Revolutionizing Neck Rejuvenation: ABO Botulinum Toxin A Solution in Multipoint Technique and NASHA Gel Skinbooster.

BACKGROUND: Neck rejuvenation is an increasingly sought-after cosmetic procedure that offers a versatile solution to address various aging-related concerns in the neck area. Because it is non-surgical, it is an appealing choice for both patients and practitioners. This protocol introduces a highly effective approach utilizing ABO Botulinum Toxin A solution and NASHA gel 12 mg/mL for neck rejuvenation, targeting patients with muscle hypertonicity and skin degeneration.  Materials and Methods: Patient selection is based on specific criteria. ABO Botulinum Toxin A solution is administered with tailored dosages and with a multipoint technique, followed by a structured NASHA gel skinbooster regimen. Precise injection techniques address muscle hypertonicity and improve skin quality. Follow-up appointments and personalized touch-up sessions maintain results. RESULTS: This is a minimally invasive, cost-effective approach with minimal downtime. ABO Botulinum Toxin A solution's precision and composition (efficacy) make it preferred. NASHA gel 12 mg/ml consistently enhances skin quality, providing tone, elasticity, hydration, and radiance. Gradual, long-lasting improvements boost patient satisfaction and confidence. CONCLUSION: Physicians can expand their repertoire of treatment offerings with the combined use of ABO Botulinum Toxin A solution and NASHA gel 12 mg/ml for neck rejuvenation. This innovative approach aligns with ethical and environmental considerations, enhancing patient satisfaction and overall well-being. By learning and implementing this innovative protocol, aesthetic physicians can offer their patients a highly effective and sought-after (repetitioned) treatment option.  J Drugs Dermatol. 2024;23(1):1344-1348.     doi:10.36849/JDD.8095.

Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendations.

BACKGROUND AND OBJECTIVES: Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS: An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS: The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION: Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

Injectable Non-Animal Stabilized Hyaluronic Acid as a Skin Quality Booster: An Expert Panel Consensus.

Hyaluronic acid (HA) is used extensively in aesthetic medicine thanks to its documented role in skin rejuvenation. The specific applications of HA-based products are not always fully acknowledged due to a lack of consistent recommendations. In this paper, the authors have summarized available published data on the range of applications of non-animal stabilized hyaluronic acid (NASHA®) gel skin boosters (NSBs) in several anatomical areas and types of patient, as well as their own recommendations. Overall, the panel agreed that a standard initial protocol treatment of up to 3 sessions, followed by a maintenance schedule, would allow patients to improve and then preserve skin quality over time. Indeed, distinct effects are evident after the first session, but a progressive enhancement of skin texture is detectable for up to 12 months after repeat treatment at 4 to 6 month intervals. Moreover, the authors agreed that the NASHA gel, reaching the dermis, is able to reestablish a greater degree of hydration and stimulate collagen that, in turn, restores the volume and density of the skin. Thus, a strong consensus was reached that NSB procedures are minimally invasive, safe, and effective, and designed to improve skin texture and maintain skin quality.

J Drugs Dermatol. 2018;17(1):83-88.

Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach.

In this study, we aimed to quantify the effects of fractional ablative carbon dioxide laser therapy in the treatment of widespread hypertrophic burn scars. While many different pilot studies have described the potential of the technology and expert groups and current guidelines, alike, recommend its use, the level of evidence for the efficacy of fractional CO2-laser treatment for burn scars is currently very low. Ten patients (three male, seven female) with hypertrophic burn scars were treated with a single course of fractional CO2-laser therapy in an in-patient controlled setup, using a standardized treatment paradigm. Documentation was based on modern scar scales and questionnaires, like the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI), as well as state of the art clinical measurements (PRIMOS, Cutometer). Over the course of 6 months after treatment, VSS and POSAS scores showed significant improvement in the rating of scar parameters, as did the quality of life rating according to the DLQI. In the treated scars, surface relief improved significantly, as S max decreased by 1893 µm (-36.92%) (p = 0.0273) and S z by 1615 µm (-36.37%) (p = 0.0488). Scar firmness in treated scars could be reduced by 30% after one treatment session, as R 0 improved by 0.0797 mm (+30.38%) (p = 0.0212). Fractional ablative CO2-laser treatment is a safe and efficacious option for the treatment of hypertrophic burn scars. While more treatment sessions are required for satisfying results, significant improvement is already apparent after a single course of treatment.

Fractional high intensity focused radiofrequency in the treatment of mild to Moderate laxity of the lower face and neck: A pilot study.

BACKGROUND AND AIMS: The aging process is commonly associated with skin laxity in the lower face and neck. Conventional surgery can correct this at least to some extent, but is invasive. Fractional high-intensity focused radiofrequency delivered to the dermis with insulated microneedles has recently attracted attention in facial rejuvenation. The present pilot study was designed to assess the efficacy of HiFR for skin laxity of the lower face and neck. METHODS: Thirty-three patients (7 males, 26 females, age range 37-74 years) with mild to moderate skin laxity of the lower face/neck participated in the study. Three treatments were given at monthly intervals with protocols developed by the authors, three passes per session, at decreasing dermal depths for each pass. Histologic assessment of skin immediately after treatment was performed to identify the site and area of damage in the dermis. Clinical digital photography was taken at baseline and at 6 months after the final treatment session, based on which standardized computer measurement of improvement in the gnathion and cervicomental angles was the primary objective evaluation. A global assessment of improvement was graded by blinded assessors based on the photography. A telephone survey of patient satisfaction was performed at 12 months post-treatment. RESULTS: A significant post-treatment decrease in the cervicomental and gnathion angles was seen of 28.5° and 16.6°, respectively (P < 0.0001 for both). Histology immediately post-treatment showed a clear demarcated and roughly oval area of coagulation associated with the tip of the needle, confined to the dermis and not involving the epidermis. In the global assessment 81.8% of the patients achieved moderate or higher results, and 87% of patients were very satisfied or better. Downtime was minimal, lasting 3-4 days, and no persistent adverse events were recorded. CONCLUSIONS: Fractional HiFR proved safe and effective in the treatment of neck laxity in a large age range of patients, including the elderly. Lasers Surg. Med. 48:461-470, 2016. © 2016 Wiley Periodicals, Inc.

Updated international clinical recommendations on scar management: part 1--evaluating the evidence.

BACKGROUND: There is an ongoing need to standardize scar management by establishing safe and effective treatment options that can be applied in routine clinical practice. OBJECTIVE: To review available data on methods for preventing and treating cutaneous scarring. MATERIALS AND METHODS: Relevant scientific literature was identified through a comprehensive search of the MEDLINE database. Additional data and published studies were submitted for consideration by members of the International Advisory Panel on Scar Management. RESULTS: One of the most significant advances in scar management over the past 10 years has been the broader application of laser therapy, resulting in a shift in status from an emerging technology to the forefront of treatment. Accumulated clinical evidence also supports a greater role for 5-fluourouracil in the treatment of hypertrophic scars and keloids, particularly in combination with intralesional corticosteroids. Encouraging data have been reported for newer therapies, including bleomycin, onion extract-containing preparations, imiquimod, and mitomycin C, although methodologic limitations in available studies merit consideration. In general, clinical and aesthetic outcomes seem to be enhanced by a combination approach to treatment. CONCLUSION: Advances in therapeutic options and new study data necessitate a revision of algorithms for the prevention and management of cutaneous scarring.

Three-dimensional analysis for measuring volumetric changes after a noninvasive treatment performed with a new system delivering microwave energy for unwanted abdominal fat reduction.

BACKGROUND: A growing demand for aesthetic treatments for localized abdominal unwanted fat has developed as a healthy lifestyle is not always able to improve abdomen appearance. AIMS: The purpose of this retrospective nonrandomized observational study was to evaluate the efficacy and safety of a new device delivering microwaves energy for unwanted fat reduction, using three-dimensional (3D) imaging analysis. METHODS: Twenty patients (both female and male) were treated in the abdominal area. Subjects received 4 treatments with the study device. Follow-up evaluations were conducted to estimate safety and efficacy. A Numerical Rating Scale (NRS) was used for pain assessment. Patient's 3D imaging analysis was performed at baseline and at 3 months follow-up. Finally, a satisfaction questionnaire was filled in by all the patients. RESULTS: All subjects completed the whole cycle of treatments and presented for the follow-up visits. Analysis of 3D imaging yielded a significantly reduction in circumference (cm) and volume (cm3 ), passing, respectively, from 85.2 ± 8.1 cm and 1950.6 ± 471.0 cm3 at baseline to 80.8 ± 8.2 cm and 1728.9 ± 490.9 cm3 (p < 0.001) at 3-months follow-up after the last treatment. According to the NRS results, the treatment was well tolerated. From the analysis of the satisfaction questionnaire the 90% of patients are interested in carrying out the same treatment in other body areas. CONCLUSION: With the use of three-dimensional imaging techniques, the efficacy of a new system delivering microwaves energy for the reduction of abdominal volume correlated to a subdermal fat reduction while preserving/improving skin tightening, was quantitatively and objectively demonstrated.

A new multi-modal fractional ablative CO2 laser for wrinkle reduction and skin resurfacing.

BACKGROUND: The concept of fractional delivery modality of the energy with both ablative and non-ablative devices is now well known and accepted as an effective method to attain significant aesthetic improvements on facial aging skin. A new, multi-modal, fractional, ablative CO2 laser that can create, using same scanner/handpiece, deep columns in addition to superficial ablation has been recently proposed and therefore investigated. METHOD: Twenty-four patients were enrolled in this evaluation. Each of them received one multi-modal, fractional ablative treatment. Patients were clinically and photographically evaluated at baseline and 6 months after the procedure. The degree of photoaging and the efficacy of treatment were evaluated using a VAS five-point scale of some skin features. A 3D images comparison was furthermore performed to objectify the improvements. RESULTS: For all of the analysed skin features of photodamage a significant, statistical improvement was obtained. The data collected with the 3D system demonstrated an average improvement of 42% of the wrinkles and an average improvement of the melanin variation of 40.1%. CONCLUSIONS: The multi-modal approach with a single handpiece allows obtaining good outcomes with a very low incidence of adverse effects and a short downtime.

Combined laser treatment for ear keloids: Case series: Comparison between two mini-invasive protocols: Comparison between two mini-invasive protocols.

BACKGROUND: Keloids are benign fibrous tumors derived by excessive proliferation of fibroblasts and collagen synthesis after an injury, and they do not regress spontaneously. Earlobes keloids may develop either on the helix or on the anterior or posterior lobe, up to several years after piercing. AIMS: To evaluate the effectiveness of a combined protocol of CO2 laser + dye laser versus CO2 laser + dye laser + Enerjet. METHODS: Eighty patients with a total of 83 ear keloids were divided in two groups: One group has been treated in the same session with a single CO2 laser procedure + a pulsed Dye laser procedure; the second group has been treated as the group one with an adjunctive Enerjet procedure. RESULTS: Of the 40 patients for a total of 41 treated keloids in the first group, 85.4% of keloids did not recur during a follow-up period (3 months-7 years), 14.6% of the lesions recurred (6/41) with mild thickening of the scar and underwent to further treatments. The second group (40 patients, 42 keloids) results showed a 90.5% of keloids which did not recur during a follow-up period (3 months-2 years), while 9.5% of the lesions recurred (4/42) with mild thickening of the scar and underwent to further treatments. CONCLUSIONS: Lasers demonstrated a synergistic effect when combined together and an excellent outcome has been obtained in the 88% of treated lesions, with a slighter higher prevalence of excellent outcome of the group treated with a further procedure with Enerjet.

Nonablative laser skin resurfacing for periorbital wrinkling-A case series of 16 patients.

BACKGROUND: Many modalities have been described for the treatment of periorbital wrinkling. AIMS: The purpose of this study is to quantify the improvement of periorbital wrinkling achieved by current nonablative modalities, using a fractional 1565 nm Er:glass fiber laser. METHODS: Our study is a retrospective two-center case series including 16 patients treated with nonablative laser for periorbital wrinkling at the Tel-Aviv Sourasky Medical Center in Israel and Laserplast Aesthetic Medicine Center in Italy between 2017 and 2019. Patients were assessed for objective and subjective improvement, patient satisfaction, side effect profile, and downtime. RESULTS: Improvement in average Fitzpatrick Wrinkle Scale scores (from 4.3 to 2.7 by ranking physician 1 and 3.8 to 2.4 by ranking physician 2, P < .001) was observed after 8 weeks. Global Assessment Improvement Scale scores were 2.6 (physician 1) and 2.2 (physician 2) on average. This correlated to mild-moderate subjective sense of improvement by patients. Side effects and downtime were minimal. CONCLUSION: Our study suggests that current nonablative laser skin resurfacing technology offers a mild-moderate improvement in periorbital wrinkling.

Photodynamic photorejuvenation of the face with a combination of microneedling, red light, and broadband pulsed light.

BACKGROUND: High efficacy and safety, coupled with in-office, short contact protocols have made photodynamic therapy (PDT) with aminolevulenic acid (ALA) for the treatment of actinic keratoses a mainstay option over the last decade. Clinical improvement in photoaged skin has also been reported to accompany PDT treatments. The study objective was to maximize epidermal penetration and subsequent activation of ALA for the treatment of photodamaged facial skin, utilizing a microneedle roller prior to incubation and combined irradiation with red light and broadband pulsed light in a single treatment. MATERIALS AND METHODS: A full-face treatment of 21 patients was performed with 630 nm light and broadband pulsed light after multiple passes with a microneedle roller and 1-hour ALA incubation. The primary endpoint was clinical improvement, scored during two separate live assessments by three physicians blinded to previous scores, using a 5-point standardized photoaging scale. The secondary endpoint was evaluation of patient satisfaction based on a quartile scale comparing baseline to 6-month post-treatment photography. RESULTS: Statistically significant improvement was seen in the global photoaging scores, as well as sub-components of the scale (fine lines, mottled pigmentation, sallowness, tactile roughness, and telangiectasias) at 3 months as compared with baseline live assessment, and at 6-month live assessment compared with the 3 months. In addition, 90% of patients judged clinical improvement to be greater than 50% at 6 months compared to baseline photography. CONCLUSION: Use of a microneedle roller to "pre-treat" prior to application of ALA appears to be well tolerated and allows for even absorption and perhaps deeper penetration of ALA following a defined incubation period. Use of red light and broadband pulsed light allowed for deeper activation of ALA, potentially accounting for marked clinical improvement in photoaging.

New Developments for Fractional Co2 Resurfacing for Skin Rejuvenation and Scar Reduction.

Fractional CO2 procedures are an established, safe and effective armamentarium for managing skin rejuvenation and scarring. Very short-pulse-duration devices offer a very high ablated volume/ablated surface ratio, inducing a controlled thermal damage. With this kind of device, each procedure can be customized on the features of the skin of each patient. The same device can be used to treat severe burn scars. With a very deep fractional procedure on a scar tissue, immediate relaxation of the tension and retraction forces may be obtained, and downstream, improvements are related more to the activation of a molecular cascade. The authors review the state-of-the-art, in the use of fractioned CO2 laser technology for aesthetic and scar remodelling indications.

3D in vivo optical skin imaging for intense pulsed light and fractional ablative resurfacing of photodamaged skin.

The authors present a 3D in vivo imaging system used to assess the effectiveness of IPL and fractional laser treatments of photodamaged skin. Preoperative and postoperative images of patients treated with these procedures are analyzed and demonstrate the superior ability of this 3D technology to reveal decrease in vascularity and improvement in melanin distribution and calculate the degree of individual deep wrinkles before and after treatment.

Clinical evaluation of a new self-drying silicone gel in the treatment of scars: a preliminary report.

Topical silicone gel sheeting and intralesional steroids are the only evidence-based recommendable forms of treatment to control the quality of a scar. The advantages and disadvantages of both are well known. This study was undertaken to verify the efficacy of a new topical silicone treatment: a self-drying spreadable gel that needs no means of fixation and cannot be seen because of complete transparency. Fresh surgical scars treated with the tested product showed significantly better outcomes than those untreated in a prospective trial involving a group of 160 patients. Patient compliance was particularly good, especially for scars on exposed areas such as the face, where the traditional gel sheeting is frequently discontinued at an early stage by patients who object to its visibility. The results of the self-drying silicone gel have indeed been satisfactory. Considering the effective results obtained and the good patient compliance, the authors currently rate this concept of treatment as the first choice for preventing hypertrophy of recent scars.

Non-sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: preliminary clinical report.

This study evaluates results, adverse side effects and downtime of the protocol 'ActiveFX' for photodamaged facial skin. A non-sequential fractional ultrapulsed CO2 laser with specific settings is used in addition to a new computer pattern generator (CPG). From September 2006 to March 2007, 55 patients underwent this new 'soft' single-session, single-pass and full-face ablative fractional treatment. The patients were evaluated at baseline and 1 and 3 months after the treatment using a five-point scale. Seven aspects of photodamaged skin were recorded: global score, fine lines, mottled pigmentation, sallow complexion, tactile roughness, coarse wrinkles and telangiectasias. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Eight patients received a double-pass treatment on the crow's feet regions and the improvement of the coarse wrinkles was analyzed with a quartile grading scale. Significant differences (p<0.05) between baseline and 1 and 3 months post-treatment were observed for all features except telangiectasias. Coarse wrinkles presented a good improvement only in the regions submitted to a double-pass. Minimal and isolated adverse side effects were noted and the downtime was very low. Non-sequential fractional ultrapulsed CO2 light treatment ('ActiveFX') can be considered an excellent alternative for photodamaged facial skin.

Intense pulsed light treatment of 1,000 consecutive patients with facial vascular marks.

BACKGROUND: Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. METHODS: Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1-9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. RESULTS: Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. CONCLUSION: The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.

Facial teleangectasias: our experience in treatment with IPL.

BACKGROUND AND OBJECTIVES: Facial teleangectasias can be a relevant cosmetic problem, which the patient usually hides with a thick layer of makeup. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. METHODS: Five hundred eighteen consecutive patients were treated with Photoderm VL (Lumenis Ltd.). The average age of patients of various skin types (Fitzpatrick I to IV) was 48.5 years. They were subjected to a mean of 1.69 treatments (range 1-9) followed up 48 hours, 72 hours, 1 week, 3 weeks, and 1 month after each treatment. All patients were followed up after 2 months from the last treatment and the percentage of clearance was assessed by comparing pre- and post-treatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The physicians evaluation was also recorded on the same form. RESULTS: Patients (87.64%) presented a clearance of 75%-100%. The results appear not correlated with lesions size, age, skin type but with operator experience. Minimal side adverse effects occurred in 20% of the patients. CONCLUSION: The IPL source, Photoderm VL, can be considered an alternative or a supplement to the existing laser devices for facial teleangectasias treatment.