Photoaging assessment by Glogau classification: correlation of dermoscopy findings in the coastal population of Indonesia.

INTRODUCTION: To date, there is no gold standard for identifying photoaging. This study investigates the correlation of photoaging profiles based on the Glogau scale and the dermoscopy photoaging scale (DPAS) in a coastal population. METHODS: An analytical cross-sectional study was conducted at Cilincing Municipal Health Center in Jakarta in October 2022. Individuals living in the coastal area, 20 years and older, with Fitzpatrick skin types III-V, and with a mean daily sun exposure of ≥ 3 hours were included. The Glogau scale and DPAS were assessed through history taking, physical examination, and dermoscopic examination. A Spearman correlation test was used to assess the correlation between the Glogau scale and DPAS. RESULTS: Thirty individuals with a mean age of 41.5 ± 11.5 years participated in the study. The median Glogau score was 3 (range: 2-4). The mean DPAS score was 28.5 ± 5.6. Lentigo, hypo-hyperpigmented macules, telangiectasia, deep wrinkles, and superficial wrinkles were observed in all subjects. There was a moderate positive correlation between the Glogau scale and DPAS (r = 0.536, p = 0.002). CONCLUSIONS: The Glogau scale has a significant correlation with DPAS. DPAS can serve as a reliable, easy, practical, and fast diagnostic tool to assess the severity of aging.

Higher Responder Rates Observed With Live Participant Assessment Versus Photographic Assessment After VYC-20L Hyaluronic Acid Treatment for Chin Augmentation.

BACKGROUND: In an evaluator-blinded, randomized controlled trial, the hyaluronic acid soft-tissue filler VYC-20L injectable gel was safe and effective for correcting volume deficits and retrusion in the chin. OBJECTIVES: The objective of this subanalysis was to compare responder rates obtained with photographic vs live assessments. METHODS: Participants were randomized 3:1 to VYC-20L treatment or a 6-month, no-treatment control period followed by optional treatment. Responder rates (≥1-point improvement from baseline on the validated Allergan Chin Retrusion Scale [ACRS]) obtained with photographic assessments and live assessments at Month 6 were compared. Prespecified subgroup analyses compared responder rates by baseline ACRS severity, filler volume, cannula usage, and investigation site. RESULTS: VYC-20L was effective for chin augmentation as evaluated with both live and photographic assessments. The ACRS responder rates at Month 6 were 91.8% with live assessments and 56.3% with photographic assessments. Consistently higher response rates were observed by live vs photographic assessment regardless of baseline ACRS severity, filler volume, cannula usage, and investigation site. CONCLUSIONS: Live assessment of ACRS response after VYC-20L treatment resulted in higher responder rates than photographic assessment, supporting the use of live assessment for this indication to approximate real-world clinical practice.

Assessment of in vitro anti-skin aging activities of Phyllanthus indofischeri Bennet extracts for dermatological and aesthetic applications.

Giant Indian Gooseberry (GIG) or Phyllanthus indofischeri Bennet are commercially cultivated and commonly used herbs in Traditional medicine, especially in Thailand. The aim of this study was to assess the potential of the GIG extracts in anti-aging activities to be a dermatological application. The juice, meat residues, and seeds of GIG collected from Sra Kaeo Province, Thailand, were extracted by the Boiling method (B) and the Maceration process (M) by using 95% ethanol as a solvent. The GIG extracts gave the total phenolic, total flavonoid contents and quercetin contents, as well as exhibited anti-oxidative activities. The GIG-R-B extract inhibited tyrosinase activity and had the highest anti-melanogenesis activity on B16F10 cells at 31.63 ± 0.70%. The GIG-S-B, GIG-S-M, and GIG-R-M extracts demonstrated the highest collagen biosynthesis, which was comparable to vitamin C (p < 0.05), whereas the GIG-R-B extracts gave the highest stimulation of anti-aging genes (SIRT1 and FOXO1). All extracts at the concentration of 0.1 mg/mL showed no cytotoxicity on human skin fibroblasts. Therefore, the GIG-S-B extract was discovered to be a promising natural anti-aging agent for dermatological health and aesthetic applications that can be further developed in cosmetic, functional food and food supplement industries.

Assessment of efficacy of carboxytherapy in management of skin aging through evaluation of gene expression profile: a 2-split randomized clinical trial.

Skin aging is a continuous and irreversible process which results in impairment of the skin role as barrier against all aggressive exogenous factors. It mainly manifests by photoaging, laxity, sagging, wrinkling, and xerosis. Carboxytherapy is considered as a safe, minimally invasive modality used for rejuvenation, restoration, and recondition of the skin. In the current study, the efficacy of carboxytherapy in the treatment of skin aging was assessed through investigation of gene expression profile for Coll I, Coll III, Coll IV, elastin, FGF, TGF-ß1, and VEGF. Our study is a 2-split clinical trial in which carboxytherapy was performed on one side of the abdomen in 15 cases with intrinsically skin aging manifestations weekly for 10 sessions, while the other side of the abdomen was left without treatment. Two weeks after the last session, skin biopsies were taken from both the treated and control sides of the abdomen in order to assess gene expression profile by qRT-PCR. The analysis of gene expression levels for all of Coll I, Coll III, Coll IV, elastin, TGF-ß1, FGF and VEGF genes showed a statistically significant difference between the interventional and control groups. The findings for all of these seven genes showed increase in the interventional group, among which Coll IV, VEGF, FGF, and elastin showed the higher mean changes. Our study confirmed the effectiveness of carboxytherapy in treating and reversing the intrinsically aging skin.Clinical Trial Registration Code and Date of Registration: ChiCTR2200055185; 2022/1/2.

Tolerability and efficacy assessment of an oral collagen supplement for the improvement of biophysical and ultrasonographic parameters of skin in middle eastern consumers.

BACKGROUND: Topical skin care products often do not reach the deeper layers of the skin, and oral hydrolyzed collagen is one of the newest and most popular systemic supplementations for skin rejuvenation. However, there are limited information in case of Middle Eastern consumers OBJECTIVE: The purpose of this study was to evaluate the tolerability and efficacy of an oral collagen supplement for improvement of skin elasticity, hydration, and roughness in Middle Eastern consumers. METHODS AND MATERIALS: It was a 12-week, before-after clinical study, conducted on 20 participants (18 women and 2 men) aged 44.15 ± 5.36 years with skin type III-IV. Skin elasticity parameters (R0, R2, R5, and R7), skin hydration and friction, as well as the thickness and echo density of the dermis, were measured after six and 12 weeks daily intake of the study product, as well as 4 weeks after stopping its use (week 16). Participants' satisfaction was assessed on the basis of their answers to the standard questionnaire, and tolerability of the product was assessed by monitoring the adverse effects. RESULTS: A significant improvement was detected in R2, R5, and skin friction at week 12 (p-values 0.041, 0.012 and <0.01, respectively). At week 16, the values remained at an increased level, which indicates the persistence of the results. The increase of dermis density in week 16 was also significant (p-value = 0.03). Moderate overall satisfaction was reported with the treatment, and a few gastrointestinal complications were reported. CONCLUSION: The study demonstrated that oral collagen peptides could significantly improve the skin elasticity, roughness, and dermis echo density, and they also proved to be safe and well-tolerated.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.

BACKGROUND: There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. OBJECTIVES: The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. METHODS: A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS: The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. CONCLUSIONS: The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.

Objective, measurable assessment of the elasticity of the skin around the eyes following the carboxytherapy treatment.

BACKGROUND: Carboxytherapy is one of the most popular procedures used in dermatology. The treatments are known to be minimally invasive and highly effective for various skin disorders. Therefore, the research carried out in the paper is purposeful and addresses an important area of aesthetic therapies. AIMS: Objective, apparatus-based assessment of the effect of carboxytherapy on skin elasticity around the eyes. PATIENTS/METHODS: The study included a group of 39 Caucasian individuals aged 35-55 years. Participants were subjected to a series of five carboxytherapy treatments of eye area at weekly intervals. The Cutometer measuring probe was used to assess skin elasticity. Additionally, photographic documentation was out using the Fotomedicus system. RESULTS: In this study, statistically significant increase in R2 parameter was found as the result of applied treatment. This parameter is considered to be the most important indicator of changes in skin elasticity. In 29 out of 39 subjects, the carboxytherapy treatment significantly improved skin tension and elasticity. Such therapy may also exert a beneficial effect on flexibility since in 28 participants the favorable change in the R7 parameter was visible. CONCLUSIONS: The objective analysis of the impact of carboxytherapy treatment on parameters determining skin elasticity revealed that this therapy can be used as an anti-aging method in the eye area. Obtained results are in agreement with other biochemical, histological, and photographical documentation analyses of the effect of carboxytherapy on skin, performed by independent researchers.

Establishment and validation of visual assessment for the severity of lacrimal groove wrinkles in Chinese females.

OBJECTIVE: This study was undertaken to establish and validate a new wrinkle clinical assessment scale to measure Chinese Han women`s validated lacrimal groove. METHODS: Three clinical investigators asked to rate lacrimal groove wrinkles severity one each side for 30 photographic images from 15 subjects. Five-grade rating scale has been used in this clinical assessment. Scale definitions was standardized by 6 researchers in visual and descriptive formats. Assessments were conducted independently and were repeated after 1 week. RESULTS: For 30 photos from 15 subjects, test-retest of three investigators analyzed by Spearman's correlation were between 0.967 and 0.993 (p < 0.001), and by ICC Cronbach's α were between 0.989 and 0.997 (p < 0.001); intraobserver agreement of three investigators analyzed by Spearman's correlation were between 0.652 and 0.897 (p < 0.001), and by ICC Cronbach's α were between 0.840 and 0.959 (p < 0.001). CONCLUSION: This lacrimal groove wrinkles visual assessment scale is a valid and reliable instrument for quantitative assessment of China woman skin folds with inter- and intraobserver consistency. This assessment scale should prove a useful clinical tool by allowing objective and reproducible grading for assessing the effectiveness of lacrimal groove area.

Aesthetic Implantation of Calcium Hydroxylapatite Does Not Interfere With Radiological Assessment of Bones in the Dorsum of the Hands.

BACKGROUND: Calcium hydroxylapatite (CaHA) is a radiopaque dermal filler used to provide volume correction in the dorsum of the hand. OBJECTIVES: The aim of this study was to evaluate whether CaHA implantation in the dorsum of the hand interferes with radiological assessment by obscuring the bones. METHODS: This 2-year, prospective, single-center, open-label study enrolled 20 subjects with Merz Hand Grading Scale (MHGS) grades ranging from moderate (MHGS 2 or 3; n = 10) to very severe (MHGS 4; n = 10). All subjects received an initial CaHA treatment and were offered up to 3 retreatments to provide volume correction in the dorsum of the hands, over a period of 18 months. Bone obscuration was assessed by blinded, licensed radiologists responsible for interpreting plain radiographs (X-rays). RESULTS: CaHA was seen to be present in 100% of hands in Month 1 X-rays and in 83.3% in Month 24 X-rays, but no bone obscuration was reported in any X-rays at any evaluated time point. CONCLUSIONS: According to blinded radiologists, treatment with CaHA in the dorsum of the hand does not obscure radiographic assessment of the bones seen on X-rays up to 24 months after initial injection. The safety of CaHA retreatment was also demonstrated by the lack of bone obscuration after multiple retreatments.

Integrative Assessment for Optimizing Aesthetic Outcomes When Treating Glabellar Lines With Botulinum Toxin Type A: An Appreciation of the Role of the Frontalis.

Despite the perception that treatment of glabellar lines with botulinum toxin A is straightforward, the reality is that the glabellar region contains a number of interrelated muscles. To avoid adverse outcomes, practitioners need to appreciate how treatment of 1 facial muscle group influences the relative dominance of others. In particular, practitioners need to understand the independent role of the frontalis in eyebrow outcomes and the potential for negative outcomes if the lower frontalis is unintentionally weakened by botulinum toxin A treatment. In addition, practitioners must recognize how inter-individual variation in the depth, shape, and muscle fiber orientation among the upper facial muscles can affect outcomes. For optimal results, treatment of the glabellar complex requires a systematic and individualized approach based on anatomical principles of opposing muscle actions rather than a one-size-fits-all approach. This review provides the anatomical justification for the importance of an integrated assessment of the upper facial muscles and eyebrow position prior to glabellar treatment. In addition, a systematic and broad evaluation system is provided that can be employed by practitioners to more comprehensively assess the glabellar region in order to optimize outcomes and avoid negatively impacting resting brow position and dynamic brow movement.

Assessment of the Interference of Hyperdiluted Calcium Hydroxyapatite for Neck Rejuvenation in the Ultrasonographic Evaluation of Thyroid.

BACKGROUND: Sagging neck skin is a common complaint, and the use of calcium hydroxyapatite injection is a traditional treatment approach for this region. The published literature is limited concerning the possible interference in imaging exams of hyperdiluted product, which presents radiopaque features, for the assessment of deep structures to the application. OBJECTIVE: To assess possible interferences in the ultrasonographic evaluation of thyroid after application of hyperdiluted CaHA on the neck region. METHODS: This was a prospective, blinded, and controlled study. Patients had their cervical regions treated with diluted CaHA (1:4). Ultrasonographic evaluations of thyroid were conducted on day 0 (pre-procedure), day 15, and day 60 by two radiologists blinded to the application. RESULTS: On day 0 no exclusion criteria were observed. On day 15 technical artifacts that difficulted the evaluation but did not make the complete assessment of the thyroid unable, were seen. On day 60 the artifacts of posterior acoustic shadowing were considerably reduced, not bringing any difficulty whatsoever for evaluation of the gland. CONCLUSION: Treatment of sagging neck skin with diluted CaHA in 1:4 does not negatively impact the ultrasonographic evaluation of the thyroid as early as 15 days, and particularly after 60 days from the procedure.J Drugs Dermatol. 2022;21(11):1243-1248. doi:10.36849/JDD.6877.

Assessment of features in facial hyperpigmentation: Comparison study between VISIA and CSKIN.

BACKGROUND: Hyperpigmentary disorder is one of the commonest skin concerns in dermatology clinics. The availability of noninvasive instruments provided a convenient, objective, and reproducible methodology for the evaluation of pigmentation and skin color. The aim of this study is to compare CSKIN and VISIA in measuring facial hyperpigmentation, as well as to assess the correlation between the instrumental analyzing and clinical evaluation. METHODS: Eighty Chinese patients were enrolled. Images were taken and analyzed by VISIA from Canfield and CSKIN from Yanyun Technology, and the facial hyperpigmentation was graded by three dermatologists. RESULTS: Feature counts within the facial pigmented areas analyzed by VISIA showed positive correlations with brown pixels (r = 0.331, p < 0.05) and brown percent (r = 0.395, p < 0.0001) measured by CSKIN. The parameters measured by CSKIN and VISIA were significantly correlated with visual scores graded by the dermatologists, with VISIA presenting a moderate correlation (r = 0.509, p < 0.001) and CSKIN a slightly stronger correlation with the visual scores (r = 0.653, p < 0.001). CONCLUSION: CSKIN could serve as an alternative in the assessment and follow-up of skin disease featuring with facial hyperpigmentation.

Impact on the Quality of Life Following Minimally Invasive Cosmetic Procedures: Assessment Through the Skin Rejuvenation Outcome Evaluation Questionnaire.

BACKGROUND: Aesthetic procedures are widely performed by dermatologists and plastic surgeons, often with subjective results. In cosmetic dermatology, there is a lack of studies that use accurate instruments to assess result outcomes. Quality of life (QoL) questionnaires can objectively assess results. OBJECTIVE: To assess the impact of nonsurgical facial cosmetic procedures on QoL. MATERIALS AND METHODS: This was a longitudinal observational study performed with 81 patients who underwent facial cosmetic procedures at a University Hospital in Rio de Janeiro, Brazil. The Skin Rejuvenation Outcome Evaluation questionnaire, previously adapted and translated to the Portuguese language spoken in Brazil, was selected, and the results were compared with the Dermatology Life Quality Index. The impact on QoL was statistically evaluated after the interventions. RESULTS: The Skin Rejuvenation Outcome Evaluation scores after the procedures were significantly higher than before ( p < .001), independent of sociodemographic characteristics. Patients treated with botulinum toxin and dermal fillers showed greater satisfaction than those treated with laser, chemical peels or microneedling. CONCLUSION: Minimally invasive cosmetic procedures result in improvements in QoL. The use of translated, adapted, and validated questionnaires favors the comparison of results among different populations and reinforces the confidence on the results of established cosmetic treatments.

High-Frequency Ultrasound for Long-term Safety Assessment of Poly-L-Lactic Acid Facial Filler.

BACKGROUND: Injectable poly- l -lactic acid (PLLA) is a new type of biodegradable dermal filler that has been utilized for soft tissue filling. However, there is no convenient and reliable method to assess the long-term safety of PLLA filler. OBJECTIVE: To assess the long-term safety of PLLA injection into nasolabial folds by high-frequency ultrasound and to select the ultrasonic probes with the most appropriate frequency. MATERIALS AND METHODS: After a 30-month PLLA injection into the deep dermis of the nasolabial fold, subjects were examined by high-frequency ultrasound with the 20 MHz and 50 MHz probes. RESULTS: Twenty subjects with nasolabial fold contour deficiency were enrolled in this study. After a 30-month PLLA injection in nasolabial folds, PLLA degraded entirely in 16 subjects (16/20, 80%), and abnormal echo in the skin was observed in 4 subjects (4/20, 20%) caused by undegraded PLLA microparticles, PLLA microparticles deposition, fibrous nodules, and granuloma. The 20-MHz probe is more appropriate than the 50-MHz probe for evaluating the adverse effects of PLLA injection. CONCLUSION: High-frequency ultrasound is a rapid, reliable, and noninvasive method to monitor the degradation condition of PLLA and the formation of papules and nodules associated with PLLA injection.

Open-Label assessment of the efficacy and tolerability of a skin care regimen for treating subjects with visible and physical symptoms of sensitive skin.

BACKGROUND: Sensitive skin is a common concern with 60%-70% of women and 50%-60% of men reporting skin sensitivity and redness. Facial redness is associated with a higher incidence of embarrassment, social anxiety, and diminished quality of life. While there is no cure for sensitive skin, it can be controlled. AIMS: The objective of this 12-week, open-label clinical trial was to assess the efficacy and tolerability of a topical facial regimen for treating subjects with facial redness and sensitive skin. PATIENTS/METHODS: Enrolled subjects were healthy male and female individuals, 25-60 years old with Fitzpatrick skin types I-VI who were seeking treatment for moderate or severe facial redness. Subjects were provided with products which were applied each morning and evening. The investigator assessed change in subject appearance using Overall Redness and Global Improvement Scales and subjects rated changes in appearance and tolerability with self-assessment scales. RESULTS: The mean Overall Redness Scale Score improved by 34% and 25% at Weeks 8 and 12, respectively. There was Mild or Moderate improvement in Global Improvement Scale scores beginning at Week 2 with over 50% achieving Marked improvement by Week 12. All subjects Agreed or Strongly Agreed that their facial redness was less noticeable, their skin appeared less inflamed, overall skin appearance improved, and skin looked and felt healthier at Week 12. The regimen was well-tolerated. CONCLUSIONS: This study demonstrated a treatment regimen designed to neutralize skin redness and calm inflamed skin was well-tolerated and improved the symptoms of sensitive skin.

Assessment of a 3050/3200 nm fiber laser system for ablative fractional laser treatments in dermatology.

BACKGROUND AND OBJECTIVES: Mid-infrared (IR) ablative fractional laser treatments are highly efficacious for improving the appearance of a variety of dermatological conditions such as photo-aged skin. However, articulated arms are necessary to transmit the mid-IR light to the skin, which restricts practicality and clinical use. Here, we have assessed and characterized a novel fiber laser-pumped difference frequency generation (DFG) system that generates ablative fractional lesions and compared it to clinically and commercially available thulium fiber, Erbium:YAG (Er:YAG), and CO2 lasers. MATERIALS AND METHODS: An investigational 20 W, 3050/3200 nm fiber laser pumped DFG system with a focused spot size of 91 µm was used to generate microscopic ablation arrays in ex vivo human skin. Several pulse energies (10-70 mJ) and pulse durations (2-14 ms) were applied and lesion dimensions were assessed histologically using nitro-blue tetrazolium chloride stain. Ablation depths and coagulative thermal damage zones were analyzed across three additional laser systems. RESULTS: The investigational DFG system-generated deep (>2 mm depth) and narrow (<100 µm diameter) ablative lesions surrounded by thermal coagulative zones of at least 20 µm thickness compared to 13, 40, and 320 µm by the Er:YAG, CO2 , and Thulium laser, respectively. CONCLUSION: The DFG system is a small footprint device that offers a flexible fiber delivery system for ablative fractional laser treatments, thereby overcoming the requirement of an articulated arm in current commercially available ablative lasers. The depth and width of the ablated microcolumns and the extent of surrounding coagulation can be controlled; this concept can be used to design new treatment procedures for specific indications. Clinical improvements and safety are not the subject of this study and need to be explored with in vivo clinical studies.

Assessment of Circadian-based Antioxidants Plus a Comprehensive Brightener in Skin of Color Patients With Hyperpigmentation.

BACKGROUND: Hyperpigmentation disorders disproportionately affect individuals with skin of color. There is an unmet need for safe and effective topical treatments for this population. OBJECTIVE: The efficacy and tolerability of LYT2 in combination with LVS were assessed in skin of color patients with moderate to severe facial hyperpigmentation. METHODS: A single-arm study was performed in Asian, Hispanic, or African American patients (Fitzpatrick phototypes III–VI). Subjects applied LYT2 and LVS daily, in addition to a basic skincare regimen, for 12 weeks. Overall hyperpigmentation, skin-tone evenness, and radiance were evaluated by the investigator, and subjects completed questionnaires regarding self-perceived efficacy. RESULTS: After 12 weeks, the combination of LYT2 and LVS produced a 23% improvement in overall hyperpigmentation, a 33% increase in skin-tone evenness, and a 51% increase in radiance compared to baseline. At the study conclusion, all patients noted at least a slight improvement in skin condition, and 70% reported good or excellent satisfaction. One subject (8%) experienced a treatment-related adverse event. CONCLUSION: The combination of LYT2 and LVS was well-tolerated and improved the appearance of hyperpigmentation and overall quality in skin of color. J Drugs Dermatol. 2022;21(4):376-380. doi:10.36849/JDD.6687.

Social Profiloplasty: A Practical Assessment and Injection Guide.

The trend of aesthetic medical procedures continues growing every year since decades all over the globe, especially considering minimal invasive treatments since the results are immediate and the downtime minimal. Hence, treatments with hyaluronic acid fillers have become extremely popular and routinely used in common practice. However, numerous areas of treatment were identified and described in the last years clinical training and consciousness of possibly complication remain still under represented. In the following article, we present four key treatment areas for optimal overall facial rejuvenation of what the authors define the social profile. Of each area an assessment, anatomical considerations, danger zones, and the preferred personal technique of the authors are described.

ONE21 technique for an individualized assessment and treatment of upper face wrinkles in five pairs of identical twins with IncobotulinumtoxinA.

BACKGROUND: Facial aging is a complex process, which, beyond a genetic predisposition, involves both physical and environmental factors. Even identical twins with the same genetic load may differ substantially in facial wrinkles and aging, demanding a personalized treatment approach. OBJECTIVE: To demonstrate the ONE21 technique as an excellent tool to a customized assessment and IncobotulinuntoxinA treatment to address phenotype discordances and epigenetic drifts in identical twins, expressed by different patterns of upper face muscle contractions and wrinkles intensity. PATIENTS/METHODS: Five pairs of identical Caucasian twin sisters, from 30 to 45 years of age, were evaluated for hyperfunctional upper facial wrinkles (forehead, glabella, and periorbital), assessing the individual anatomy, muscle function and habitual facial movements of each patient. All the subjects were treated with the ONE21 technique using IncobotulinumtoxinA and reevaluated 30 days after the procedure. RESULTS: Though the clinical-anatomical pattern of the forehead contraction was similar between the pairs, the strength of the muscles, the number and depth of wrinkles differed. This varied presentation demanded distinct points of distribution and dosages of incobotulinumtoxinA for all the twins, according to the ONE21 approach. The results 30 days after treatment were satisfactory in all the subjects. CONCLUSION: The ONE21 technique allows an objective and careful evaluation of the wrinkles of the upper face, based on an individualized assessment, which may vary even in identical twins.