Improvement in Cellulite Appearance After a Single Treatment Visit With Acoustic Subcision: Long-Term Findings From a Multicenter Clinical Trial.

BACKGROUND: Cellulite is an aesthetically displeasing rippling or dimpling of the skin, primarily on the buttocks/thighs. A recent study showed a novel acoustic subcision device produced significant short-term (12-week) improvement in the appearance of cellulite after a single rapid acoustic pulse (RAP) treatment. OBJECTIVE: To evaluate the long-term (>52-weeks) efficacy and safety of RAP treatment for improvement in the appearance of cellulite. MATERIALS AND METHODS: In this prospective, multicenter trial, female participants ( n = 42) with severe cellulite were treated with the acoustic subcision device in a single visit. At >52 weeks, blinded board-certified dermatologists assessed efficacy by correctly identifying post-treatment photographs and using a 6-point simplified Cellulite Severity Scale (CSS). Participant satisfaction was also collected. Safety was assessed throughout. RESULTS: The blinded panel correctly identified post-treatment photographs at a rate of 95.2%; 70.4% of participants had a >1-point reduction in the CSS score from baseline (mean reduction of 1.09). All participants (100%) reported improved cellulite appearance. Overall pain during treatment was rated as 2.4 and 0.3 post-treatment (pain scale 0-10). No device or treatment-related adverse events were reported at the >52-week follow-up. CONCLUSION: Rapid acoustic pulse treatment significantly improved the long-term appearance of cellulite and was well-tolerated.

A Review of Current Data on Duration of Effect in Glabellar Lines After Treatment With AbobotulinumtoxinA 50 U.

BACKGROUND: AbobotulinumtoxinA has become well established as a treatment option for moderate to severe glabellar lines since its first aesthetic approval in 2009. OBJECTIVE: Pivotal trials leading to regulatory approval showed that abobotulinumtoxinA treatment was associated with high responder rates when defined as achievement of none or mild glabellar lines (0 or 1 on the glabellar line severity scale) and a duration of action of up to 5 months. More recently, the goals for treatment of glabellar lines have shifted toward not only achieving a decrease in glabellar line severity but also ensuring that patients are satisfied with their experience. MATERIALS AND METHODS: Patients seek an improvement in the appearance of their glabellar lines while maintaining a "natural look," fast onset of effect, and long duration of response. RESULTS: Trial designs have evolved to meet these new targets, including expanding the definition of responders to those having at least 1-grade improvement in the glabellar line severity scale score from baseline coupled with the use of subject satisfaction and psychological well-being questionnaires. CONCLUSION: The findings demonstrate that abobotulinumtoxinA remains a well-tolerated and consistently effective treatment option associated with a rapid onset of effect, duration of efficacy lasting up to 6 months, and high, long-lasting levels of patient satisfaction.

A Novel Approach to Shaping the Lateral Abdomen: Simultaneous Application of High-Intensity Focused Electromagnetic (HIFEM) Therapy and Synchronized Radiofrequency at the Flanks: A Multicenter MRI Study.

BACKGROUND: An accumulation of adipose tissue on the lateral abdomen (flanks) coupled with muscle deconditioning negatively affects core stability, muscular balance, and the intrinsic strength essential for maintaining optimal body mechanics and posture. This lateral fat accumulation and diminution of muscle result in an unfavorable abdominal profile and present challenges in finding appropriately fitting attire. OBJECTIVES: The aim of this study was to explore the effectiveness and safety of the simultaneous application of high-intensity focused electromagnetic (HIFEM) therapy and synchronized radiofrequency for sculpting the lateral abdomen. METHODS: All patients were scheduled to undergo four 30-minute treatments at approximately weekly intervals and then subsequent follow-up visits at 1 month and 3 months after the last treatment. The primary evaluation assessed changes in the oblique muscles, adipose tissue thickness, and cross-sectional area (CSA) by MRI performed at baseline and follow-ups. The secondary outcomes included digital photographs of the treated areas, a Subject Satisfaction Questionnaire, and a Therapy Comfort Questionnaire. Adverse events and side effects were monitored throughout the study duration. RESULTS: The muscle tissue showed a substantial increase in thickness (+27.2%) and CSA (+29.0%). The adipose tissue measurements showed a decrease of -30.5% in CSA and -28.8% in thickness. As secondary outcomes, 81.8% of patients reported feeling more toned, and 84.9% of patients found the treatment comfortable and reported less than mild pain. CONCLUSIONS: Based on the evaluation, the study suggests that the simultaneous application of HIFEM and synchronized radiofrequency is safe and effective for reducing adipose tissue and strengthening muscle in the area of the lateral abdomen.

A Multicenter, Randomized, Evaluator-Blinded Study to Examine the Safety and Effectiveness of Hyaluronic Acid Filler in the Correction of Infraorbital Hollows.

BACKGROUND: Hyaluronic acid injections are increasingly administered for correction of infraorbital hollows (IOHs). OBJECTIVES: The objective of this study was to examine the effectiveness (IOH correction) and safety of Restylane Eyelight hyaluronic acid (HAEYE) injections. METHODS: Patients with moderate/severe IOHs, assessed with the Galderma infraorbital hollows scale (GIHS), were randomized to HAEYE injections (by needle/cannula) (Day 1 + optional Month 1 touch-up) or no-treatment control. The primary endpoint was blinded evaluator-reported Month 3 response, defined as ≥1-point GIHS improvement from baseline (both sides, concurrently). Other endpoints examined investigator-reported aesthetic improvement on the Global Aesthetic Improvement Scale (GAIS), patient-reported satisfaction (FACE-Q satisfaction with outcome; satisfaction questionnaire), and adverse events. RESULTS: Overall, 333 patients were randomized. Month 3 GIHS responder rate was significantly higher for HA-EYE (87.4%) vs control (17.7%; P < .001), and comparable between HA-EYE-needle and HA-EYE-cannula groups (P = .967). HAEYE GAIS responder rate was 87.5-97.7% (Months 3-12). Mean FACE-Q Rasch-transformed scores were 64.3-73.5 (HAEYE) vs 14.1-16.2 (control) through Month 12. Patients reported looking younger (≥71%) and less tired (≥79%) with reduced undereye shadows (≥76%) and recovered within 3-5 hours posttreatment. Efficacy was maintained through Month 12 (63.5% GIHS responders) and through Month 18, after Month 12 retreatment (80.3% GIHS responders; 99.4% GAIS responders; FACE-Q scores 72.5-72.8). Forty patients (12.7%) reported typically mild adverse events (4.9% HAEYE-needle; 20.9% HAEYE-cannula). CONCLUSIONS: HAEYE treatment was effective in correcting moderate/severe IOHs at the primary endpoint (Month 3). Efficacy was sustained through Month 12 after first treatment for 63.5% and through Month 18 for 80.3% (after 1 retreatment) with needle or cannula administration. Safety outcomes were reassuring.

Cellulite: Current Treatments, New Technology, and Clinical Management.

BACKGROUND: Cellulite is a well-known concern for many women; however, treatment can prove challenging because of the complexities of cellulite etiology, the various factors contributing to its appearance, and the multitude of therapies and procedures available. OBJECTIVE: To discuss current cellulite treatment options and effective clinical management. METHODS: A roundtable meeting was convened to discuss and share views on current cellulite treatment options, new technologies, and clinical management. The participants' views helped guide a narrative review on this topic. RESULTS: Advanced interventions for cellulite treatment-such as physical and acoustic subcision, radiofrequency, and injectable biostimulators-are gradually being established, with accumulating evidence showing efficacy, patient satisfaction, and potentially long-lasting outcomes. Cellulite severity rating scales are necessary for assessing treatment outcomes, but these can be complex to use in clinical practice, and the majority do not include patient or clinician perspectives. CONCLUSION: With the advent of new treatments and technologies, cosmetic surgeons and dermatologists will need to tailor their approach to each patient's needs and manage patient expectations because multimodal methods are likely to be required to address the various factors underlying cellulite appearance.

WATCH VIDEO ABSTRACT: Dermatoporosis: Strategies for Rebuilding the Extracellular Matrix of the Skin.

Dermatoporosis as a disease entity is relatively newly described, the title conceived as recently as 2007. The background of chronic skin fragility, bruising, and atrophy appears to start in some patients as early as their mid-forties, but is full blown over the age of 65 years. The dehydration and fragility of the skin with recurrent bruising and breakdown were initially attributed to increased vessel fragility and permeability thought to be associated with inherent vascular tissue defects in a milieu of increased inflammation and extracellular matrix (ECM) degradation. It has subsequently been demonstrated that this ECM breakdown directly affects the structural support system of the superficial vessels, leading to stretch, increased permeability, and vulnerability to mechanical damage. Add to that the ECM atrophy and general accumulation of non-functional metabolic waste products in the form of fragmented collagen, elastin, and increased circulating glycation end products, and it becomes apparent that much of the problem resides in a structural defect, non-functioning, dehydrated, senescent cellular matrix and unsupported vascular system that presents as dermatoporotic characteristics. This paper describes a strategy of ECM replacement to counteract these foundational deficiencies. J Drugs Dermatol. 2023;22(9): doi:10.36849/JDD.7549.

Improvement in the appearance of cellulite and skin laxity resulting from a single treatment with acoustic subcision: Findings from a multicenter pivotal clinical trial.

INTRODUCTION AND OBJECTIVES: Surface depressions and skin laxity together play a role in the appearance of cellulite. Cellulite depressions can be improved through disruption of the subcutaneous fibrous structures. Some currently utilized approaches accomplish this through invasive techniques requiring local anesthesia and potential down time. Skin laxity can exacerbate the appearance of cellulite, however current invasive approaches do little to improve skin laxity. The objective of this study was to evaluate a noninvasive approach to improving both cellulite depressions and skin laxity through the use of rapid acoustic pulses (acoustic subcision). Safety, efficacy, tolerability, and participant satisfaction results were measured. METHODS: Women (n = 56) with moderate to severe cellulite were treated in a single acoustic subcision treatment session without anesthesia. Posttreatment adverse events (AEs) and tolerability were recorded. At 12-weeks cellulite outcomes were assessed using a 6-point simplified Cellulite Severity Scale (CSS), Global Aesthetic Improvement Scale (GAIS), and a participant satisfaction questionnaire. Additionally, laxity improvement was measured using a 4-point Laxity Score (LS) and GAIS. RESULTS: Improvement in cellulite appearance measured at 12-weeks showed that participants (n = 56) had a mean CSS reduction of 1.01 (a 29.5% reduction from baseline). The posttreatment photograph was correctly identified by blinded independent reviewers from randomized pairs of pre/posttreatment photographs for 96.4% of participants. Cellulite was graded as improved, much improved or very much improved using the GAIS at 90.9% of treated locations. Finally, 92.9% of participants reported positive satisfaction responses. Scoring for improvement in skin laxity appearance at 12-weeks showed a mean LS reduction of 0.57 (a 27.9% reduction from baseline). GAIS for laxity was graded as improved, much improved or very much improved in 67.3% of treated areas. No unexpected or serious AEs were noted at treatment or follow-up. Overall average pain score during treatment was 2.4 (0-10 pain scale) and 0.3 immediately posttreatment. CONCLUSION: A single noninvasive acoustic subcision session can safely provide meaningful improvement in the appearance of cellulite in terms of depressions, as well as skin laxity, with minimal treatment pain and no posttreatment down time. Further improvement in appearance is expected with multiple treatments over time. Additional trials to verify this are planned.

Efficacy and Safety of Simultaneous Application of HIFEM and Synchronized Radiofrequency for Abdominal Fat Reduction and Muscle Toning: A Multicenter Magnetic Resonance Imaging Evaluation Study.

BACKGROUND: Radiofrequency and high-Intensity Focused Electromagnetic (HIFEM) field procedure are well-known, stand-alone, body-shaping modalities, yet their simultaneous application has not been investigated. OBJECTIVE: The aim is to evaluate the efficacy of a novel device simultaneously delivering HIFEM and radiofrequency for subcutaneous fat reduction and muscle toning. MATERIALS AND METHODS: Forty-one subjects with an average age of 39.7 ± 11.5 years were recruited. The subjects received 3 abdominal treatments (one per week). Magnetic resonance imaging images of the treated area were evaluated at baseline and at 1-, 3-, and 6-month visits for changes in subcutaneous fat, muscle thickness, and abdominal separation (AS). Anthropometric data and digital photographs were collected. Subject satisfaction and therapy comfort were evaluated. RESULTS: The muscle mass increase peaked at 3 months, showing 26.1% thickening. The fat thickness reduction was most prominent at 3 months, showing a 30.8% reduction. The AS decreased by 18.8% at 3 months after treatment. The waist circumference reduced by 5.87 ± 3.64 cm at a 3-month follow-up. Six-month data showed maintenance of these outcomes. The treatment was considered as comfortable with high patient satisfaction. CONCLUSION: The analysis of magnetic resonance imaging images and waist measurements showed that the therapy combining HIFEM and radiofrequency is highly effective in reducing subcutaneous fat and muscle thickening.

A Multicenter Study to Evaluate Subject Satisfaction With Two Treatments of AbobotulinumtoxinA a Year in the Glabellar Lines.

BACKGROUND: Real-world re-treatment intervals for botulinum toxins vary, but most subjects receive treatment less frequently than the manufacturer-recommended minimum intervals. In subjects receiving treatment with AbobotulinumtoxinA (ABO) less frequently, high levels of satisfaction and psychosocial improvements in well-being, self-confidence, and quality of life are observed. OBJECTIVE: To evaluate subject satisfaction with a twice yearly re-treatment schedule. METHODS AND MATERIALS: This open-label, multicenter, interventional study evaluated subject satisfaction following injections of ABO 50 U in the glabellar lines at baseline and 6 months. The primary end point was subject satisfaction at 12 months. Secondary endpoints included subject satisfaction, FACE-Q scales, and glabellar line severity scale (GLSS). RESULTS: Ninety-five percent of the 120 subjects were "highly satisfied" or "satisfied" with their treatment outcomes at 12 months. FACE-Q total scores suggested that subjects were less bothered by glabellar lines and felt better about their facial appearance with each treatment versus baseline. Approximately half of subjects had ≥1-grade improvement from baseline in GLSS at 12 months. Median onset of effect was 2 days. CONCLUSION: The majority of subjects (95%) were satisfied with ABO treatment every 6 months; results were supported by high subject satisfaction, long duration, rapid onset, natural-looking results, and overall psychological wellness and safety.

Developing a Topical Adjunct to Injectable Procedures.

Injectable procedures have come to play an enormous part in everyday aesthetic medical practice. Whether its use is directed at volumizing with fillers, decreasing volume using enzymes, skin-tightening using multi-needle approaches, or neuromuscular blockade, the injectable route is the means of delivery in all these cases, making injectable procedures the most common aesthetic procedure performed. As with all procedures, expected and unexpected consequences may follow including bruising, swelling, discomfort, and the possibility of infection. This paper outlines the scientific process and validation of a product designed as an adjunct to injection therapy and the scientific deep dive needed to encompass both symptomatic and adjunctive purposes. On the symptomatic side, bruising, swelling, and pain were considered, while volumetric enhancement, regeneration, and anti-microbial/biofilm effects were desired outcomes from the adjunctive perspective. Utilizing peptides and active agents aimed at reducing excess residual iron and stimulating macrophage absorption of red blood cells, we were able to achieve efficient resolution of bruising. In addition, peptides were included to stimulate collagen, elastin, and hyaluronic acid in synergy with the injectable. Anti-inflammatory, antimicrobial, and antibiofilm agents were added to aid in the safety profile of the injectable. In vivo testing of bruising resolution demonstrated that at day 2/3, participants using the study product (INhance Post-Injection Serum with TriHex Technology®, Alastin Skincare, Inc. Carlsbad, CA) had 73% less bruise color intensity and statistically significant improvement over the bland moisturizer. Overall, 81% of subjects applying the study topical product had less bruising at day 2/3 compared to the bland moisturizer. J Drugs Dermatol. 2020;19(4):398-404. doi:10.36849/JDD.2020.5016.

A Review and Update of Treatment Options Using the Acne Scar Classification System.

BACKGROUND: An unfortunate consequence of acne vulgaris is residual scarring that can negatively affect a patient's quality of life. OBJECTIVE: Jacob and colleagues have previously described an acne scar classification system based on acne scar pathology that divided atrophic acne scars into icepick, rolling, and boxcar scars, and this review will evaluate new and developing treatment options for acne scarring. METHODS: A Medline search was performed on the various treatments for acne scars, and particular attention was placed on articles that used the acne scar classification system of icepick, rolling, and boxcar scars. RESULTS: Therapies for acne scarring included surgical modalities, such as subcision, and punch excision and elevation, injectable fillers, chemical peels, dermabrasion, microneedling, and energy-based devices. In the past decade, there has been a trend toward using cosmetic fillers and energy-based devices to improve acne scarring. CONCLUSION: There were few high-quality evidence-based studies evaluating the management of acne scarring. Many disparate acne severity scores were used in these studies, and the acne scar type was frequently undefined, making comparison between them difficult. Nonetheless, research into interventions for acne scarring has increased substantially in the past decade and has given patients more therapeutic strategies.

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.

High Intensity Focused Electro-Magnetic Technology (HIFEM) for Non-Invasive Buttock Lifting and Toning of Gluteal Muscles: A Multi-Center Efficacy and Safety Study

Objective: Surgical intervention has been the only method to improve the aesthetic appearance of buttocks apart from physical exercising. This study evaluates the efficacy of high intensity focused electro-magnetic (HIFEM) treatments as a non-invasive solution for improvement of buttocks through toning and lifting of gluteal muscles. Materials and Methods: A total of 75 patients (aged 22-59) were treated using a device with HIFEM technology which stimulates gluteal muscles (EMSCULPT, BTL Industries, Boston, MA). The protocol included four 30-minute treatments. Patients' weight was monitored throughout the study. Standard photographs were taken at the baseline, after the 4th treatment, and at the 1-month follow-up. Two 7-point Likert scale questionnaires were used to evaluate patients' buttock and treatment satisfaction. Total score of buttock satisfaction was calculated as a sum of all individual questions to reflect the overall perception of patients' buttocks. The level of comfort during procedures was assessed on a visual analog scale (VAS). Results: The overall buttock satisfaction score (range, 4-28) of all subjects improved from 13.1±5.7 at baseline to 18.4±5.2 after the treatment and 18.9±5.1 at follow-up. For subjects with initial buttock dissatisfaction the scores improved from 8.7±1.6 to 16.3±3.1 after the treatment and to 17.3±3.1 at follow-up. The average score of all treatment satisfaction questions (range, 1-7) was 5.2±1.2 immediately after the treatments and 5.1±1.3 at follow-up. In total, patients initially dissatisfied with the appearance of their buttocks reported a significant 85% improvement after the fourth treatment. Immediately after the fourth treatment, all the subjects reported that their buttocks felt more lifted and toned. Results were maintained at one-month follow-up. Weight of the patients didn't change significantly. Digital photographs showed aesthetic improvements of the buttocks for most of the patients. No adverse events were reported. Conclusion: The results show that the investigated device safely and effectively improves the aesthetic appearance of buttocks non-invasively. The treatments not only resulted in a significant visual improvement but also increased patient confidence and satisfaction. The procedure is suitable for patients seeking improvement in tone, shape, lift, and tightness of the buttocks. J Drugs Dermatol. 2018;17(11):1229-1232.

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.

Treatment of hyperhidrosis with microwave technology.

Hyperhidrosis is the production of sweat above and beyond normal physiological needs, regardless of the ambient temperature, and it affects > 4% of the population. In addition, a poll showed up to 21% of the population is bothered on a daily basis by their amount of underarm sweating. Despite the large number of patients who suffer from hyperhidrosis, there are relatively few effective nonsurgical treatment options. A new, nonsurgical, lasting treatment for axillary hyperhidrosis has now been developed using microwave technology to eliminate sweat glands.

Simultaneous HIFEM and Synchronized RF Procedure Can Be Effectively Used for Increasing Muscle Mass and Decreasing Fat in the Upper Arm.

Objective: Several studies on the simultaneous use of high-intensity focused electromagnetic field (HIFEM) and radiofrequency (RF) have shown safety and effectiveness of fat reduction and muscle mass increases in other parts of the body. This study investigated HIFEM+RF procedure effect on muscle mass and adipose tissue in the upper arms. Methods: Thirty-four subjects enrolled in this multicentric study underwent four, 30-minute bilateral procedures over the upper arms spaced one week apart, with the device simultaneously emitting HIFEM and RF energies. Fat and m. triceps muscle tissue change was measured via magnetic resonance imaging at baseline, 1-month, and 3-month follow-up visits. Additionally, digital photographs, patient comfort, and satisfaction questionnaires were obtained. The trial is registered on ClinicalTrials.gov under NCT04596241. Results: MRI images analysis showed significant improvement at both follow-up visits. At 1-month follow-up (n=28) patients showed 22.3 percent (-4.0±1.2 mm) decrease of average fat tissue, and 21.5 percent (+8.2±2.3 mm) muscle mass increase. Twenty-five patients completed the 3-month follow-up visit, with average decrease in fat tissue by 25.5 percent (-4.9±1.5 mm) and average increase in muscle mass by 23.9 percent (+8.9±2.01 mm). Analysis of questionnaires revealed high satisfaction with the results (84.64%), high comfort during the treatment (91.18%), and low VAS score (1.58±2.0), indicating painless procedure. Conclusion: Presented results demonstrate the safety and effectiveness of the HIFEM+RF procedure for muscle mass increase and fat reduction in the upper arm area. These findings correspond with the outcomes seen in other body parts.

Treatment of mild-to-moderate facial cutaneous aging using a combination peel containing 6% trichloroacetic acid and 12% lactic acid.

Chemical peeling treats facial cutaneous aging and may avoid risks in patients with sensitive skin, darker skin types, limited finances, or concern for side effects of other resurfacing techniques. Tolerability and improvement of photoaging using a combination peel containing 6% trichloroacetic acid and 12% lactic acid for treatment of mild-to-moderate signs of facial photoaging were assessed. This is a prospective, single-center, single-arm, study of 32 female subjects with mild-to-moderate signs of facial aging and Fitzpatrick Skin Types I-V treated with three monthly treatments of a combination peel containing 6% trichloroacetic acid and 12% lactic acid. After 3 treatments, there were statistically significant improvements in clarity, brightness, redness, pigmentation, fine lines, tactile and visual roughness, and overall appearance scores. Subjective improvements in photoaging parameters varied from 53% (fine lines) to 91% (clarity/brightness). Three treatments with a combination peel containing 6% trichloroacetic acid and 12% lactic acid achieved improvements in signs of facial photoaging. This procedure is safe and effective at treating cutaneous aging for all skin types and a viable option for patients who wish to avoid other resurfacing techniques such as laser resurfacing, microneedling among others.

Retrospective analysis of high-intensity focused electromagnetic procedure synchronized with radiofrequency energy for visceral fat reduction.

BACKGROUND: Visceral adipose tissue (VAT), present in the abdominal cavity, oftentimes contributes to an unpleasant aesthetic appearance and can be correlated with serious health issues. High-intensity focused electromagnetic field (HIFEM) technology with synchronized radiofrequency (RF) was recently used for abdominal body shaping through subcutaneous fat reduction and muscle growth. AIM: This study aimed to assess the effect of HIFEM + RF technology on VAT tissue. METHODS: Data of 16 men and 24 women (22-62 years, 21.2-34.3 kg/cm2 ) from the original study were retrospectively reviewed. All subjects received three 30-min HIFEM + RF abdominal treatments once weekly for three consecutive weeks. The VAT area was measured in the axial plane of MRI scans at two levels: L4-L5 vertebrae and 5 cm above this level. The VAT was identified, segmented, and calculated, yielding total area in square centimeters per scan at both specified levels. RESULTS: By thoughtful review of the subject's post-treatment MRI scans, no other changes in the abdominal cavity were found except for VAT. The evaluation showed a VAT reduction of 17.8% (p < 0.001) on average at 3-month follow-up, maintaining the results up to 6 months (-17.3%). Averaging the values obtained from both measured levels, the VAT, occupied an area of 100.2 ± 73.3 cm2 at the baseline. At the 3-month follow-up, the subjects achieved an average reduction of 17.9 cm2 , preserving the results at 6 months (-17.6 ± 17.3 cm). CONCLUSION: This retrospective analysis of MRI images objectively documented the effect of HIFEM + RF abdominal therapy on VAT. The data indicates considerable VAT reduction without serious adverse events following the HIFEM + RF procedure.

Effect of multisyringe hyaluronic acid facial rejuvenation on perceived age.

BACKGROUND: The objective of aesthetic treatments is to create a more youthful appearance. Most injectable fillers are indicated for the reduction of nasolabial folds, but the current aesthetic movement is toward volume replacement in multiple areas, known as global fillers or liquid face-lift. OBJECTIVES: To quantify the degree of perceived age reduction from multisyringe hyaluronic acid treatment. MATERIALS AND METHODS: Ten women were treated with 6 to 8 mL of hyaluronic acid. Exclusion criteria were no laser for 6 months and no hyaluronic acid fillers for 6 months or semipermanent fillers for 1 year. High-resolution photographs were taken in identical lighting and position before and 2 and 4 weeks after treatment. Three blinded dermatologists rated patients' ages before and after from photographs. RESULTS: The dermatologists reported an average of 6.1 to 7.3 years of reduction in apparent age at 2 and 4 weeks, respectively. The patients perceived a decrease in apparent age of 7.8 and 9 years. CONCLUSION: Multisyringe injection of hyaluronic acid filler into the aging face results in a reduction of apparent age from 6.1 to 9 years after 2 to 4 weeks. Full-face correction with hyaluronic acid is an important procedure in the armamentarium of anti-aging techniques.

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.