Effects of a Topical Growth Factor Regimen Following Pre-elected Cosmetic Facial Injection Procedures.

BACKGROUND: There are limited studies evaluating topical cosmetic skincare products following cosmetic facial injections. OBJECTIVE: An open-label study assessed a novel medical-grade topical skincare regimen following cosmetic facial injections. METHODS: The study enrolled 20 women with moderate to severe facial photodamage who used non–physician-dispensed skincare products and pre-elected to receive facial neuromodulator and hyaluronic acid (HA) dermal filler injections. All subjects continued regular skincare through week 4 after facial injection, then switched to the novel regimen (growth factor product, TNS Advanced+; day/night antioxidant serum system, Lumivive; HA-based hydrator, HA5; and basic skincare components) through week 16. RESULTS: At week 4, significant (P≤0.05) improvements from baseline were seen for multiple investigator-graded skin quality parameters, including overall photodamage, tactile roughness, and skin tone evenness, as well as fine and coarse lines/wrinkles. After switching to the novel regimen, additional significant improvements in overall skin quality and forehead, cheek, and perioral fine lines/wrinkles were observed at week 8 (all P≤0.05 vs week 4), which continued through week 16. CONCLUSION: This study highlights the importance of topical skincare in conjunction with cosmetic facial injections to holistically optimize overall skin quality and appearance. J Drugs Dermatol. 2023;21(1): doi:10.36849/JDD.7160.

Intense Pulsed Light: A Methodical Approach to Understanding Clinical Endpoints.

BACKGROUND: Intense Pulsed Light (IPL) is a non-coherent polychromatic broadband filtered flashlamp that emits light in the spectrum of approximately 400–1200 nm. Its effects on photorejuvenation are well documented. The goal of this study is to help practitioners better conceptualize and fine tune IPL device settings in order to produce the most effective and safest clinical outcome. MATERIALS/METHODS: This was a prospective study testing several filters (515 nm; 560 nm; 590 nm and 530–650; 900–1200 nm vascular filter), fluences, pulse durations, and pulse numbers (ie, multiple sequence pulsing or MSP) with a new IPL system. RESULTS: Post-procedure erythema response was more pronounced with increasing fluence, decreasing wavelength, fewer pulses and shorter pulse duration. The exception was the 515 nm filter with regard to pulse duration, which was observed to have a more pronounced response with longer pulse durations. The overall clinical outcome at the 4-week follow-up visit demonstrated greatest improvement in erythema and pigmentation using the 515 nm filter on a Fitzpatrick Skin Type III individual. CONCLUSION: Greatest clinical endpoint response at 4-week follow-up was observed with more robust initial responses. This was most apparent at higher fluence levels and fewer pulse counts. However, when the IPL is pushed to aggressive parameters, there is risk of hypopigmentation and hair loss as seen in this case study. Skin type is an important consideration when using IPL and MSP adds to its safety profile. J Drugs Dermatol. 2021;20(2):203-207. doi:10.36849/JDD.5638.

A Dynamically Cooled, Variable Spot-Sized 1,064 nm Neodymium-doped Yttrium Aluminum Garnet Laser as a Treatment Option for Facial Reticular Veins.

BACKGROUND: Facial reticular veins can be treated with laser therapy, sclerotherapy, or surgical removal. The use of a 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been reported to be successful in the treatment of facial reticular veins. OBJECTIVE: To report a large retrospective study examining the efficacy, side effects, and satisfaction of a dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser for the treatment of facial reticular veins in the periorbital and temporal area. PATIENTS AND METHODS: Contact was made with 100 patients from 2006 to 2019 who underwent treatment with a 1,064 nm Nd:YAG laser for facial reticular veins through office follow-up or telephone interviews. Percent resolution of veins, satisfaction, and adverse effects were evaluated. RESULTS: Eighty-nine of the 100 patients ranked their satisfaction with the treatment as 3 or very satisfied. Most patients reported 75% to 100% improvement. The most commonly reported adverse event seen after treatment was mild edema. Sixty-eight percent of patients reported no adverse effects at all. CONCLUSION: The dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins with minimal side effects. The results are usually immediate and, based on the long-term follow-up, tend to be long lasting.

Evaluation of Long-Term Outcome and Patient Satisfaction Results After Tumescent Liposuction.

BACKGROUND: Liposuction is one of the most common cosmetic surgery procedures around the world. Tumescent liposuction using local anesthesia has been shown to be the safest technique. Few long-term studies of results and satisfaction have been published on tumescent liposuction. OBJECTIVE: To evaluate long-term results and patient satisfaction of tumescent liposuction in a single-center institution. METHODS: Patients (n = 600) who had tumescent liposuction performed in our practice from 2002 to 2014 were contacted through letter, email, or phone to complete a questionnaire survey and in-office follow-up visit regarding their past liposuction procedures. RESULTS: Thirty-two patients (n = 32) completed the patient questionnaire survey and followed up in the office. Surgeon and blinded evaluators saw significant differences in both the neck volume (surgeon evaluator: 2.42 vs. 0.71, p < .01; blinded evaluator: 2.8-1, p = .02) and Investigator Assessment Skin Laxity scales (blinded evaluator: 1.14 vs. 0.77, p < .01 for laxity and 1.33 vs. 0.75, p < .01 for firmness; surgeon evaluator: 1.17 vs. 0.83, p = .01 for laxity and 1.31 vs. 0.83; p < .01 for firmness). The mean follow-up period was 8.9 years overall and 9.9 years for the neck. Overall, 85.7% of the patients would recommend liposuction to their friends and family members. CONCLUSION: Tumescent liposuction is a safe procedure with long-lasting results and high patient satisfaction.

A Single Site, Open Label Clinical Trial, Evaluating the Duration, Efficacy, and Safety of a Novel Lip Plumper.

INTRODUCTION: Lip plumpers are topical agents that offer immediate, but temporary, volumization of the lips. While these products are becoming increasingly popular and are available at multiple retailers, there is a lack of clinical studies to evaluate the efficacy, longevity, and safety of the lip plumping products. METHODS: This is a prospective, single center, clinical trial to evaluate the duration, efficacy, and safety of a lip plumping agent in two clinical visits. Lip volume and adverse event were assessed by two clinicians at various time points: 15 minutes, 1 hour, 2 hours, 3 hours, and 4 hours. RESULTS: Twenty-two subjects were enrolled in the study, and eighteen completed the study. Investigator assessments of global improvement 15 minutes after application of the lip plumping product demonstrated improvement in lip fullness in 100% of the subjects (18/18), and 1 hour post-application 67% (12/18) showed an improvement in lip fullness that was statistically significant compared to the 2-hour assessment (P less than 0.05). Subject evaluations noted improvement in lip fullness 15 minutes post-application in 94.4% (17/18) of subjects, and 1 hour post-application, 89% (16/18) of the subjects who completed the trial noted some improvement in the volume of their lips that was statistically significant compared to the 2-hour post-application time point (P less than 0.0001). Subjects noted that they did experience a tingling and heat sensation, but a majority noted that that this sensation lasted less than 15 minutes. DISCUSSION: Our study demonstrated that the lip plumping product increased lip volume in almost all patients 15 minutes post-application and showed a continued improvement in lip fullness per investigator assessments 1 hour after application. Adverse events of a tingling or heat sensation were expected and observed as the topical product contained capsaicin, cinnamon, and menthol, all of which can induce this sensation by the release of substance P. J Drugs Dermatol. 2018;17(9):999-1004.

Prospective studies of the efficacy and safety of the picosecond 755, 1,064, and 532 nm lasers for the treatment of infraorbital dark circles.

BACKGROUND: Infraorbital dark circles result from a combination of factors. The fractionated picosecond 755 nm alexandrite laser and dual wavelength picosecond Nd:YAG laser have not been examined as a method of addressing infraorbital hyperpigmentation. OBJECTIVE: To determine the efficacy and safety of treatment of infraorbital dark circles using fractionated picosecond 755 nm and dual wavelength picosecond Nd:YAG laser. METHODS AND MATERIALS: These trials did not utilize a comparative design; rather, these were separate, prospective, open-label, evaluator-blinded trials utilizing two treatment regimens: (i) 19 adult subjects were treated in a single session with the dual wavelengths of 532 nm and 1,064 nm in consecutive passes using the fractionated lens; (ii) 10 adult subjects were treated using the picosecond 755 nm laser via the fractionated lens in three treatment sessions at 3 week intervals. Subjects in both studies were followed-up for blinded-investigator assessment of infraorbital hyperpigmentation, adverse events, and improvement compared to baseline. RESULTS: The dual wavelength picosecond Nd:YAG laser, blinded-investigator assessment did not demonstrate a significant improvement in infraorbital hyperpigmentation at day 60 (P = 0.16). The picosecond 755 nm alexandrite laser significantly improved infraorbital hyperpigmentation by day 42, with improvement maintained through day 132 (P = 0.07 and 0.00001, respectively). Adverse events were mild and temporary. CONCLUSION: A single treatment with the fractionated picosecond 1,064/532 nm lasers did not produce a significant improvement in infraorbital hyperpigmentation. A series of three treatments with the fractionated picosecond 755 nm laser resulted in significant improvement in hyperpigmentation. Lasers Surg. Med. 50:45-50, 2018. © 2017 Wiley Periodicals, Inc.

The Efficacy of Massage in Reducing Nodule Formation After Poly-L-Lactic Acid Administration for Facial Volume Loss: A Randomized, Evaluator-Blinded Clinical Trial.

BACKGROUND: The risk of nodule formation following poly-L-lactic acid (PLLA) injections for facial volume loss is well known. Traditionally, post-treatment massage according to the 5-5-5 rule (5 times per day for 5 minutes for 5 days) has been applied to mitigate this risk. However, such a regimen may be onerous for patient compliance. Using currently accepted injection technique and product dilution, the efficacy of massage for nodule prevention has never been formally evaluated. OBJECTIVE: To evaluate the efficacy of massage in reducing the incidence of nodule formation post-PLLA injection. MATERIALS AND METHODS: After obtaining informed consent, 20 subjects with facial lipoatrophy were enrolled in this randomized, evaluator-blinded clinical trial. Each subject was treated with 1 vial of PLLA each month for 3 months. Vials were diluted with 1 mL of 1% lidocaine and 7 ml of bacteriostatic water, shaken with a vortex and refrigerated for 24 to 48 hours before injection. Ten subjects were instructed to massage the treated areas according to the 5-5-5 rule and 10 subjects did not perform any massage post-treatment. Six-month follow-up data were collected for treatment efficacy and adverse events. RESULTS: No nodules were reported by subjects or detected by the blinded evaluator regardless of massage status. Significant improvements in facial lipoatrophy were detected 1, 3, and 6 months after the final treatment session and were not statistically different between the 2 groups. CONCLUSION: Using currently recommended guidelines for product preparation and injection, the application of massage post-PLLA facial treatment does not have a significant impact on nodule formation or treatment efficacy.

Multiple sequential light and laser sources to activate aminolevulinic acid for rosacea.

BACKGROUND AND AIMS: The use of multiple, sequential light and laser sources for topical ALA activation in photodynamic therapy (PDT) of rosacea has been largely absent from the literature. The aim of this study was to evaluate ALA-PDT for rosacea using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL). PATIENTS/METHODS: Thirty patients (39 treatments) were enrolled in this retrospective, single-center study. Treatment groups included blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Patient-reported outcome measures (incidence of adverse events, improvement in rosacea, and improvement in overall skin quality) were obtained via a telephone questionnaire and graded on a 4-point scale. RESULTS: There was no statistically significant difference in patient-reported rosacea or overall skin quality improvement. Apart from decreased peeling following blue light + IPL compared to blue light + PDL (P = 0.041) and blue light + IPL + PDL (P = 0.005), there were no other statistically significant differences in postprocedure adverse events. CONCLUSIONS: The use of multiple, sequential light and laser sources with ALA-PDT for rosacea, while well tolerated, did not lead to statistically significant improvements in patient-reported efficacy. Although this retrospective study is limited by a small sample size with disparate patient numbers between groups and no physician-evaluated outcome criteria, it does demonstrate that multiple light sources with PDT can be safely used in a single session.

Multiple sequential light and laser sources to activate aminolevulinic acid in the treatment of photodamage: A retrospective study.

INTRODUCTION: The aim of this study was to retrospectively evaluate photodynamic therapy (PDT) with aminolevulinic acid (ALA) for cutaneous photorejuvenation using blue light sequentially with red light, pulsed-dye laser (PDL), and/or intense pulsed light (IPL). MATERIALS AND METHODS: Ninety-six patients (121 treatments) had photodamage treated with field-directed ALA-PDT from 2001 to 2010 in this single-center study. Treatments were performed with blue light + PDL, blue light + IPL, blue light + PDL + IPL, or blue light + red light + PDL + IPL. Outcome measures were obtained via telephone questionnaire and graded on a four-point scale. RESULTS: There were no significant differences in patient-reported improvement in photodamage, overall skin quality, and postprocedure adverse events between treatment arms. However, number of patients in the blue light + red light + PDL + IPL group was markedly smaller (n = 2) than that in the other groups (n = 14-46). DISCUSSION: Although results showed a trend toward greater efficacy with similar tolerability using multiple, sequential light and laser sources with ALA-PDT for photorejuvenation, the potential for recall bias and widely disparate number of patients between treatment groups and follow-up times between patients severely limit this retrospective study. Nevertheless, despite these major statistical flaws, the results may provide valuable information regarding the safety of multiple modalities with PDT of photodamage in a single session.

Dark circles: etiology and management options.

Given their multifactorial nature and the fact that individual patients may have more than a single underlying cause, cosmetic practitioners should be well versed in a number of potential treatment options encompassing all facets of under-eye dark circles. New therapeutic options are also forthcoming. Longer-lasting HA fillers, wavelength tunable laser devices, and topicals speeding up healing and enhancing results after fractionated laser therapy will all serve to make the future of dark circle treatment unabatedly bright.

Combination of intense pulsed light, Sculptra, and Ultherapy for treatment of the aging face.

INTRODUCTION: Facial aging is a gradual process that involves a complex interaction of multiple factors including cutaneous photodamage and laxity, subcutaneous tissue volume loss, and bony resorption. These features have all been show to significantly improve with intense pulsed light (IPL), microfocused ultrasound (MFUS, Ultherapy), and poly-L-lactic acid (PLLA). METHODS: To review the use of IPL, MFUS, and PLLA in combination with the treatment of facial aging. RESULTS: Despite their extensive individual safety record, there is little data regarding combination therapy with these minimally invasive modalities. CONCLUSIONS: IPL, MFUS, and PLLA may be safely performed in a single treatment session to target multiple tissue planes concurrently without increased adverse events.

Application of intense pulsed light in the treatment of dermatologic disease: a systematic review.

BACKGROUND: The Food and Drug Administration (FDA) has approved intense pulsed light (IPL) devices for the treatment of a variety of benign pigmentary and vascular lesions, but the range of disease amenable to IPL treatment continues to expand, and there are no evidence-based clinical guidelines for its use in FDA-approved and off-label indications. OBJECTIVE: To provide evidence-based recommendations to guide physicians in the application of IPL for the treatment of dermatologic disease. EVIDENCE REVIEW: A literature search of the CENTRAL (1991 to May 6, 2013), EMBASE (1974 to May 6, 2013), and MEDLINE in-process and nonindexed citations and MEDLINE (1964 to present) databases was conducted. Studies that examined the role of IPL in primary dermatologic disease were identified, and multiple independent investigators extracted and synthesized data. Recommendations were based on the highest level of evidence available. FINDINGS: Level 1 evidence was found for the use of IPL for the treatment of melasma, acne vulgaris, and telangiectasia. Level 2 evidence was found for the treatment of lentiginous disease, rosacea, capillary malformations, actinic keratoses, and sebaceous gland hyperplasia. Level 3 or lower evidence was found for the treatment of poikiloderma of Civatte, venous malformations, infantile hemangioma, hypertrophic scars, superficial basal cell carcinoma, and Bowen's disease. CONCLUSIONS: IPL is an effective treatment modality for a growing range of dermatologic disease and in some cases may represent a treatment of choice. It is typically well tolerated. Further high-quality studies are required.

Comparison of intense pulsed light with 1,927-nm fractionated thulium fiber laser for the rejuvenation of the chest.

BACKGROUND: Rejuvenation of the aging chest is important to prevent noticeable disparities between the treated skin of the face and that of the untreated chest. OBJECTIVE: To compare a high-density thulium fiber laser (TFL)-based protocol for the rejuvenation of the aging chest with intense pulsed light (IPL). METHODS AND MATERIALS: We conducted a retrospective chart review comparing patients treated with IPL and those treated with TFL in combination with a quality-switched alexandrite laser and long pulsed dye laser. Blinded photographic assessment of overall improvement, rhytides, skin texture, dyspigmentation, and telangiectasia was performed. Patient satisfaction was assessed in a standardized follow-up survey. Cost and practicality were compared. RESULTS: At a mean follow-up of 45.8 days for IPL and 78.3 days for TFL, the two protocols had comparable clinical efficacy in achieving rejuvenation of the chest. Differences existed in terms of cost and practicality. CONCLUSION: TFL can be used at high density and in simultaneous combination with other targeted laser modalities to achieve rejuvenation of the aging chest. IPL achieves similar clinical efficacy. The choice between treatment modalities depends on physician and patient preferences.

Treatment of melasma and the use of intense pulsed light: a review.

Melasma is a complex multifactorial disorder whose pathogenesis is not well understood. In addition to increased pigmentation, increased vascularity associated with pigmentation is present. A variety of topical treatments targeting pigmentation are available with temporary improvement of mainly the epidermal components of melasma. Intense pulsed light (IPL) is a broadband light source that can target a wide range of cutaneous structures, including deeper pigmentation and vasculature. We describe 5 cases of persistent facial melasma treated with the IPL and a hydroquinone-based skin care system (Obagi Nu-Derm; Obagi Medical Products, Long Beach, CA), showing improvement of facial melasma pigmentation and vascularity.

The safety and efficacy of combining poly-L-lactic acid with intense pulsed light in facial rejuvenation: a retrospective study of 90 patients.

BACKGROUND: Poly-L-lactic acid (PLLA) is an effective treatment for panfacial volumization. Typically, patients who are candidates for volume restoration can benefit from lasers and light sources for photorejuvenation. OBJECTIVE: To evaluate the safety and efficacy of combining PLLA with intense pulsed light (IPL) in facial photorejuvenation. MATERIALS AND METHODS: This was a retrospective, single-center study of 90 patients treated with IPL immediately before or as early as 6 days after PLLA injection from January 2003 and June 2011. Patients were contacted with regard to efficacy and adverse reactions after their treatment. RESULTS: One hundred fifteen patients had IPL treatments to the face from immediately before to up to 700 days after PLLA injection to the face. Ninety patients responded; 19% experienced edema, 17% bruising, 10% erythema, 7% nodule formation after PLLA injections with 0 nodules occurring after IPL, and 12% mild discomfort during the IPL treatment. The majority of patients (86.7%) reported at least mild photorejuvenating effects from the combination of PLLA and IPL treatments, with 64.4% reporting good to excellent correction independent of number of treatments. CONCLUSION: The combination of PLLA with IPL in photorejuvenation of the face is safe and effective.

Sequential treatment with triple combination cream and intense pulsed light is more efficacious than sequential treatment with an inactive (control) cream and intense pulsed light in patients with moderate to severe melasma.

BACKGROUND: Triple combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% and is currently the only hydroquinone-containing drug approved by the Food and Drug Administration for the treatment of melasma. OBJECTIVE: To evaluate the safety and efficacy of TC cream when used sequentially with intense pulsed light (IPL) treatments in patients with moderate to severe melasma. MATERIALS & METHODS: This was a 10-week, split-face study in which 56 patients with symmetrical melasma lesions were treated with TC cream on one side of the face and an inactive control cream on the other side of the face. Patients also had two IPL treatments at weeks 2 and 6. (Topical treatment was suspended during IPL treatments ± 1 day.) RESULTS: Melasma severity was significantly less with TC cream and IPL than with inactive cream and IPL at weeks 6 (p=.007) and 10 (p=.002). Improvement in melasma was greater with TC cream and IPL than with inactive cream and IPL according to investigator and patient evaluations at weeks 6 and 10 (p<.001 for both time points). Treatment with TC cream and IPL was well tolerated. CONCLUSION: The results of this study suggest that TC cream and IPL treatment is an effective and safe treatment option for patients with melasma.