A survey on the cosmetic use of injectable polynucleotide: The pattern of practice among Korean Dermatologists.

BACKGROUND: Skin boosters denote injectables that promote global improvement of the skin which includes skin texture, elasticity, hydration, and overall appearance. Polynucleotide (PN) products have become popular, but there is surprisingly little guidance on their use. We aimed to maximize the safety and efficacy of injectable PN by providing information on their pattern of practice among board-certified dermatologists. METHODS: A total of 235 Korean board-certified dermatologists familiar with skin boosters participated in a survey which questioned the participant's years of practice, selection of skin boosters in one's clinic, and range of lasers and light sources as well as skin care devices that are available. For those who use PN, one was asked to check all its aesthetic indications, mode of delivery, injection depth, treatment interval as well as options for combined therapy. RESULTS: Seventy-one percent of the survey participants had at least 5 years of professional experience as a board-certified dermatologist, and among the different skin boosters, 88% replied that they practiced PN injection. The top six indications for PN were fine lines on the cheek followed by infraorbital fine lines, periorbital fine lines, uneven skin texture, dry skin, and fine lines on the forehead. Many opted for a 33G needle and the serial puncture technique targeting the dermis. A total of three sessions of PN injection spaced 4 weeks apart is most often recommended. 79 percent of PN users blended PN injection with lasers and light therapy with the most popular being radiofrequency (non-invasive, needle RF) and high-intensity focused ultrasound (HIFU). CONCLUSION: PN is a skin booster which is widely practiced among Korean dermatologists. According to our survey, the best indication of PN is facial fine lines, and as such PN injection is often repeated and combined with a variety of non-surgical rejuvenation procedures. We hope our data help dermatologists better understand and utilize PN injection.

Lip Lifting Efficacy of Hyaluronic Acid Filler Injections: A Quantitative Assessment Using 3-Dimensional Photography.

The study aimed to compare the volume enhancement and the lifting capacity of two different hyaluronic acid gels for lip injection. Thirty-six Korean female patients were randomized into two groups according to the cross-linking degree of the hyaluronic acid filler injected. Using a fixed injection protocol, patients were injected with 1 mL of hyaluronic acid filler in the lips and followed up at four and 12 weeks after injection. Lip volume, lip projection, and columella-labial angle were measured using a 3-dimensional imaging system at each time point. Follow-up values were compared with baseline. Compared with pre-treatment values, there was a statistically significant increase in mean lip volume and lip projection at four and 12 weeks after injection, with no significant differences between the two groups. Lips injected with hyaluronic acid filler of intermediate cross-link density resulted in more acute angles than lips injected with lightly cross-linked hyaluronic acid. The difference was statistically significant at each follow-up time point. No serious complications were observed throughout the study period. Our results imply that in patients who want a prominent upper lip lift, lip injections using hyaluronic acid fillers with intermediate cross-linking density can be a good option due to their lift capacity. The degree of cross-linking may not be a significant determinant of simple lip volume augmentation when other variables are constant.

An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists.

The efficacy and safety of botulinum toxin injection have made it a popular aesthetic procedure worldwide. A cross-sectional survey was performed in order to determine the pattern of type A botulinum toxin injections in cosmetic practice, for which an 18-item questionnaire was distributed to dermatologists. A total of 469 Korean board-certified dermatologists participated in the survey, with the following results: the main candidates for type A botulinum toxin injection were individuals in their 40-50 years (46.1%), followed by those in their 20-30 years (33.4%), and people over 60 years of age (20.5%). Overall, the upper face (the glabella, forehead, and crow's line, in decreasing order) was the most favored area of injection (51%). In contrast, body contouring (i.e., shoulder, calf) and treatment for benign masseter hypertrophy were significantly more popular in the 20-30 years age group than their older counterparts. For wrinkle effacement, the most preferred dilution was 100 units/2.5 mL with isotonic sodium chloride injection (51.2%), and the most often used interval was six months (43.6%). About half (46.3%) of the dermatologists reported the experience of clinical cases which were suspicious of botulinum toxin resistance. Despite this, regarding the choice of the product, type A botulinum toxin products with greater cost-effectiveness were favored over products with a lower risk of antibody formation. Other than its cosmetic usage, botulinum toxin is applied for a variety of skin conditions. Further studies are suggested in order to identify the practice pattern of type A botulinum toxin for therapeutic uses in dermatology, such as hyperhidrosis and rosacea.

Efficacy and safety of incobotulinum toxin A in periocular rhytides and masseteric hypertrophy: side-by-side comparison with onabotulinum toxin A.

BACKGROUND: Incobotulinum is a newly developed botulinum toxin A in which the complexing proteins had been removed. OBJECTIVE: The aim was to compare the efficacy and safety of incobotulinum with onabotulinum in treating periocular rhytides and masseteric hypertrophy. METHODS: A randomized, double-blind, split-face study was planned. Fifty-six patients were treated for periocular rhytides and the other 56 patients were treated for masseteric hypertrophy. Onabotulinum was injected on one side of the face and incobotulinum was injected on the other side of the face. The degree of periocular rhytides and masseteric hypertrophy was rated using Fitzpatrick Wrinkle Classification System (FWCS) and 10-point visual analogue scale (VAS) (0: the minimum to 10: the maximum). Objective and subjective rating was performed at pretreatment and every posttreatment follow-up visit by investigators and subjects. RESULT: The efficacy and safety of incobotulinum were not inferior to those of onabotulinum in treating periocular rhytides and masseteric hypertrophy up to 16 weeks after injection. There were no noteworthy differences in the onset time of effect between two botulinum toxins for periocular wrinkles and masseteric hypertrophy. No adverse event was reported. CONCLUSION: Incobotulinum provided non-inferior efficacy and safety for the treatment of periocular rhytides and masseteric hypertrophy compared with classic onabotulinum.

Botulinum toxin A treatment for contouring of the lower leg.

BACKGROUND: Botulinum toxin type A is widely used in the treatment of bilateral masseteric hypertrophy in Asians. Botulinum toxin A may have plausible effects on the oversized calf muscles that cause mental distress in Korean women. OBJECTIVE: We report our successful use of botulinum toxin A in the treatment of two patients with muscular legs. METHODS: The toxin was injected into the gastrocnemius muscle, 300-360 U per side. RESULTS: A reduction in calf circumference was noticed 3 weeks after treatment and was maintained for 6-8 months without systemic side effects. CONCLUSION: Botulinum toxin treatment for enlarged gastrocnemius muscles is a non-invasive alternative method for the improvement of calf contours.

Alteration of the TGF-beta/SMAD pathway in intrinsically and UV-induced skin aging.

In an effort to characterize transforming growth factor (TGF-beta) signaling and to determine its association with the aging and photoaging processes, we directly compared the expressions of TGF-beta/SMAD in intrinsically aged and photoaged human skin in vivo. By using an RNase protection assay and by immunohistochemistry, we found that the expression levels of TbetaRII mRNA and protein in the epidermis of the forearm (sun-exposed) of the elderly were significantly lower than that of the upper-inner arm (sun-protected) skin of the same individual. In the epidermis, the expressions of Smad7 mRNA in both the intrinsically aged and photoaged skin of the elderly were higher than in the sun-protected skin of the young, and this was elevated in the photoaged epidermis. Decreased pSmad2 immunoreactivity was observed in the epidermis of photoaged forearm skin versus matched intrinsically aged skin. This decrease was also found in the epidermis of upper-inner arm skin of the elderly versus the young. These results suggest that the UV-induced down-regulation of TbetaRII and the concerted over-expression of Smad7 may trigger the inhibition of the TGF-beta-induced phosphorylation of Smad2.