DaxibotulinumtoxinA-lanm (Daxxify™): A Comprehensive Overview.

Botulinum toxin A (BoNTA) is produced by Clostridium botulinum and widely used for aesthetic indications requiring neuromuscular blockade. For dynamic facial lines, BoNTA is effective and safe, but also temporary, requiring repeat injections approximately every 3-4 months for maintenance of effects. There is a desire by both patients and providers for a longer-lasting neurotoxin to prevent periods of suboptimal correction. Approved by the US Food and Drug Administration (FDA) in September 2022, daxibotulinumtoxinA for injection (DAXI or Daxxify™) is the first long-lasting BoNTA formulated with a 150-kDa BoNTA (RTT150) and proprietary stabilizing excipient peptide (RTP004) in place of human serum albumin. DAXI is approved for treatment of moderate to severe glabellar lines. The median duration of effect was 6 months and results lasted as long as 9 months in some patients. Its unique formulation and prolonged effectiveness positions DAXI as a safe, novel BoNTA for improved durability and patient satisfaction.

Lifting effect of onabotulinumtoxinA in patients treated for glabellar and crow's feet rhytids.

OnabotulinumtoxinA injection can enhance the appearance of the eyes. This study evaluated the lifting effect of onabotulinumtoxinA treatment of the eye area. A retrospective, single-center audit of patients treated for glabellar and crow's feet rhytids was undertaken. Standardized photographs taken before and 2-4 weeks after treatment were assessed. Computer-based measurements were made of the height of the visible superior tarsal plate (STP) and brow (measured from upper eyelid lash edge to eyebrow base) at rest and maximum frown. One hundred patients were included (96 females; mean age: 46.2 ± 8.8 years). Mean onabotulinumtoxinA doses were 14.95 ± 0.61 units (glabella) and 17.83 ± 2.74 units (crow's feet). There were significant post-treatment increases in mean STP height at rest (left side, 0.76 ± 0.99 mm, p = .02; right side, 0.79 ± 0.94 mm, p = .01) and maximum frown (left, 2.25 ± 1.52 mm, p < .0001; right, 1.87 ± 1.34 mm, p < .0001), and mean brow height at rest (left side, 1.54 ± 1.49 mm, p = .0006; right side, 1.47 ± 1.84 mm, p = .0009) and maximum frown (left, 4.37 ± 2.29 mm, p < .0001; right, 4.16 ± 1.88 mm, p < .0001). OnabotulinumtoxinA injection is effective for elevating brow position and increasing STP show.

Unconventional use of ablative fractional photothermolysis in arm contouring.

Brachioplasty, in addition to several nonsurgical interventions (e.g. cryolipolysis, noninvasive radiofrequency, and intense-focused ultrasound) have been described as efficacious in the elimination of excess skin laxity from the upper arms. Recently, fractional CO2 ablation has gained attention for its ability to reduce rhytids and improve skin texture on the face, neck, and hands. In this article, we report the first successful case of fractional CO2 ablation for upper arm contouring.

Efficacy of noninvasive multisource radiofrequency treatment on periorbital rhytids using an imaging device.

OBJECTIVE: To evaluate the efficacy of the multisource radiofrequency in periorbital wrinkles treatment using a VISIA imager. METHODS: This is a prospective cohort study involving 30 sites in 15 patients. INCLUSION CRITERIA: healthy subjects with periorbital wrinkles. Patients underwent five treatment sessions for each site using multisource radiofrequency. VISIA imager was used before and after each treatment, and in 12-week follow-up. The wrinkle scores were calculated and compared between baseline and 12-week follow-up. Changing in periorbital wrinkles were evaluated by blinded dermatologist using a scale of 0-3. After the study, patients rated their satisfaction using a scale of 0-3. The study protocol was approved by our institutional human research review committee, according to the ethics guideline of Helsinki (1975). RESULTS: The effect of treatment on subjects on follow-up compared to baseline showed a highly significant difference with P-values <0.05. Only two patients had no improvement according to blind dermatologist assessment of photographs. Thirteen patients reported satisfaction scale between 1 and 3. CONCLUSIONS: The multisource radiofrequency is safe and effective in reducing periorbital rhytids, and with the help of VISIA imager we can get more objective data to evaluate the efficacy of radiofrequency treatment on the periorbital areas. Lasers Surg. Med. 51:251-255, 2019. © 2018 Wiley Periodicals, Inc.

Platelet-Rich Plasma (PRP): Current Applications in Dermatology

Platelet-rich plasma (PRP) is an autologous serum containing high concentrations of platelets and growth factors. PRP continues to evolve as an important treatment modality with many applications in dermatology, particularly in the areas of hair restoration, skin rejuvenation, acne scars, dermal augmentation, and striae distensae. Furthermore, combining PRP with laser therapies, microneedling, dermal fillers, and autologous fat grafting produces synergistic effects, leading to improved aesthetic results. Future studies should standardize PRP treatment protocols for specific indications. PRP holds considerable promise in dermatology with therapeutic applications continuing to expand.

OnabotulinumtoxinA treatment of moderate to severe glabellar lines in Chinese subjects after laser therapy: A prospective, open-label, noncomparative study.

INTRODUCTION: This study evaluated safety and efficacy of onabotulinumtoxinA for moderate to severe glabellar lines (GL) following laser therapy in Chinese subjects. MATERIALS AND METHODS: Subjects (n = 173) were followed for 120 days following a single onabotulinumtoxinA (20 U) treatment for GL after recent laser therapy. Subjects completed validated patient-reported outcomes, including Facial Lines Outcome 11-item (FLO-11) Questionnaire and Facial Lines Satisfaction Questionnaire (FLSQ). Physicians and subjects assessed GL severity at maximum frown and at rest using the Facial Wrinkle Scale with Asian Photonumeric Guide (FWS-A). RESULTS: Mean total FLO-11 scores increased from 47.7 (baseline) to 75.9 (day 120) (p < 0.0001), with mean improvement of at least two grades for most items maintained to day 120. Most subjects were mostly or very satisfied, per the FLSQ. Percentages of subjects with at least one-grade improvement in FWS-A (responders) at maximum frown per subjects and physicians were 93.1% and 97.1%, respectively, at day 30, and 72.3% and 81.5% at day 120 (all, p < 0.0001). More than 70% were FWS-A responders at day 120. All adverse events were mild or moderate; none were related to onabotulinumtoxinA. CONCLUSIONS: A single onabotulinumtoxinA (20 U) treatment following laser therapy was safe and effective in correcting GL for up to 120 days.

Anatomocosmetic implication rules of the corrugator supercilii muscle for youthful eye appearance.

The dynamic balance of the eyebrows is maintained by the frontal muscle which acts as a brow elevator, and the brow depressors include corrugator supercilii muscle (CSM), procerus, depressor supercilii, and orbicularis oculi muscles. The glabellar rhytids might appear as a result of negative emotions, such as anger, anxiety, fatigue, fear, or disapproval. For youthful and calmer eyes, CSM may restore the muscle balance more safely and effectively for the treatments of forehead rejuvenation. In 50 cadaver hemibrows, CSM was dissected to investigate the location, position, muscle patterns, and its relationships to other muscles. The location of the CSM was variable; five different CSM patterns were defined. Pattern 1: rectangular-shaped classical type was observed with the frequency of 42.5 %. Also, three bellies were present in 25 %, and duplicate muscle in 12.5 %. Irregular flat (15 %) and hypoplastic types (5 %) were introduced as previously unidentified patterns. In muscle specimens, 30 % had complete symmetry, 45 % complete asymmetry, and 25 % semi-assymetry. Mean CSM thickness, length, and width were measured as 1.62 ± 0.4, 29.24 ± 6.4, and 12.62 ± 3.3 mm, respectively. The distances of the medial origo of the CSM-midline and the lateral origo of the CSM-midline were measured as 5.54 ± 4.89 and 14.62 ± 4.17 mm. The different patterns of the CSM were undefined previously. The findings manifest the necessity of botox treatment peculiar to each individual. As, insertion points have been releasing fibres to the peripheral muscles, it is an evidence of its complicated structure. The muscles in the glabella are difficult to demarcate precisely from surface anatomy due to overlapped muscles with intermingled borders, where they are attached as individual patterns. Hence, it might be disadvantageous that different patterns may lead to the risk of asymmetry of the face and brow ptosis in the postinjection period.

Perioral Filler Augmentation.

Perioral tissues are among the first areas to show signs of facial aging, leading many patients to seek perioral fillers as their initial cosmetic treatment. These fillers offer a temporary solution by enhancing volume and reducing common facial lines. Various regions within the perioral area can be targeted, including the lips, nasolabial folds, philtral columns, vertical lip rhytids, oral commissures, melomental folds, mentolabial folds, and nasolabial folds. The technique for injecting perioral fillers depends on the specific region, chosen product, and the desired outcome of augmentation.

Cosmetic Dermatology Concerns in Older Adults.

It is important to understand that each layer of facial tissue, from the underlying facial skeleton to the overlying skin, undergoes significant changes during the aging process. Bony support is lost along the mandible and maxilla and the orbital aperture widens. Superficial and deep fat pads undergo volume loss and migration and the overlying skin begins to reveal signs of both intrinsic aging with skin laxity and fine rhytids as well as extrinsic aging in the form of coarse, deeper rhytids and dyspigmentation.

Radiofrequency Microneedling.

Radiofrequency microneedling is a technique that allows energy to be delivered to specified target depths in the skin via needle electrodes and measures temperature and impedance within the tissue. This method of delivery and real-time feedback has increased safety and efficacy, providing clinically significant improvements in skin laxity, rhytids, and cellulite.

Antiaging Effects of Topical Defensins.

Topical defensins have recently gained attention as agents to improve skin composition. This study aimed to aggregate and synthesize studies in the literature assessing the effects of topical defensins on skin composition in the context of its ability to combat signs of aging.

Heterogeneous crow's feet line patterns and customized botulinum toxin rejuvenating treatment.

BACKGROUND: From early dynamic lines in smiling and squinting young people, crow's feet lines in the lateral canthal region evolve through prolonged tissue remodeling into mature, stable rhytids after the mid-to-late thirties, and requests for rejuvenating treatment. Because of the heterogeneous fanning behavior of crow's feet lines, individualizing neuromodulation with botulinum toxin injections might be a sound strategy to maximize aesthetic outcomes. AIMS: To investigate the prevalence of variable crow's feet line patterns at maximum contracture and while smiling and comment on the relative distribution of such patterns and the influence of aging. These considerations will be the basis and rationale for future studies that will individualize the total 24-unit dose according to the distribution of crow's feet lines. METHODS: Identifying CFL orientation at maximum frown and while smiling; assessment tool: the four-class 2015-version of Kane's classification further modified by converting the former "central fan pattern" into a new, more precisely defined "extended full-fan pattern" class. RESULTS: The 323 cohort subjects had a mean age of 51.5 ± 9.28 years. Although with some differences, outcomes in a central-southern real-world European Caucasian population appear similar to the distribution first studied in 2003 in a highly selected population in New England involved in double-blind clinical trials. The full-fan pattern predominated both at maximum contraction and when smiling, followed in prevalence by the upper-fan pattern at maximum contraction and the extended full-fan pattern while smiling. Age significantly influenced the crow's feet line pattern-lower-fan patterns were more frequent than other patterns in the real-world younger middle-age group (40-49 years old); full-fan and extended full-fan patterns progressively more prevalent with aging. CONCLUSIONS: The study confirms but somewhat modifies the previous evidence about the non-homogeneous distribution of crow's feet line fanning patterns in different age groups and reinforces the case to individualize the topography of botulinum toxin injections.

Treatment of Mild to Moderate Facial Chrono- and Photodamage with a Novel Intense Liquid Trichloroacetic Acid Peel.

Background: Chemical peeling with trichloroacetic acid (TCA) is a well-established modality to improve the appearance of chrono- and photodamaged skin. Objective: We sought to evaluate the efficacy and safety of a novel formulation of TCA and hydrogen peroxide for the treatment of chrono- and photodamaged skin. Methods: Healthy subjects (N=5, 100% female) aged 49 to 72 years and Fitzpatrick Skin Types II (n=2) and III (n=3) enrolled in the Institutional Review Board-approved study. Subjects had mild to moderate facial wrinkles. Subjects were treated with a TCA-peroxide product four times at one-week intervals and applied at-home care products daily between visits. Investigator Global Assessments (IGA), investigator tolerability assessments, and subjective tolerability assessments were conducted on all subjects at each visit. The median score at each visit was calculated and compared to baseline using the Friedman test for repeated measures. Results: Among IGA attributes, differences in median scores from baseline were significant among the four visits for tone (p=0.0174), smoothness (p=0.0014), texture (p=0.0017), redness, ((p=0.0013) and overall appearance (p=0.0073), while the difference approached significance for radiance (p=0.0749). Twenty percent of subjects showed immediate improvement in radiance, tone, smoothness, and texture (Visit 1, immediately after the initial treatment) while 100 percent of subjects showed improvement by Visit 3 for smoothness, texture, and redness, and the improvements persisted to the end of the study. The treatment was well-tolerated and adverse events were not observed. Conclusion: The TCA-peroxide and at-home care products appear to provide rapid and consistent improvement of chrono- and photodamaged skin without adverse effects.

Role of botulinum toxin A in improving facial erythema and skin quality.

Botulinum toxin A (BTX-A) injections have become the most popular noninvasive cosmetic procedures performed worldwide. With growing interest, investigators continue to uncover an expanding array of aesthetic indications for BTX-A. Botulinum toxin A has been used off-label in the management of masseter hypertrophy for facial slimming, platysmal bands, nasal 'bunny' lines, perioral rhytides, gummy smile and scars, to name a few. Interestingly, the injection of multiple microdroplets of dilute BTX-A into the dermis, sometimes referred to as 'microbotox', has been investigated as a tool for facial rejuvenation. A handful of prospective studies and case series have demonstrated the benefit of BTX-A in the treatment of facial erythema and improving skin texture. The aim of this review is to summarize and appraise currently available data on the role of BTX-A in treating facial erythema and skin quality, with a special focus on potential pathophysiologic mechanisms.

Subject satisfaction following treatment with nanofractional radiofrequency for the treatment and reduction of acne scarring and rhytids: A prospective study.

BACKGROUND: Skin-related changes, such as fine lines, wrinkles, and acne scarring, are a source of distress to both men and women. Nanofractional radiofrequency delivers thermal energy to skin layers leading to dermal remodeling that can address skin conditions related to aging. The objective of this study was to evaluate the subject satisfaction of nanofractional radiofrequency for the treatment of facial wrinkles and acne scarring in both lighter and darker skin tones. MATERIALS AND METHODS: 30 subjects (skin types II-VI) were enrolled in this prospective, evaluator-blind study. The average age of subjects was 51.9 ± 13.5 years. Subjects received three treatments at 3- to 5-week intervals on both sides of the face using the 80- or the 160-pin tip disposables. Follow-up visits were conducted at 6- and 12 weeks after the last treatment. Subject satisfaction was evaluated using a self-assessment of a reduction of wrinkles or acne scars, and subject satisfaction questionnaire. Pain, tolerability, and safety were monitored throughout. RESULTS: Subjects treated for acne or wrinkles were satisfied with their treatment at both the 6-week and 12-week follow-up visit (mean score 3.0; range 0 = very unsatisfied to 4 = very satisfied). The treatments were well tolerated at all treatment sessions, averaging a score of 3.5 on the tolerability scale (0 = very intolerable to 4 = very tolerable) with treatment-associated pain reported to be mild (3.2 out of 10). There were no adverse events or unanticipated side effects. CONCLUSIONS: This clinical study demonstrates subjects are satisfied with nanofractional radiofrequency treatments for improvement of their wrinkles and acne scars.

Nonablative laser skin resurfacing for periorbital wrinkling-A case series of 16 patients.

BACKGROUND: Many modalities have been described for the treatment of periorbital wrinkling. AIMS: The purpose of this study is to quantify the improvement of periorbital wrinkling achieved by current nonablative modalities, using a fractional 1565 nm Er:glass fiber laser. METHODS: Our study is a retrospective two-center case series including 16 patients treated with nonablative laser for periorbital wrinkling at the Tel-Aviv Sourasky Medical Center in Israel and Laserplast Aesthetic Medicine Center in Italy between 2017 and 2019. Patients were assessed for objective and subjective improvement, patient satisfaction, side effect profile, and downtime. RESULTS: Improvement in average Fitzpatrick Wrinkle Scale scores (from 4.3 to 2.7 by ranking physician 1 and 3.8 to 2.4 by ranking physician 2, P < .001) was observed after 8 weeks. Global Assessment Improvement Scale scores were 2.6 (physician 1) and 2.2 (physician 2) on average. This correlated to mild-moderate subjective sense of improvement by patients. Side effects and downtime were minimal. CONCLUSION: Our study suggests that current nonablative laser skin resurfacing technology offers a mild-moderate improvement in periorbital wrinkling.

1540-nm fractional erbium: Glass laser is a safe and effective modality for nonablative facial rejuvenation.

BACKGROUND: Laser treatments for facial rejuvenation are common, with ablative modalities being of more common use for this indication. Efficient nonablative modalities are of rising demand. AIM: Our aim was to determine the safety and efficacy of high-fluence, nonablative 1540-nm fractional Erbium:glass laser for facial rejuvenation. PATIENTS AND METHODS: A retrospective study of patients treated with 3-4 treatments using the 1540-nm fractional Erbium:glass laser for facial rejuvenation, using 2500-3000 mJ/stacked pulses (51-61 mJ per pixel). Patients were followed-up for 3 months following their last treatment. Before and after photos were independently blindly evaluated by 2 dermatologists, who graded them using a scale from 0 (exacerbation) to 4 (76%-100% improvement) for 2 different facial regions (frontal face region and lateral canthal region). Pain perception and adverse effects as well as patient satisfaction were documented throughout the study. RESULTS: Sixteen patients completed both treatment and follow-up period. At the 3-months posttreatment follow-up visit, moderate-to-significant improvement in rhytids appearance (mean grade of improvement: 2.93 for frontal face and 3 for lateral canthal region) was observed. Patients' satisfaction was high (4.25). Patients reported mild and transient erythema posttreatment with no other adverse effects. CONCLUSION: The high-fluence 1540-nm fractional Erbium:glass laser is a safe and effective nonablative modality for facial rejuvenation.

Epidermal Growth Factor in Aesthetics and Regenerative Medicine: Systematic Review.

INTRODUCTION: Epidermal Growth Factor (rhEGF) is a promising skin antiaging agent that successfully promotes skin wound repair, and it has been investigated in the past decade for these purposes. However, there are no updated systematic reviews, in English or English, that support the efficacy of rhEGF as a regenerative skin treatment or systematic reviews that compile the uses of rhEGF as facial aesthetic therapy and regenerative medicine. AIM: To describe the current state of facial aesthetic and regenerative medicine treatments in which rhEGF has been effectively used. MATERIALS AND METHODS: An exhaustive search was carried out in "Medline" (via "PubMed"), "Cochrane," "Bireme" through the Virtual Health Library (VHL), "Elsevier" via "Science Direct," "Springer," "SciELo," "ResearchGate," and Google Scholar. Studies related to the use of rhEGF in addressing skin disorders or skin aging are included. RESULTS: Overall, 49 articles were found, which described the use of rhEGF for skin regeneration and restructuring. Efficacy in the regeneration of skin wounds was verified through the intradermal and topical application of formulations with rhEGF. Most clinical trials in aesthetics point to an effective inversion of skin aging. However, uncontrolled or randomized trials abound, so that does not represent enough evidence to establish its efficiency. There are transient adverse effects for both cases. CONCLUSION: The rhEGF considers an effective therapeutic alternative for patients with recalcitrant skin wounds and skin aging, as it is a potent and specific mitogenic factor for the skin.

Effect of defensins-containing eye cream on periocular rhytids and skin quality.

BACKGROUND: Defensins are peptides shown to activate LGR6 stem cells to stimulate the production of new basal stem cells in the epidermis. Use of topical definsin-containing products has been shown to address signs of global skin aging including decrease of wrinkles and increase of epidermal thickness. AIMS: To investigate the ability of a topical defensin-containing skincare product in improving the structure and function of aging periocular skin using objective and subjective outcome measures. PATIENTS/METHODS: A prospective pilot trial of a defensin-containing eye cream was performed in patients with periocular rhytids over 6 weeks. Subjective changes in skin quality and aging characteristics were compared using a patient survey tool. Objective changes in periocular skin quality were analyzed using the QuantifiCare imaging system and the DermLab ultrasound scanner by blinded reviewers. RESULTS: A total of eight patients completed treatment; two were male, and six were female. The average age was 51 years (range 37-63). Compliance with product application as reported on the participant application log was over 90%. Overall, there was an average 2.1 point improvement in subjective measures of skin quality on the consumer questionnaire (P = .002). QuantifiCare imaging of pores, wrinkles, and oiliness showed 370% improvement, 55% improvement, and 12% improvement, respectively. DermaLab noninvasive measurements of elasticity, skin thickness, and hydration showed improvement of 120%, 28%, and 6%, respectively. CONCLUSION: The use of topical formulations of definsin-containing eye cream statically improves patient-reported outcomes of skin quality, especially redness, sensitivity to weather, age spots, and crow's feet.