Diluted Calcium Hydroxylapatite for Skin Tightening of the Upper Arms and Abdomen.

BACKGROUND: The collagen-stimulating properties of Radiesse® (calcium hydroxylapatite, CaHA) can be used for skin-tightening procedures by hyper-diluting the product with lidocaine or saline. OBJECTIVE: To evaluate the effectiveness and safety of diluted CaHA for skin tightening in two case series of women with skin laxity in the upper arms or abdomen. METHODS: For each case series, 10 female subjects were enrolled. In the upper arms, CaHA diluted 1:2 with normal saline solution and 2% lidocaine was injected subdermally using a short, linear-threading technique. Skin elasticity was assessed at baseline and Months 1 and 3 using a cutometer. In the abdominal wall, CaHA diluted 1:4 with saline solution was injected subdermally using a linear-threading technique. Subjects underwent pre- and post-treatment (70 days) ultrasound scans to determine dermal thickness around the umbilicus and sides of the abdomen. Subjects and physicians assessed treatment outcomes using the 5-point Global Aesthetic Improvement Scale (GAIS). Adverse events and tolerability were recorded. RESULTS: Cutometry results for upper arm skin showed an increase in skin elasticity from 72 U at baseline to 82 U at Month 3 (P≤0.05). Ultrasound measures of the abdominal wall demonstrated statistically significant increases in dermal thickness after injection of diluted CaHA of 0.7 mm (umbilicus) and 0.4 mm (sides of abdomen). Diluted CaHA resulted in an overall increase in dermal thickness of 26.7% (P≤0.05). In both case series, 90% of subjects and physicians rated treatment outcomes on GAIS as much or very much improved. Treatment was well tolerated. CONCLUSIONS: Diluted CaHA improved skin elasticity and increased dermal thickness in the upper arms and abdomen after only a single treatment. The procedures were well tolerated, and subject and investigator satisfaction with treatment results was very high. Injection of diluted CaHA is an effective procedure for skin tightening in the upper arms and abdomen.

J Drugs Dermatol. 2017;16(9):900-906.

IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations.

BACKGROUND: Although there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians. METHODS: Thirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts' extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics. RESULTS: All experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies. CONCLUSION: On the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for augmentation of glabellar lines, periorbital wrinkles, forehead lines, bunny lines, perioral wrinkles, depressor anguli oris, mentalis, masseters and platysmal bands, and performing the Nefertiti lift, are presented here.