A newer approach in the treatment of seborrheic dermatitis with QR678® and QR678 Neo®-A prospective pilot study.

BACKGROUND: Seborrheic dermatitis is a common chronic inflammatory skin disorder that affects the scalp and is characterized by erythema and oily scales. It could perhaps be difficult to control and could seriously degrade one's quality of life. The study's objective is to assess the effectiveness of intradermal administrations of QR678 Neo® hair growth factor therapy for the treatment of scalp seborrheic dermatitis in both men and women. METHOD: Forty male and female patients with clinically diagnosed seborrheic dermatitis of the scalp in the age 18-45 years, not satisfactorily responding to standard therapy for at least 6 months, were included. 1 mL solution of QR678 Neo® was administered in the scalp skin of all patients at 3-week interval till eight sessions. Patients were advised to continue with antifungal shampoo and topical antifungal solution with steroid combination which they had been on during the treatment. Assessment of disease severity, dermoscopic evaluation, and self-assessment were done at baseline and at the end of the fourth and the eighth sessions. RESULTS: Improvement was observed in adherent scalp flaking score after eighth session (mean = 12) compared to baseline (mean = 60). The dermoscopic evaluation showed a noticeable difference from baseline (mean = 11) in erythema and scaling with the Seborrheic Dermatitis Scalp Severity Index tool at the end of treatment (mean = 2). A high satisfaction score was given for the efficiency in the self-assessment questionnaire. CONCLUSION: Our study proved that treatment with QR678 Neo® led to an improvement in the overall scalp condition by the resolution of flaking and inflammation.

Patterns and Trends of Facial Fractures at a Tertiary Care Trauma Center in India - A 13 years Retrospective Study.

Study Design: Retrospective study. Objective: The purpose of this study was to retrospectively analyze the prevalence, pattern, diagnosis, and treatment of the facial fractures falling under ambit of facial plastic surgery in a multi-specialty hospital at India from the year 2006-2019. Methods: This retrospective study analyzed 1508 patients, having orbital fractures (from 2006 to 2019) for demographic data, cause of trauma, type of fracture, and the treatment given. The data were compiled in excel and analyzed by using SPSS version 21.0. Results: Out of these 1508 patient (1127 (74.73%)-males and 381 (25.27%)-females), the etiology of injuries was Road traffic accident (RTA) (49.20%), assault (26.52%), and sports injuries (11.47%). The most common fracture pattern was Isolated Orbit and/or Orbital Floor fracture in 451 patients (32.08%), followed by Mid-facial fractures (21.93%). Also, 105 patients (6.96%) experienced ocular/retinal trauma along with other fractures. Conclusions: Orbit, peri-ocular, and mid-face trauma comprised a large position of this study. It requires a great deal of expertise to treat such complex trauma, which is not covered in one specialty alone. Hence, a holistic approach of craniofacial fracture management, rather than limiting these skills to water-tight craniofacial compartments becomes necessary. The study highlights the critical need of multidisciplinary approach for predictable and successful management of such complex cases.

Effectiveness of HIFU Therapy for Nonsurgical Facial and Body Contouring: A Systematic Review of Prospective and Experimental Studies.

BACKGROUND: Liposuction, the most common body sculpting surgical procedure known today is associated with the risk of numerous complications. A safer and more noninvasive approach involves the use of high-intensity focused ultrasonography (HIFU) lasers, which work by selectively damaging fat tissue through apoptosis or necrosis induction of fat cells. The authors' systematic review was designed to identify the effectiveness of HIFU for nonsurgical facial and body contouring. METHODS: An exhaustive literature search was conducted of the PubMed/MEDLINE, Cochrane Central, Scopus, and EBSCO electronic databases for the period from November of 2005 to July of 2020. The full text of selected articles was reviewed for possible study inclusion, and articles fulfilling the inclusion criteria were recruited. Characteristics of the included studies were noted, and outcomes were assessed. Assessment of quality and risk of bias was performed for all the studies using the RevMan tool and the methodological index for nonrandomized studies. RESULTS: The initial search revealed a total of 4584 citations, of which only 11 were included in the present review: nine used HIFU for recontouring of the abdomen and only two used HIFU over the face and neck. Studies evaluated either the efficacy of HIFU or the safety of its use. The average total energy ranged from 140 to 248 J/cm 2 for the abdominal region and 0.3 to 1.2 J/cm 2 for the face and neck. The focal depth ranged from 1.1 to 1.8 cm. All the studies showed promising results with the use of HIFU. CONCLUSION: HIFU therapy is safe, effective, and minimally invasive, with predictable results when used for body and facial recontouring.

Determinants of the influence and experiences of cosmetic and aesthetics profiling on interpersonal relationships among Indian patients.

BACKGROUND: The notion of facial beauty is a fast-expanding field in many different disciplines. The determinants and the nature of inter-personal relationships remain a controversial issue. Here, we tackle such questions proposing a novel experimental approach by analyzing first-hand experiences and quality of life among Indian patients, who underwent cosmetic procedures and the subsequent impact of these aesthetic treatments on interpersonal relationships. METHODS: The data collection tool consisted of questions pertaining to the relations between the human face and facial image, relations between the race and facial image and interpersonal relationships and facial image. The tool consisted of 27 questions that were descriptive and closed ended without alternate choices. RESULTS: The study gauged the perception of an ideal facial image among both genders also highlighting the multifaceted nature of a persons' beauty and how its perception is affected by peers, society, and race. CONCLUSION: Though there was a gender-based difference found in the opinions on facial image, majority of the people experienced an ameliorated experience in their relationships with family and peers.

Evaluation of the safety and effectiveness of intradermal administration of QR678 Neo® hair growth factor formulation: A phase-IV, open-label, single-arm multi-ethnicity clinical trial.

BACKGROUND: Intradermal administration of QR678 Neo® hair re-growth factor formulation has already proven its effectiveness and safety in treating androgenetic alopecia and female pattern hair loss. AIM: This study aims to evaluate effectiveness and safety of hair re-growth factor formulation at multiple centers for reduction of hair fall and regrowth of hair in androgenetic alopecia and female pattern hair loss. MATERIALS AND METHODS: An open-label, prospective, and interventional study was carried out at multiple centers of different countries. A total of 2428 patients with androgenetic alopecia and female pattern hair loss within the age range of 18-65 years were included in the study. Hair pull test, global photographic assessment, videomicroscopic assessment tests were performed at the beginning, after fourth and eighth sessions, and self-assessment through questionnaire related to satisfaction and side effects was carried out at beginning and at after eight session. RESULTS: Hair pull test was positive in only 12% of the patients after eight sessions. Beneficial results were noted in the global assessment score (mean-6) after fourth session and eighth session (mean-8). Huge improvement was noted in terminal hair count, vellus hair count, and hair density after eighth sessions. Also, with self-assessment score, a higher satisfaction score was noted. On long-term follow-up as well, no side effects were noted. CONCLUSION: Intradermal administration of QR678 Neo® is an innovative, efficacious, and safe technique for the treatment of androgenetic alopecia and female pattern hair loss.

Effectiveness of QR678 and QR678 Neo® with intralesional corticosteroid vs. intralesional corticosteroid alone in the treatment of alopecia areata -A randomized, comparative, prospective study.

BACKGROUND: Alopecia areata (AA) is an inflammatory disorder, marked by chronic, persistent, and patchy loss of hair. At present intralesional/topical corticosteroids, Minoxidil solution, and topical immune-therapies are used for treatment. Though all these have side effects and high rate of relapse. As QR678 Neo® is proved to be effective in hair regrowth in male and female pattern hair loss, the aim of the study is to compare the efficacy of QR678 Neo® with intralesional steroid therapy vs. intralesional steroid alone in the treatment of AA of scalp in men and women. MATERIALS AND METHODS: A total of 20 participants in age group of 20-50 years with nonscarring patchy hair loss were chosen for the study. Patients were arbitrarily divided into two groups (Group A-intralesional steroid with placebo and Group B-intralesional steroid with QR678 Neo® ). All the participants were evaluated at baseline, 3 months and 6 months with standard global photography, dermoscopic assessment, and self-evaluation questionnaire at the end of study. RESULT: Marked improvement was seen in the global assessment score after 6 months (mean- 6.6 SALT) as compared to baseline (38.5 SALT score) in group B. There was significant reduction of black dots, yellow dots, broken hairs, and tapered hair at 6 months on video dermoscopic examination in group B. Also, higher satisfaction was experienced with the treatment in group B patients. CONCLUSION: QR678 Neo® in combination with intralesional steroids therapy proved to be significantly beneficial, efficient, and can be considered as safer treatment option for alopecia areata.

Efficacy of QR678 Neo® hair growth factor formulation for the treatment of hair loss in Covid-19-induced persistent Telogen Effluvium-A prospective, clinical, single-blind study.

BACKGROUND: Telogen Effluvium (TE) in a post-Covid-19 patient causes excessive shedding of hair. No definite treatment is available till now. Past studies demonstrates that QR678Neo® has shown promising results in various types of Alopecia. AIM: In this study, we aim to establish efficacy of QR678 Neo® hair growth factor formulation administration in Covid-19-induced persistent TE for treatment of hair loss and for hair regrowth. MATERIAL & METHOD: Twenty adult patients (all females) presenting with persistent TE starting few weeks after recovery from Covid-19 infection, and continuing beyond 6 months were included for the study. A 1.5 mL solution of QR678 Neo® hair growth factor formulation was administered in the scalp per session. A total of 8 sessions (one session every 4 weeks) were done. The results were assessed at the baseline, after 4thsession, and 1 month after 8th session. RESULTS: Most of the patients showed significant reduction in hair fall; 89% patients showed excellent hair growth. Global photographic assessment score showed marked improvement, which maintained even post therapy. Videomicroscopic assessment showed increase in the hair count (mean =29.32) after 8th session, that further improved even post therapy. The subjective assessment scores for overall hair growth, appearance of hair, reduction in visibility of the scalp, and hair loss were 4, 4.5, 4.25, and 5, respectively. CONCLUSION: Management of Covid-19-induced persistent Telogen Effluvium has been unclear and futile so far. Intra-dermal administration of QR678 Neo® hair growth factor formulation in the scalp, reduces hair fall, improves hair regrowth, and increases the hair density.

Innovative approach for tear trough deformity correction using higher G prime fillers for safe, efficacious, and long-lasting results: A prospective interventional study.

BACKGROUND: One of the most challenging areas for facial rejuvenation is the lower eyelid. Apart from the protruding orbital fat causing lower lid bags, a discrete entity called the "tear trough deformity" is distinguishable in this area. AIM: The objective of this study is to compare and evaluate the standard technique of tear trough deformity correction with the lateral injection technique using a high G prime filler to establish a guideline for the safe and effective correction of tear trough deformity. METHODS: A prospective, double-blind, study was carried out from Dec 2017 to 2019 including 30 participants in the age range of 35-60 years. The participants were divided into two groups of 15 patients each. In group A patients, conventional technique with a low G Prime filler was used, whereas in group B, lateral injection technique with a high G Prime filler was used. RESULTS: Marked improvement was seen in appearance and skin quality on both the sides in all the patients. As compared to our technique (lateral injections) where a mean of 0.5 ml of filler was used to lift the cheek and reduce the tear trough, the standard technique (Mauricio de Maio's 3-point tear trough reshape technique) required a mean of 1.2 ml of filler for the same. Post-procedure complications including bruising and Tyndall effect were much higher (statistically significant) using the standard medial technique for the correction tear trough. CONCLUSION: Aesthetically satisfying results for the tear trough correction are possible, without actually injecting the tear trough directly, based on the knowledge of the underlying anatomy.

A prospective, open-label, multicentric, single-arm, post-marketing clinical study to evaluate effectiveness and safety of Cross-Linked Sodium Hyaluronate 24mg with Lidocaine 3mg Injection in subjects undergoing treatment for facial wrinkles and lip augmentation.

BACKGROUND: Hyaluronic acid (HA) fillers are quite commonly used since several years for soft tissue augmentation. AIM: The purpose of this study was to evaluate primarily the safety and secondarily the clinical effectiveness of Cross-Linked Sodium Hyaluronate 24 mg with Lidocaine 3 mg (Jeunesso 24L) injection, in subjects undergoing treatment for facial wrinkles and lip augmentation. METHOD: Patients between the age groups of 18 and 75 years, who were seeking soft tissue augmentation treatment on the face and with wrinkle severity score (WSS) ≥2 for bilateral Nasolabial Folds (NLF), were included in the study. The appropriate quantity of the filler was injected at the treatment site. Clinical efficacy assessments were conducted independently at 3 and 6 months after baseline. Clinical efficacy was assessed using Wrinkle Severity Rating Scale (WSRS) and a Global Aesthetic Improvement Scale (GAIS). RESULTS: The mean pain score was found to be 2.57 ± 2.06 immediately after injection which was reduced to 0.1 ± 0.675 at 15 min and this further subsided to "No Pain" in any of the participants at 60 min post the injection. WSRS mean score before treatment was 2.76, which were significantly reduced to 2.14, at 3 months. Majority of participants found an improvement in the marionette line severity. Also, significant improvements were seen in the perioral and lip areas. The Study filler was well-tolerated and no side effects were reported. CONCLUSION: The study indicates that this particular filler, HA+L, is useful for cosmetic improvements in the nasolabial folds and for enhancement of the lips.

Non-surgical rhinoplasty using hyaluronic acid dermal fillers: A systematic review.

BACKGROUND: Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years. AIM: This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications. METHODS: A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias. RESULTS: Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma. CONCLUSIONS: Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.

Personalized video consent in Blepharoplasty: A new paradigm in the preoperative consent giving process.

BACKGROUND: Informed consent is not simply the signing of a form by the patient but more significantly, a process of an in-depth communication between the doctor and the patient. AIM: The written informed consent process typically involves reading a lengthy document involving the medical terms which at times lead to misinterpretation. Therefore, the current research envisages assessing the effectiveness and acceptability of the video consent tool athwart the traditional written consent procedure. METHODS: A retrospective questionnaire study was carried out with 30 patients posted for Blepharoplasty surgery between ages of 18-50 years. They were divided into two groups randomly. All the participants were given written consent. Video consent was taken additionally for group 2 subjects. All the participants received pre-validated questionnaire. The evaluation scale used was a 5-point Likert scale. RESULTS: People with video consent group were more satisfied with the consent process. It was noted that all the patients who received video consent were happier and understood the consent process better than patients with written consent only. CONCLUSION: The inference drawn from our study depicts that video consent is not just easy to understand and clarifies the doubts associated with the surgery but also significantly reduces the anxiety of the patient preoperatively. Also, in other 'quality of life' improving cosmetic procedures including rhinoplasty, face lift surgeries, jaw surgeries, botox, fillers, lasers etc., video consenting tool can be used to a maximum benefit. It is strongly recommended to adopt the practice of taking video consent format in all forms of cosmetic procedures.

Evaluation of efficacy of intradermal injection therapy vs derma roller application for administration of QR678 Neo® hair regrowth formulation for the treatment of Androgenetic Alopecia-A prospective study.

BACKGROUND: Non-surgical hair restoration is one of the most exciting and innovative fields in cosmetic surgery today. The addition of latest technique like derma roller seeks to achieve better results for delivering pharmaceutical solution for hair growth in comparison with topical administration. AIM: We aim to compare intradermal injection vs. derma roller technique for administration of QR678Neo® hair regrowth therapy for the treatment of androgenetic alopecia (AGA) in male and female patients. METHOD: A sum of 50 patients in the age range of 20-70 years with AGA were included and divided into 2 groups; Group A (intradermal) and Group B (derma roller). Intradermal injection of QR678Neo® formulation and derma roller with superficial application of QR678Neo® was given in each group. Assessment was done using hair pull test, global photographic assessment, video-microscopic assessment, and patient subjective assessment at baseline, 6 months, and 1 year. RESULTS: Significant diminution in hair fall was seen in both the groups. All the video-microscopic assessment factors were better in intradermal injection group compared to the derma roller group, but not significant. Erythema and pain were high in derma roller group in compare to intradermal. CONCLUSION: Derma roller technique is more convenient and easy to perform, especially when the availability of a trained person to carry out intradermal injection is not feasible, it gives satisfactory results. It is also beneficial in needle phobic and apprehensive patients. Though the results are more efficacious with intradermal scalp injection technique, this study established satisfactory results with derma roller technique as well.

Evaluation of efficacy of QR678® and QR678® Neo hair growth factor formulation in the treatment of persistent chemotherapy-induced alopecia caused due to cytotoxic chemotherapy-A prospective pilot study.

BACKGROUND: Cancers are one of the main reasons of morbidity and mortality globally. Chemotherapy-induced alopecia (CIA) is one of the most alarming, terrifying, and traumatic adverse effects. A range of therapeutic measures has been suggested to alleviate CIA, but at present, there is no accepted pharmacological therapy that can assure prevention or management. AIM: The aim of the present study was to evaluate the efficacy of QR 678 Neo® therapy in the treatment of persistent chemotherapy-induced alopecia in women and men treated with cytotoxic chemotherapy for breast and lung cancers, respectively. METHODS: A total of 8 male patients with history of lung cancer and 12 female patients with history of breast cancer in the age range of 25-60 years, with WHO classification of grade I and II persistent alopecia who had undergone chemotherapy treatment, were selected for the study. At each visit, 1.5 mL solution of QR 678® was injected into the scalp skin of patients. A total of 8 sessions were performed at an interval of 3 weeks each. All the patients were evaluated with standard global photography, video microscopic assessment, and patient self-assessment questionnaire at baseline, 6 months, and 1 year. RESULTS: Marked improvement was seen in the global assessment score at 6 months (mean-8) which was maintained even after 1 year. Mean score increase in hair count at 6 months was 12.71 which further increased at 1 year. High satisfaction score was given by patients for slowing of hair loss (mean = 4.2) and also for overall hair growth. For appearance and growth of hair, the mean value was 3.4 and 3.8, respectively. CONCLUSION: The formulation of QR 678® and QR 678® Neo showed to be significantly safe and efficient for chemotherapy-induced alopecia in both men and women. Improvement in hair growth was maintained even at 1 year of follow-up. No patient had any severe adverse effects, and injections were also easily bearable by most of them.

QR678 & QR678 Neo Hair Growth Formulations: A Cellular Toxicity & Animal Efficacy Study.

Current treatment modalities are limited in their approach and success for hair loss. QR 678 & QR 678 Neo are new formulations, consisting of a combination of growth factors and peptides. This study demonstrates safety analysis of QR 678 & QR 678 Neo formulation, using in vitro cytotoxicity assay and in vivo animal efficacy. METHODS: Factors including vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-1, keratinocyte growth factor, and copper tripeptide 1 (QR 678) or their biomimetic peptides (QR678 Neo) were suspended in a sterile injectable vehicle. The 3-2,5-diphenyl tetrazolium bromide assay was used to explore the cytotoxic effects of each factor used in the compositions in human keratinocyte cell and human fibroblast cell assays. An in vivo analysis, wherein study animals were given intradermal QR 678 & QR 678 Neo injections, was conducted to assess whether the formulations produce hair growth. Also, hair follicle viability was checked by intradermal injection of the pharmaceutical compositions in secondary alopecia. RESULTS: In both formulations, a positive response was observed with respect to the number of mice exhibiting hair growth at the injection sites. The injections caused retention of hair in a 0.25-cm radius around the injection site. On cytotoxicity study, all the factors were found to be safe in human keratinocyte cell and human fibroblast cell assay. A positive response was demonstrated in animals on treatment with the chemotherapeutic agent. CONCLUSIONS: Intradermal injections of QR 678 & QR 678 Neo hair growth factor formulations are a safe and efficacious option for alopecia. Results seem encouraging enough to warrant a trial in humans with secondary alopecia, post cancer chemotherapy.

Aging and the Indian Face: An Analytical Study of Aging in the Asian Indian Face.

Asian Indians make up almost one-sixth of the world's population. Although some aspects of facial beauty are universal, anthropometric morphology and age-related changes differ in all ethnic groups. Currently, there are hardly any published studies highlighting the process of aging in Asian Indians. We wanted to understand the aging patterns in different ethnic subgroups within Asian Indians and also compare the aging patterns with Caucasians. METHOD: 300 participants, above 30 years of age, were selected from different Indian ethnic groups (North, South, East, West). Recent good-quality photographs as well as those from the preceding decades (20 years and beyond) were studied. A validated grading score of 1-5 was used for assessing various aging parameters. RESULTS: Significant differences exist in the process of aging between Asian Indians and Caucasians. Maximum signs of aging were reported in the age group of >70 years. Earlier signs of aging (in 30-40 years) were more visible in North and East Indian ethnic groups followed by West and South Indians in decreasing order. Also, South Indians showed the least signs of aging (early as well as overall) compared to the other 3 ethnic groups in any given age range. CONCLUSIONS: This study attempts to understand in greater detail the aging process of the Asian Indian population. This study could open up specific treatment protocols to treat this population in the fields of facial esthetics and facial cosmetic surgery.

Efficacy of Incobotulinum toxin-A for the treatment of masseter muscle hypertrophy in Asian Indian patients: A 2-year follow-up study.

BACKGROUND: With the changing trends, more and more patients are opting for nonsurgical or minimally invasive options for reshaping the face. Noninvasive treatments such as incobotulinumtoxinA (Xeomin Cosmetic® ; Merz Pharma Canada Ltd., Burlington, ON, Canada) are a preferred modality for reducing the volume of the muscle and therefore reducing the width of masseter. AIMS: To evaluate the efficacy of Xeomin treatment in long-term management of bilateral masseter hypertrophy in Asian Indian patients. PATIENTS/METHODS: A total of 30 patients were enrolled in the study and were injected with 30 U Xeomin on each side of face, at baseline. Fifteen patients received a second session of Xeomin injection at 12th week, and remaining 15 patients received an additional third session, at 12th and 24th weeks post the first injection, respectively. Follow-up was done at 4th-, 12th-, 24th-, and 36th-week and at first- and second-year follow-ups. RESULTS: For the patients who received two injections, the maximum reduction of 26.85% was observed at 24th week, which was maintained as 20.04% reduction until second follow-up year. The patients who received three injections exhibited very high reduction of 43.12% of masseter volume at 36th week, which was maintained at 38.72 % until the second follow-up year. Three sessions of Xeomin injections were proved to be more effective in long-term maintenance of reduced masseter volume than 2 sessions of injections. CONCLUSIONS: Xeomin injections were found to be effective in long-term management of bilateral masseter hypertrophy. This is the first of its kind paper, which evaluates the long-term effects of Xeomin injections for the treatment of masseter hypertrophy.