Abdominal Remodeling in Postpartum Women by Using a High-intensity Focused Electromagnetic (HIFEM) Procedure: An Investigational Magnetic Resonance Imaging (MRI) Pilot Study.

Objective: High-intensity focused electromagnetic (HIFEM) technology offers an alternative to surgical procedures in terms of correction of altered body shape. In this pilot study, we investigated whether HIFEM technology can positively affect abdominal appearance in postpartum women. Methods: Ten women (3-36 months postpartum; average age: 37.7 years) received four 30-minute abdominal HIFEM treatments. Magnetic resonance imaging (MRI) examination of abdominal fat thickness, rectus abdominis thickness, and the width of abdominal separation was performed and evaluated at baseline, one month, three months, and six months post-treatment. Additionally, weight was recorded, standardized photographs were taken, and patient comfort levels with the procedures were assessed, using a 7-point scale, at these same time points. The paired t-test was used to statistically analyze the mean differences between the baseline and post-treatment data. Results: Results obtained from MRI images showed an average abdominal fat reduction of 17.0 percent at the one-month follow-up visit, while at the three-month follow-up, it was 20.2 percent. The average muscle thickness increase at the one-month follow-up was 20.5 percent, and at the three-month follow-up, it was 21.3 percent. The distance between the rectus abdominis muscles was reduced by 16.7 percent at the first follow-up visit and by 22.7 percent at three-month follow-up visit. The nine subjects who attended the six-month visit showed, on average, a 17.6-percent fat reduction, 21.7-percent increase in muscle, and a 23.2-percent reduction of abdominal separation. Weight did not change significantly. Conclusion: HIFEM treatments appeared to reduce the fat layer and width of abdominal separation, while increasing the thickness of abdominal muscle thickness in postpartum women. The observed results at one month post-procedure were improved at three months post-procedure and remained stable at the six-month follow-up visit. Future studies that include a control or sham group are needed to identify and reduce the risk of bias.

Simultaneous Changes in Abdominal Adipose and Muscle Tissues Following Treatments by High-Intensity Focused Electromagnetic (HIFEM) Technology-Based Device: Computed Tomography Evaluation

Objective: This study investigates the effects of high-intensity focused electromagnetic technology for induction of changes in abdominal muscles and abdominal subcutaneous fat. Methods: 22 male and female subjects (aged 34 to 64, mean BMI, 23.5kg/m2) underwent 8 treatments of the abdomen (2 per week) with a high-intensity focused electromagnetic field device. Subjects were scanned by computed tomography (CT) at baseline and 1 month after the eighth treatment. Sub-umbilical and epi-umbilical slices were used to measure the thickness of subcutaneous fat and abdominal muscles and the abdominal separation. In addition, standardized photographs, weight, and circumference measurements were collected. Results: While comparing baseline to follow-up measurements, CT data showed on average 17.5% (-3.1±1.9mm) reduction in subcutaneous fat and simultaneous 14.8% (+1.5±0.8mm) thickening of the rectus abdominis muscle. Subjects lost on average 3.9±3.1cm in the waist circumference. Most of the waist reduction effect was achieved after the fourth treatment. The width of abdominal separation decreased by 9.5% (-2.0±1.7mm). All results were highly significant (P<0.01) while weight change was insignificant (P<0.05). Digital photographs showed aesthetic improvement in most subjects. The treatments were painless and without adverse events. Conclusion: Results suggest that the investigated device is effective for abdominal body sculpting. This technology produced rectus muscle hypertrophy and a reduction in subcutaneous abdominal fat. Data suggests 4 treatments as the ideal protocol delivering 86% of the observed improvement. J Drugs Dermatol. 2019;18(11):1098-1102.

Examining hyperhidrosis: an update on new treatments.

Primary hyperhidrosis is a debilitating condition that causes significant distress and financial burden for affected patients, triggering them to seek medical care for their excessive sweating. Once a diagnosis of primary hyperhidrosis has been established, treatment is initiated to help control sweat production and increase quality of life. While there are no current guidelines in the United States for the treatment of primary hyperhidrosis, there are International Hyperhidrosis Society guidelines that clinicians can use. Currently, a step-therapy approach with the least invasive treatments prioritized first is recommended; the patient's reported disability should also be taken into consideration when selecting a first-line treatment. This update will discuss new treatment modalities, surgical procedures, associated comorbidities, and the impact on managed care of hyperhidrosis, so clinicians can tailor therapy, improve outcomes, and increase patient satisfaction.

Safety and efficacy of a novel high-intensity focused electromagnetic technology device for noninvasive abdominal body shaping.

BACKGROUND: Thermal fat reduction technologies are leading the market for nonsurgical abdominal contouring. However, they are ideal principally for patients with fat bulges. OBJECTIVES: Our study investigates the effects of a novel nonthermal technology affecting the abdominal musculature and subcutaneous adipose tissue. MATERIALS AND METHODS: A total of 22 patients (avg. BMI 23.8 kg m-2 ) underwent 4 treatments on abdomen with high-intensity focused electromagnetic (HIFEM) field device. Treatments took 30 minutes and were spaced apart by 2-3 days. Photographs, weight, and waist measurements were taken at the baseline, after the last treatment, and at month 3 follow-up. Patient satisfaction was noted. Photographs were evaluated by blinded evaluators. RESULTS: The study protocol was completed by 19 patients. At month 3, the average waist size reduction was 4.37 ± 2.63 cm (P < 0.01). The evaluators identified the before image from the 3-month image 89.47% of the time. About 91% of patients reported their abdominal appearance improved, and 92% stated they are satisfied with treatment results at month 3. No adverse events occurred. CONCLUSION: Observed waist size reduction and aesthetic improvement appear to be a combination of fat reduction and increased muscle definition of abdominal wall. In lower BMI patients, the increased abdominal muscle definition was largely responsible for the improvement. This novel energy device provides an additional tool for body contouring with primary application for lower and medium BMI patients.

Advancing the Care of Post-Acne Scarring: Expert Insights Into New Treatment Options.

Most patients with acne have some degree of facial scarring even after their acne resolves, extending the period of psychosocial distress. Unfortunately, management of acne scars remains challenging. Many treatments for post-acne scarring including chemical peels, skin needling, laser resurfacing, surgical repair, subcision lifting, and punch elevation lifting, are limited by moderate and unpredictable results, significant morbidity, and substantial patient investments in time and money. The most recent addition to the armamentarium is tissue augmentation with soft tissue fillers, including a recently approved polymethylmethacrylate-collagen filler. Matching individual patient needs to the appropriate treatment is crucial. While many patients with acne scars have unrealistic expectations about treatment outcomes, open, honest, and realistic dialogue regarding their treatment options and concerns can facilitate realistic expectations. This article is based on a consensus discussion by the authors, who all have experience managing post-acne scarring, as well as the content of a series of live CME-accredited symposia in connection with major dermatology meetings.

J Drugs Dermatol. 2016;15(5):518-525.

Fast and easy treatment for reduction of the Tyndall effect secondary to cosmetic use of hyaluronic acid.

The use of hyaluronic acid (HA) filler substances for facial skin wrinkling and volume loss has become popular. With increasing use, physicians are likely to encounter side effects. One such side effect is a bluish discoloration known as the Tyndall effect. Recently, we have encountered a few cases in which patients presented with a bluish tint in the areas where hyaluronic acid was injected. A number of treatments can be performed to reverse these unwanted effects. We present a simple method for correction of misplacement of HA gel.

A quality rating scale for aesthetic surgical procedures.

BACKGROUND: Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients. OBJECTIVE: (A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale. METHODS: (A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results. RESULTS: (A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A "physician adjustment factor" was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05. LIMITATIONS: Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures. CONCLUSIONS: Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication.

Botulinum toxin for the treatment of facial flushing.

BACKGROUND: Facial flushing is a common problem that is encountered by fair-skinned patients of Celtic and Northern European descent. Although usually transient in nature, some patients display a persistent reddened skin tone, with periods of increased erythema. Treatment of this condition is limited. OBJECTIVE: To describe a novel method for the treatment of persistent facial flushing. METHOD: We report a case of persistent facial flushing that was resistant to multiple pulsed dye laser treatments and was successfully treated with botulinum toxin A. RESULTS: The posttreatment appearance was dramatic, and the patient was highly satisfied with the cosmetic outcome. CONCLUSION: Botulinum toxin A can be used in small quantities to decrease persistent facial flushing temporarily.

A prospective survey of patient experiences after laser skin resurfacing: results from 2 1/2 years of follow-up.

BACKGROUND: Laser skin resurfacing (LSR) is a common cosmetic surgical procedure, yet there are no prospective long-term studies on patients' perceptions of their procedure. OBJECTIVE: To prospectively document patients' subjective experiences after LSR. DESIGN: Twenty-seven consecutive patients who underwent combination carbon dioxide/erbium:YAG full-face laser resurfacing for acne scarring or photodamage were surveyed at postoperative days 1 and 3, within 1 week, at 3 weeks, 6 weeks, 3 months, and 30 months and asked standardized questions. SETTING: Referral-based academic practice. RESULTS: One day after LSR, 10 patients (37%) were concerned about the outcome, and 3 (11%) considered it a "terrible" experience. At 2.7 days after the procedure, 23 patients (85%) would recommend LSR, and after 3.7 days, 24 (89%) would have the procedure again. At 3 months, the patients' mean rating of appearance was 2.3 (0-3 scale), and all 27 (100%) felt that their appearance had been improved by LSR. After 30 months, 18 patients (75%) would recommend the procedure, 17 (71%) would have LSR again, 21 (88%) felt that their appearance was improved, and final appearance was rated 1.8 (0-3 scale). Patients undergoing LSR to treat acne scarring were as satisfied as patients treated for photodamage. CONCLUSIONS: Data on the evolution of patient perspective after LSR can improve patient preparation. This may help the surgeon and patient achieve shared, realistic expectations for the postoperative period and for long-term results.

Botulinum neurotoxin type B--a rapid wrinkle reducer.

Botulinum toxin has been used for temporary muscle paralysis for over 13 years. The off label use of neurotoxins include treatment of dynamic lines on the face and treatment of hyperhidrosis. Several forms of botulinum toxin exist, but only 2 serotypes are available commercially. Botulinum toxin B (BoTX B) is a recently US Food and Drug Administration (FDA) approved neurotoxin used for the treatment of cervical dystonia. Investigations into the use of BoTX B for skin rejuvenation have shown rapid paralysis and reduction of wrinkles. This overview highlights the current reports on the efficacy, duration, and safety of BoTX B when used for cosmetic procedures.

Tattoo-associated dermatoses: a case report and review of the literature.

BACKGROUND: Tattoos are increasingly popular in today's society, especially with the advent of laser tattoo removal. As a result, observed reactions within tattoos are likely to become more abundant. Three main classes of tattoo-associated dermopathies can be distinguished in the English literature: allergic/granulomatous/lichenoid, inoculation/infection, and coincidental lesions. Injury to the dermis, such as during placement of a tattoo, can also flare a Koebner response in patients with active susceptible disease. OBJECTIVE: This case report and review of the English literature provides a quick reference to tattoo reactions, techniques available for removal of tattoos, and disorders other than tattoos known to exhibit the Koebner response. METHODS: The English literature was reviewed via MEDLINE citations from 1966 to December 2001 to delineate articles involving tattoo reactions and Koebner reactions significant to dermatology. CONCLUSION: Numerous conditions have been documented in association with tattoos and the process of tattoo application. Awareness and identification of dermatoses associated with tattoos, tattoo removal options, and conditions associated with the Koebner response are important to both the dermatologist and dermatologic surgeon.

The corset platysma repair: a technique revisited.

BACKGROUND: Platysma banding along with excess submental adipose tissue and sagging skin can lead to an aged appearance. Several methods for improving neck and submental contours exist, including neck liposuction, bilateral platysma plication, midline platysma plication with transection of distal fibers, necklift with skin excision, and botulinum toxin injection for platysma relaxation. With the current interest in minimally invasive procedures, surgeons and patients are searching for techniques that produce maximal improvement with minimal intervention. OBJECTIVE: To present a modified technique for maximizing neck contouring, discuss possible complications of the procedure, and describe appropriate candidates for the corset platysmaplasty. METHODS: We performed a retrospective analysis of 10 consecutive patients who underwent neck liposuction with concomitant corset platysmaplasty at our institution. RESULTS: All 10 patients achieved good to excellent submental and jawline contouring, determined by both physician and patient assessment, with no visible platysma banding at 6 months follow-up. No major complications were noted. CONCLUSION: Use of corset platysmaplasty is a safe and effective method for neck rejuvenation. This variation of platysmaplasty can be used in conjunction with neck liposuction to maximize jawline and neck contour enhancement.