less Pain Than CPM-22.5 for Treatment of Perioral Lines in a Randomized Controlled Trial.

OBJECTIVE: This trial compares the effectiveness and safety of HYC-24L (Juvéderm Ultra XC; Allergan plc, Dublin, Ireland) (24 mg/mL of hyaluronic acid, 0.3% lidocaine) and CPM-22.5 (Belotero Balance; Merz Aesthetics, Raleigh, NC) (22.5 mg/mL of hyaluronic acid) for the treatment of perioral lines. MATERIALS AND METHODS: Men and women aged 35 years or older with moderate-to-severe perioral lines were recruited for this randomized controlled, rater-blinded, 2-arm trial. The primary endpoint was a comparison of rater-assessed responder rates by the validated 4-point Perioral Lines Severity Scale at Month 6; responders were those who showed a ≥1 point improvement. A secondary endpoint was subject-assessed change in perioral lines measured by the Global Assessment of Change Scale. RESULTS: A total of 136 subjects received treatment and 132 completed the trial (mean age: 58 ± 8 years). Total volume injected was 1.18 mL (HYC-24L) and 1.32 mL (CPM-22.5). At Month 6, a significantly greater proportion of HYC-24L subjects responded to treatment (87%) than CPM-22.5 subjects (72%) (p < .04). At all time points, HYC-24L subjects reported significantly greater improvement in their perioral lines than CPM-22.5 subjects, with the greatest difference at Month 6. No unexpected adverse events occurred. CONCLUSION: HYC-24L subjects showed a higher response rate and a greater improvement in their perioral lines than CPM-22.5 subjects for up to 6 months.

Fruit and vegetable intake and eating behaviors mediate the effect of a randomized text-message based weight loss program.

INTRODUCTION: We hypothesized that fruit/vegetable intake and eating behaviors mediate the relationship between experimental condition and weight loss in a randomized trial evaluating a text-message based weight loss program. METHODS: Overweight/obese individuals from San Diego, CA (N = 52 with complete data) were randomly assigned in 2007 into one of two groups for four months: 1) the intervention group that received 2-5 weight management text-messages p/day; 2) the usual-care comparison group. Three 24-hour recalls assessed fruit/vegetable intake change and the eating behavior inventory (EBI) measured change in eating behaviors. Regression path models tested intervention mediation. RESULTS: Direct effects of the intervention were found for change in body weight (b = -3.84, R(2) = 0.074), fruit/vegetable intake (b = 2.00, R(2) = 0.083), and EBI scores (b = 7.15, R(2) = 0.229) (ps < 0.05). The treatment group to weight change path was not statistically significant (b = -0.673, R(2) = 0.208) when fruit/vegetable intake change and EBI score change were specified as intervention mediators in the model. The total indirect effect was 3.17 lb indicating that the indirect paths explained 82.6% of the total effect on weight change. DISCUSSION: Fruit/vegetable intake and eating behaviors mediated the intervention's effect on weight change. The findings suggest that sending text-messages that promote healthy eating strategies resulted in moderate short-term weight loss.

Reliability and validity of child/adolescent food frequency questionnaires that assess foods and/or food groups.

OBJECTIVE: Summarize the validity and reliability of child/adolescent food frequency questionnaires (FFQs) that assess food and/or food groups. METHODS: We performed a systematic review of child/adolescent (6-18 years) FFQ studies published between January 2001 and December 2010 using MEDLINE, Cochrane Library, PsycINFO, and Google Scholar. Main inclusion criteria were peer reviewed, written in English, and reported reliability or validity of questionnaires that assessed intake of food/food groups. Studies were excluded that focused on diseased people or used a combined dietary assessment method. Two authors independently selected the articles and extracted questionnaire characteristics such as number of items, portion size information, time span, category intake frequencies, and method of administration. Validity and reliability coefficients were extracted and reported for food categories and averaged across food categories for each study. RESULTS: Twenty-one studies were selected from 873, 18 included validity data, and 14 included test-retest reliability data. Publications were from the United States, Europe, Africa, Brazil, and the south Pacific. Validity correlations ranged from 0.01 to 0.80, and reliability correlations ranged from 0.05 to 0.88. The highest average validity correlations were obtained when the questionnaire did not assess portion size, measured a shorter time span (ie, previous day/week), was of medium length (ie, ≈ 20-60 items), and was not administered to the child's parents. CONCLUSIONS: There are design and administration features of child/adolescent FFQs that should be considered to obtain reliable and valid estimates of dietary intake in this population.

Associations of soluble fiber, whole fruits/vegetables, and juice with plasma Beta-carotene concentrations in a free-living population of breast cancer survivors.

OBJECTIVE: Soluble fiber and the physical state of fruits/vegetables affect plasma ß-carotene concentrations; however, most of this research was conducted in laboratory-based settings. These analyses investigated the relationship between soluble fiber and juiced versus whole fruits/vegetables to plasma ß-carotene concentrations in a free-living population. METHOD: This cross-sectional analysis used 12-month follow-up data from the Women's Healthy Eating & Living Study (1995-2006), a study to improve diet in breast cancer survivors in the Western United States. The dietary nutrients considered in this analysis included intake of soluble fiber (g), ß-carotene from fruit/vegetable juice (mg), and ß-carotene from whole fruits/vegetables (mg). A linear regression model was used to assess the relationship of the variables to plasma ß-carotene concentrations. RESULTS: Out of 3,088 women enrolled in the Women's Healthy Eating & Living Study, 2,397 women had complete data (mean age = 54). The final model accounted for approximately 49% of the explained variance in plasma ß-carotene concentrations. Fruit/vegetable juice had the largest positive relation to plasma ß-carotene concentrations (standardized parameter estimate = 0.23, p < 0.01), followed by whole fruits/vegetables (standardized parameter estimate = 0.09, p < 0.01). CONCLUSION: Soluble fiber may inhibit ß-carotene absorption; therefore, consumption of juice may increase plasma ß-carotene concentrations more than whole fruits/vegetables in free-living populations.

Sedentary Behavior and Cardiometabolic Health Associations in Obese 11-13-Year Olds.

BACKGROUND: Improved understanding of sedentary time's impact on cardiometabolic health can help prioritize intervention targets. OBJECTIVE: We investigated cross-sectional and longitudinal relations of reported screen time and objectively measured total percent of time spent sedentary with cardiometabolic health in obese youth. METHODS: Participants were 106 obese adolescents age 11-13 (N = 106, 51% girls, and 82% Hispanic) recruited from primary care clinics in southern California. Main predictor measures were child-reported screen time and objectively assessed sedentary time. Outcome measures were body mass index (BMI), waist and hip circumference, body fat, blood pressure, glucose, triglycerides, insulin, cholesterol, aspartate aminotransferase (AST), and serum alanine aminotransferase (ALT). RESULTS: Total percent sedentary time was not associated with the cardiometabolic health markers after adjusting for moderate-to-vigorous physical activity (MVPA). However, screen time was positively associated with BMI and diastolic blood pressure at baseline, and positive longitudinal associations were found with BMI, triglycerides, low-density lipoprotein, AST, and ALT. CONCLUSIONS: Reported screen time, but not total sedentary time, was related to multiple cardiometabolic health markers in obese adolescents, independent of MVPA. The findings suggest that limiting and replacing screen time, which was more than 3 hours per day on average in this sample, is likely an important behavior change strategy for interventions treating childhood obesity and comorbidities. The associations with screen time were strongest with AST and ALT, suggesting that this form of sedentary behavior may impact liver health.

Reliability and concurrent and construct validity of the Strategies for Weight Management measure for adults.

INTRODUCTION: This study evaluates the reliability and validity of the strategies for weight management (SWM) measure, a questionnaire that assesses weight management strategies for adults. The SWM includes 20 items that are categorized within the following subscales: (1) energy intake, (2) energy expenditure, (3) self-monitoring, and (4) self-regulation. METHODS: Baseline and 6-month data were collected from 404 overweight/obese adults (mean age=22±3.8 years, 68% ethnic minority) enrolled in a randomized controlled trial aiming to reduce weight by improving diet and physical activity behaviours. Reliability and validity were assessed for each subscale separately. Cronbach alpha was conducted to assess reliability. Concurrent, construct I (sensitivity to the study treatment condition), and construct II (relationship to the outcomes) validity were assessed using linear regressions with the following outcome measures: weight, self-reported diet, and weekly energy expenditure. RESULTS: All subscales showed strong internal consistency. The strength of the validity evidence depended on subscale and validity type. The strongest validity evidence was concurrent validity of the energy intake and energy expenditure subscales; construct I validity of the energy intake and self-monitoring subscales; and construct II validity of the energy intake, energy expenditure, and self-regulation subscales. CONCLUSIONS: Results indicate that the SWM can be used to assess weight management strategies among an ethnically diverse sample of adults as each subscale showed evidence of reliability and select types of validity. As validity is an accumulation of evidence over multiple studies, this study provides initial reliability and validity evidence in one population segment.

Exploratory and confirmatory factor analyses and demographic correlate models of the strategies for weight management measure for overweight or obese adults.

PURPOSE: There is a need for a self-report measure that assesses use of recommended strategies related to weight management. DESIGN: Cross-sectional analysis. SETTING: Universities, community. SUBJECTS: Exploratory factor analysis (EFA) involved data from 404 overweight/obese young adults (mean age = 22 years, 48% non-Hispanic white, 68% ethnic minority). Confirmatory factor analysis (CFA) involved data from 236 overweight/obese adults (mean age = 42 years, 63% non-Hispanic white, 84% ethnic minority). MEASURES: The Strategies for Weight Management (SWM) measure is a 35-item questionnaire that assesses use of recommended behavioral strategies for reducing energy intake and increasing energy expenditure in overweight/obese adults. ANALYSIS: EFA and CFA were conducted on the SWM. Correlate models assessed the associations between SWM factor/total scores and demographics by using linear regressions. RESULTS: EFA suggested a four-factor model: strategies categorized as targeting (1) energy intake, (2) energy expenditure, (3) self-monitoring, and (4) self-regulation. CFA indicated good model fit (χ(2)/df = 2.0, comparative fit index = .90, standardized root mean square residual = .06, and root mean square error of approximation = .07, confidence interval = .06-.08, R(2) = .11-.74). The fourth factor had the lowest loadings, possibly because the items cover a wide domain. The final model included 20 items. Correlate models revealed weak associations between the SWM scores and age, gender, Hispanic ethnicity, and relationship status in both samples, with the models explaining only 1% to 8% of the variance (betas = -.04 to .29, p < .05). CONCLUSION: The SWM has promising psychometric qualities in two diverse samples.

Strategies that predict weight loss among overweight/obese young adults.

OBJECTIVES: Understanding the characteristics of young adults who have difficulty achieving a healthy weight may help develop more effective interventions. METHODS: Signal detection was conducted to identify subgroups of overweight/obese young adults more or less likely to lose weight (5% weight loss) over 6 months. Data were collected from a diverse sample involved in a randomized controlled behavioral weight loss intervention (N = 404). RESULTS: Overall, 15% (N = 57) of participants achieved <5% weight loss. Change in self-monitoring weight, baseline score of gym attendance/participating in exercise classes, and change in eating less fat were the best predictors of weight loss. CONCLUSION: These strategies may be particularly helpful to promote short-term weight loss in overweight/obese young adults.

Feasibility and effectiveness of an automated bilingual text message intervention for weight loss: pilot study.

BACKGROUND: Little is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers. OBJECTIVE: This pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial. METHODS: There were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction. RESULTS: Participants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F1,17=10.80, P=.004, CI∆ 0.66-3.03, η(2)=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program. CONCLUSIONS: This fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period. TRIAL REGISTRATION: Clinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n).