Poly­d,l­lactic acid­enhanced atrophic scar treatment via transdermal microjet drug delivery in Asians.

BACKGROUND: Acne vulgaris often results in permanent scars, with atrophic scars being the most common type and posing a significant therapeutic challenge due to their prevalence and impact on patients' quality of life. Various treatment options exist, including the use of poly-d,l-lactic acid delivered via different methods. OBJECTIVE: This study aimed to assess the efficacy and safety of poly-d,l-lactic acid delivered via laser-assisted needle-free microjet injection for treating atrophic scars. METHODS: Five Korean participants with atrophic facial scars were recruited. Poly-d,l-lactic acid solution was administered via the Mirajet system in five sessions, with clinical assessments conducted at baseline, before each session, and at 12-week and 22-week follow-ups. Outcome measures included the Global Aesthetic Improvement Scale and patient satisfaction scores. RESULTS: Positive results were observed at the 12-week and 22-week follow-ups, with high patient satisfaction and improvements in atrophic scars and skin texture. Mild discomfort and transient side effects were reported, with no adverse events observed during the follow-up period. CONCLUSION: Poly-d,l-lactic acid delivered by a laser-assisted needle-free microjet injector was judged to be effective for improving atrophic the facial area. Further research, particularly through randomized controlled trials, is needed to validate these findings and assess the longer-term safety and sustainability of outcomes.

Facial Skin Rejuvenation Using Poly- dl -Lactic Acid Injected With a Laser-Generated Needle-Free Microjet Injector.

BACKGROUND: A laser-induced needle-free microjet injector was developed for rapid, high-speed drug delivery of microliters into the skin. OBJECTIVE: This study evaluated the clinical rejuvenation effect of repeated dermal injections of the collagen simulator poly- dl -lactic acid (PDLA) using a laser-induced needle-free microjet injector. METHODS: Five PDLA injection sessions using a laser-induced needle-free microjet injector were conducted in patients concerned about aging skin. Facial uplifting, darkness, redness, roughness, pore size, subjective satisfaction, and side effects were evaluated before each session and 4 weeks after treatment completion. Histological evaluation was also performed with immunohistochemical staining of collagen and elastic fibers. RESULTS: The clinical results of 27 female patients were evaluated. The treatment resulted in a noticeable skin surface uplifting (0.711 ± 0.42 mm) and significant improvements in darkness ( p = .013), redness ( p = .009), and roughness ( p = .036), with no significant difference in the pore size ( p = .770). Patients were reported being satisfied with the overall therapeutic effects, despite mild and tolerable adverse effects. Histological findings revealed growth and thickening of collagen and elastic fibers, with marked increase in collagen I and III levels. CONCLUSION: Repeated dermal injections of PDLA using a laser-induced microjet injector offer excellent drug delivery, achieving high efficacy in skin rejuvenation, patient satisfaction, and safety.

Needleless laser injector versus needle injection for skin enhancement and rejuvenation effect of dermal filler.

BACKGROUND AND OBJECTIVES: A needleless laser-induced microjet injector is a novel transdermal drug delivery system that can rapidly inject a very small and precise drug dose into the skin with minimal pain and downtime. In this study, we aimed to compare the laser-induced microjet injection versus needle injection of polylactic acid/hyaluronic acid filler for skin enhancement and rejuvenation. PATIENTS AND METHODS: A 24-week prospective, single-center, assessor-blinded, randomized, split-face study was conducted. The enrolled patients underwent one treatment session of dermal filler injection using a laser-induced microjet injector on one half of the face or a traditional needle injection on the other half of the face. Evaluation was conducted at baseline before treatment and at 4, 12, and 24 weeks after treatment. RESULTS: A single treatment of filler injection with a laser-induced microjet injector resulted in similar improvements in skin hydration and elasticity as a single treatment of filler injection by using manual needle injection, with reduced pain, side effects, and decreased treatment time. CONCLUSIONS: Laser-induced microjet injector enabled not only the application of a controlled dose and filler depth but also even distribution, improved clinical efficacy, reduced pain and side effects, and sufficient time for clinicians to perform treatment.

Poly-D,L-Lactic Acid Stimulates Angiogenesis and Collagen Synthesis in Aged Animal Skin.

Angiogenesis promotes rejuvenation in multiple organs, including the skin. Heat shock protein 90 (HSP90), hypoxia-inducible factor-1 alpha (HIF-1α), and vascular endothelial growth factor (VEGF) are proangiogenic factors that stimulate the activities of phosphoinositide 3-kinase (PI3K), protein kinase B (AKT), and extracellular signal-regulated kinase 1/2 (ERK1/2). Poly-D,L-lactic acid (PDLLA), polynucleotide (PN), and calcium hydroxyapatite (CaHA) are dermal fillers that stimulate the synthesis of dermal collagen. However, it is not yet known whether these compounds promote angiogenesis, which leads to skin rejuvenation. Here, we evaluated whether PDLLA, PN, and CaHA stimulate angiogenesis and skin rejuvenation using H2O2-treated senescent macrophages and endothelial cells as an in vitro model for skin aging, and we used young and aged C57BL/6 mice as an in vivo model. Angiogenesis was evaluated via endothelial cell migration length, proliferation, and tube formation after conditioned media (CM) from senescent macrophages was treated with PDLLA, PN, or CaHA. Western blot showed decreased expression levels of HSP90, HIF-1α, and VEGF in senescent macrophages, but higher expression levels of these factors were found after treatment with PDLLA, PN, or CaHA. In addition, after exposure to CM from senescent macrophages treated with PDLLA, PN, or CaHA, senescent endothelial cells expressed higher levels of VEGF receptor 2 (VEGFR2), PI3K, phosphorylated AKT (pAKT), and phosphorylated ERK1/2 (pERK1/2) and demonstrated greater capacities for cell migration, cell proliferation, and tube formation. Based on the levels of 4-hydroxy-2-nonenal, the oxidative stress level was lower in the skin of aged mice injected with PDLLA, PN, or CaHA, while the tumor growth factor (TGF)-ß1, TGF-ß2, and TGF-ß3 expression levels; the density of collagen fibers; and the skin elasticity were higher in the skin of aged mice injected with PDLLA, PN, or CaHA. These effects were greater in PDLLA than in PN or CaHA. In conclusion, our results are consistent with the hypothesis that PDLLA stimulates angiogenesis, leading to the rejuvenation of aged skin. Our study is the first to show that PDLLA, PN, or CaHA can result in angiogenesis in the aged skin, possibly by increasing the levels of HSP90, HIF-1α, and VEGF and increasing collagen synthesis.

Treatment of facial pigmented disorders with a 785-nm picosecond Ti:sapphire laser in Asians: A report of three cases.

Since the advent of the theory of selective photothermolysis, the importance of targeting the chromophore and minimizing the surrounding damage has been extensively discussed. Picosecond-domain laser (ps-laser) treatment with a wide range of wavelengths is an emerging option for various pigmented lesions; however, no definitive treatment choice has been confirmed. The authors aimed to investigate the efficacy and safety of a ps-laser with a 785-nm wavelength for the treatment of facial pigmented lesions in Asians. Three Korean patients with facial pigmented lesions were recruited for the study. A 785-nm ps-laser with a fractionated and an unfractionated handpiece was utilized to administer the treatment. The clinical outcome was evaluated by a clinician by comparing pre- and post-treatment photographs. All patients exhibited a significant improvement in pigmented lesions including freckles, lentigines, and melasma, after three to four sessions of treatment. No adverse events, including post-inflammatory hyperpigmentation or hypopigmentation were observed. In conclusion, this novel 785-nm Ti:sapphire ps-laser may be an effective and safe modality for treating pigmented lesions in skin of color.

Split-face comparative trial of 785-nm picosecond neodymium:yttrium-aluminum-garnet laser and precision cryotherapy combination treatment for facial benign pigmented lesions.

Cryotherapy (or cryosurgery) has been performed to treat various skin lesions in the field of dermatology; however, to the best of our knowledge, no study has investigated its efficacy and safety for benign pigmented lesions. Therefore, we conducted a split-face study to evaluate the efficacy and safety of cryotherapy in the treatment of benign pigmented lesions. A total of five subjects were included. Picosecond laser therapy was performed to treat the whole face and cryotherapy for half the face. Four weeks after completing the treatment sessions, patients showed more clinical improvement on the laser and cryotherapy combination treatment side than on the laser-only side, with no adverse events. Our study demonstrated that cryotherapy is a potential adjuvant therapeutic modality for benign pigmented lesions.

Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial.

BACKGROUND: Treatment with filler injections using a microneedle fractional radiofrequency (MFRF) device is a promising modality with proven efficacy for acne scar treatment. OBJECTIVE: To investigate the efficacy and histologic differences of intradermal injection of a filler (poly-d, l-lactic acid, PDLA) using an MFRF device for the treatment of acne scars. METHODS: Patients with acne scars on both cheeks were included. Poly-d, l-lactic acid was injected via the MFRF device every 4 weeks for a total of 4 sessions. Patients were evaluated using the grading system for acne scars before each session, as well as personal satisfaction. For histologic evaluation, 2 patients (who consented) underwent a skin biopsy from the upper arm before and after the same single session. RESULTS: After the final session, the acne scar grading (échelle d'évaluation clinique des cicatrices d'acné) scale and visual analog scale for evaluation of satisfaction showed improvement compared with initial assessment (36.99% and 79.65% respectively [p < .001, respectively]). For histologic evaluation, biodegradation of PDLA materials and increase in collagen and elastic fibers were observed after 5 months of treatment. CONCLUSION: Intradermal injection of PDLA using the MFRF device could be used as an effective treatment with fewer side effects in acne scar patients with Fitzpatrick skin type III-IV.

Topical brimonidine-assisted laser treatment for the prevention of therapy-related erythema and hyperpigmentation.

Postinflammatory hyperpigmentation (PIH) and erythema are the most common adverse effects associated with laser treatment, particularly in dark-skinned individuals. Several methods have been used to prevent or minimize these adverse effects; however, to date, no definitive precautions/strategies are known to prevent post-laser PIH and erythema. We investigated whether the topical application of the α-adrenergic receptor agonist brimonidine could reduce laser treatment-related complications such as erythema and PIH.

Effective improvement methods for striae distensae: A novel approach utilizing laser-induced micro-jet injectors with poly-d,l-lactic acid.

INTRODUCTION: Striae distensae (SD), or stretch marks, result from rapid stretching of the skin due to various factors. Conventional treatments often yield unsatisfactory results, leading to the exploration of alternative methods. Laser-induced microjet technology offers a promising approach for drug delivery to target areas. This study investigates the efficacy of using a microjet injector with poly-d,l-lactic acid for treating SD. METHODS: Four female participants with SD were treated with poly-d,l-lactic acid solution using a microjet injector over five sessions. Patients were assessed based on severity scales before and after treatment. Topical anesthetics were applied to minimize discomfort. Injection techniques were optimized to reduce side effects such as bleeding and pain. RESULTS: All patients showed significant improvement in SD appearance after 5-7 treatments. Assessment scales indicated positive outcomes both immediately after treatment and at the 32-week follow-up. Minimal side effects, primarily petechiae, were observed. DISCUSSION: Laser-induced microjet technology offers several advantages, including rapid drug delivery and mechanotransduction effects, promoting skin regeneration. Poly-d,l-lactic acid injections demonstrated effectiveness in treating SD, particularly when delivered via microjet injectors. Patients expressed high satisfaction due to the procedure's minimal invasiveness and quick recovery. CONCLUSION: Utilizing a needleless microjet injector with poly-d,l-lactic acid shows promise as a treatment for SD, typically requiring 5-7 sessions for optimal results. Mild petechiae may occur as a common side effect. This approach offers an effective and minimally invasive alternative for addressing this common cosmetic concern.

Energy-Based Device Management of Nodular Reaction Following Poly-D, L-Lactic Acid Injection for Tear Trough Rejuvenation.

BACKGROUND: Poly-D,L-lactic acid (PDLLA) is used for tear trough rejuvenation but can cause complications like nodular reactions. This report describes using a radiofrequency device to manage these nodules. CASE PRESENTATION: A 42-year-old woman developed firm, non-inflammatory nodules 3 weeks after receiving PDLLA (Juvelook) injections in the tear trough area. The nodules were firm and not associated with erythema or tenderness. INTERVENTION: The monopolar radiofrequency device was used directly on the nodules with 150 shots at an energy level 115 J, 28.75 J/cm². The treatment resulted in complete resolution of the nodules within 24 hours. RESULTS: The radiofrequency treatment effectively resolved the nodular reaction without recurrence, highlighting the device's compatibility with the unique structure of Juvelook's PDLLA. CONCLUSION: Radiofrequency therapy is effective for managing nodular reactions following PDLLA injections. Further research is needed to optimise protocols and improve the safety of biostimulator treatments in cosmetic procedures.

Skin rejuvenation effect of the combined PDLLA and non cross-linked hyaluronic acid: A preliminary study.

BACKGROUND: Skin aging is characterized by wrinkles, rough skin texture, pigmentation, facial erythema, and telangiectasia through structural and functional changes in the epidermis and dermis. Recently, injectable poly(D, L-lactic acid), a biodegradable polymer, has been used widely for skin rejuvenation. AIMS: This study aims to assess the efficacy and safety of injectable dermal poly D, L-lactic acid) for skin rejuvenation. PATIENTS/METHODS: A total of 16 patients who desired skin rejuvenation were included. All participants received two or three procedure sessions with a 4 weeks interval between sessions. Clinical and three-dimensional images at baseline, before each procedural session, and follow-up visits were obtained. Therapeutic effects were assessed by evaluating signs of aging skin and overall improvement by dermatologists and patients. Histologic examinations with special stains were performed on the posterior auricular areas of consenting patients at baseline and follow-up visits after injecting poly D L-lactic acid into the postauricular area as in the face. RESULTS: Overall, statistically significant differences were observed in all signs of aging skin, such as fine wrinkles, skin texture, irregular pigmentation, telangiectasia, and facial erythema before and after treatments. Half (50%) of patients responded that there was more than 50% overall improvement. There were no severe adverse events. Histologic examination demonstrated increases in collagen and elastic fibers in the dermis. CONCLUSIONS: Results of this preliminary study suggest that injectable dermal poly D, L-lactic acid can significantly affect skin rejuvenation without causing any serious adverse events.

Poly-d,l-Lactic Acid Via Transdermal Microjet Drug Delivery for Treating Rosacea in Asian Patients.

BACKGROUND: Rosacea, a chronic inflammatory skin condition, is marked by enduring redness, visible blood vessels, and inflammatory eruptions in facial areas. Managing rosacea remains a persistent challenge for dermatologists, especially in cases unresponsive to conventional treatments. Injectable poly-d,l-lactic acid (PDLLA) has shown promise in treating erythema and telangiectasia associated with rosacea in addition to age-related concerns. Employing Mirajet, a laser-induced microjet system, for administering PDLLA is a novel and promising treatment for rosacea. AIMS: We aimed to evaluate the efficacy and safety of injectable PDLLA delivered via a needle-free microjet system for managing rosacea. METHODS: Four Korean women with persistent and refractory rosacea received five monthly sessions of PDLLA needle-free injections. Clinical assessments were conducted using the Clinician's Erythema Assessment and Patient's Self-Assessment (PSA) at baseline, 4 weeks post-treatment, and 22 weeks post-final treatment. Adverse events were monitored throughout the study period. RESULTS: At 4 weeks post-treatment, both Clinician's Erythema Assessment and PSA scores indicated significant improvements in erythema that were sustained up to the 22-week follow-up. Patients reported high satisfaction with resolution of redness and improved skin texture. Mild swelling, redness, and petechiae were observed post-treatment but resolved spontaneously. No product-related adverse events were noted during the study period. CONCLUSION: Injectable PDLLA delivered via laser-induced microjet injection demonstrated promising efficacy in improving rosacea symptoms and skin quality for up to 22 weeks without significant adverse effects. Larger randomized controlled trials are needed to confirm these findings and evaluate long-term safety and sustainability of outcomes.

Skin rejuvenation through topical application of indocyanine green with diffractive optical element mode of 785 nm picosecond laser in Asian females.

BACKGROUND: Indocyanine green (ICG) exhibits robust absorption near 800 nm. AIMS: To examine the clinical effects of combining ICG with a 785 nm picosecond laser for treating photo-aged skin. PATIENT/METHODS: A 785 nm 600 picosecond laser was used on the facial area of 16 female patients with Fitzpatrick skin type III and IV (mean age: 58.44 ± 5.24 years) after applying 0.0125% ICG cream. A total of 3000 shots were administered in diffractive optical element mode at a pulse energy of 200 mJ and frequency of 10 Hz. Hyperpigmented lesions were treated using the Zoom handpiece set at a spot size of 3-4 mm, pulse energy of 60-120 mJ, and frequency of 3-7 Hz. Patients underwent five sessions of treatment at intervals of 1-2 weeks. Wrinkles, pores and pigmented lesions were assessed at the initial assessment and 4 weeks after the final treatment using the Modified Fitzpatrick Wrinkle Scale and 10-point visual analog scale, respectively. Skin biopsy of the postauricular area was performed on two consenting patients. RESULTS: Significant improvements in wrinkles (p = 0.02), pores (p = 0.034), and hyperpigmentation (p = 0.036) were observed, along with increased patient subjective improvement. Adverse effects were transient and well-tolerated. Hematoxylin and eosin and Masson's trichrome staining revealed increased and thickened dermal collagen fibers. Immunohistochemical staining revealed increased expression of collagen I and III throughout the papillary and upper reticular dermis, along with diffuse increase of STRO-1 in the dermis. CONCLUSIONS: The combined application of a 785 nm picosecond laser and ICG yielded promising clinical outcomes for treating photo-aged skin in Asian patients with Fitzpatrick skin type III and IV.

Survey on Resident Education for Surgical Dermatology in South Korea.

BACKGROUND: With the increasing demand for surgical procedures in dermatology, resident education in surgical dermatology has become important for delivering high-quality treatment. However, it remains unclear if a sufficient number of residency programs with quality standards exist, as there has been little research on this subject in South Korea. OBJECTIVE: To identify the status of surgical dermatology education among residents and assess dermatologists' perceptions of the subject. METHODS: A 35-question survey was developed and distributed to all resident training hospitals and local clinics listed by the Korean Society of Dermatologic Surgery. Only third- and fourth-year residents were included and board-certified specialists from training hospitals and local clinics responded to the surveys. RESULTS: Survey participants included 88 residents and 120 specialists of whom one-quarter of the residents attended regular monthly educational sessions. Most residents (93%) participated in cosmetic procedures, and many performed laser therapy. However, the opportunity for toxin or filler injection was rare, with only 12% of the residents having experience with filler injections. In response, 49% of residents and 32% of specialists said that more cosmetic training was required, whereas 28% of residents and 50% of specialists said that more training for both cosmetic and conventional surgeries was necessary. CONCLUSION: The survey demonstrated a need for more training programs in surgical dermatology during residency and a perception gap between residents and specialists. Therefore, developing educational residency programs that focus on basic dermatologic surgery principles and their applications in cosmetic procedures is essential.

Poly-D,L-Lactic Acid Filler Increases Extracellular Matrix by Modulating Macrophages and Adipose-Derived Stem Cells in Aged Animal Skin.

Poly-D,L-lactic acid (PDLLA) filler corrects soft tissue volume loss by increasing collagen synthesis in the dermis; however, the mechanism is not fully understood. Adipose-derived stem cells (ASCs) are known to attenuate the decrease in fibroblast collagen synthesis that occurs during aging, and nuclear factor (erythroid-derived 2)-like-2 factor (NRF2) increases ASCs survival by inducing M2 macrophage polarization and IL-10 expression. We evaluated the ability of PDLLA to induce collagen synthesis in fibroblasts by modulating macrophages and ASCs in a H2O2-induced cellular senescence model and aged animal skin. PDLLA increased M2 polarization and NRF2 and IL-10 expression in senescence-induced macrophages. Conditioned media from senescent macrophages treated with PDLLA (PDLLA-CMMΦ) reduced senescence and increased proliferation and expression of transforming growth factor-ß (TGF-ß) and fibroblast growth factor (FGF) 2 in senescence-induced ASCs. Conditioned media from senescent ASCs treated with PDLLA-CMMΦ (PDLLA-CMASCs) increased the expression of collagen 1a1 and collagen 3a1 and reduced the expression of NF-κB and MMP2/3/9 in senescence-induced fibroblasts. Injection of PDLLA in aged animal skin resulted in increased expression of NRF2, IL-10, collagen 1a1, and collagen 3a1 and increased ASCs proliferation in aged animal skin. These results suggest that PDLLA increases collagen synthesis by modulating macrophages to increase NRF2 expression, which stimulates ASCs proliferation and secretion of TGF-ß and FGF2. This leads to increased collagen synthesis, which can attenuate aging-induced soft tissue volume loss.

Longitudinal melanonychia in childhood: a clinical and histopathological review of Korean patients.

Longitudinal melanonychia is not frequently observed in children, and few studies exist on longitudinal melanonychia in paediatric patients, especially in Asian populations. We aimed to evaluate the clinical and histological findings of longitudinal melanonychia in Korean paediatric patients. A retrospective review of paediatric patients (≤18 years old) with longitudinal melanonychia who underwent nail biopsy between January 2010 and October 2015 was performed. Of a total of 21 patients with longitudinal melanonychia, there were 10 cases of functional melanonychia, eight of lentigo, and three of nevus, as determined by microscopic examination. Mild nuclear atypia was found in four cases, as well as a low degree of pagetoid spread in one case. No patient was diagnosed with melanoma. During the follow-up period, no signs of malignancy were noticed and one patient with nail matrix nevus showed complete spontaneous regression of the pigmented band. Clinical and histological features, generally accepted as signs suggestive of melanoma in adults, were more readily observed in benign conditions in children.