Microplasma radio frequency technology using stationary tips on pig skin: A histological study.

OBJECTIVE: To investigate the histological properties of microplasma radiofrequency (MPRF) using a stationary tip in different treatment strategies on porcine skin. METHODS: Two Bama miniature pigs received MPRF treatment with two types of stationary tips in eight groups of parameters (power, duration, and pass) on dorsal skin. Skin samples were collected from each treatment zone immediately, at 1 week and 1, 3, and 6 months after treatment. Hematoxylin and eosin (HE) and Masson staining were performed to assess histologic changes as well as neocollagenesis. The dynamic changes of heat shock protein 47 (HSP47) and heat shock protein 72 (HSP72) were also detected by immunohistochemistry. RESULTS: Skin damage increased with pulse energy, duration, and pass. Longer durations or repeated treatments may cause particularly severe skin damage. During the wound healing process, the newborn collagen of the dermis is rearranged. The distribution of HSP47 and HSP72 was consistent with the extent of collagen remodeling. It peaked 1 month after treatment. CONCLUSION: MPRF can effectively cause epidermal ablation, dermal collagen hyperplasia, and remodeling. Increasing power should be the first choice when increasing treatment intensity. For longer durations or repeated treatments, caution should be taken to avoid excessive skin trauma.

Microneedling Therapy for Striae Distensae: Systematic Review and Meta-Analysis.

INTRODUCTION: Striae distensae (SD), linear scars of derma, caused by disproportionate skin stretching, which indicates a cosmetic problem and even endangers individuals' psychosocial health. Microneedling, representing a relatively new procedural therapy, has shown brightening but diverse results in the remedy of SD. Our study systematically investigates and further evaluates the efficacy of microneedling for SD. METHOD: This study was conducted following the PRISMA guidelines. According to the preplanned search strategy, four electronic databases were comprehensively searched for eligible clinical controlled studies. Standardized mean difference (SMD) and odd ratio (OR) with 95% confidence intervals were calculated for continuous data and dichotomous data, respectively. RESULTS: According to the predetermined criteria, eleven eligible articles of six RCTs and five non-RCTs were included. Concerning clinical improvement, a significant difference was observed in the microneedle radiofrequency treatment subgroup (SMD: 0.57, 95% CI 0.20-0.94, P = 0.003). The pooled result of the second subgroup revealed that microneedling and lasers producing almost comparable effectiveness for treating SD with no significant difference (P = 0.35). The analysis result of the third subgroup of microneedling versus non-laser therapy indicated significant difference at the 5% significance level (SMD:1.01, 95% CI 0.51-1.51, P < 0.0001). With regard to patient satisfaction, the pooled estimate concluded that participants' satisfaction with therapeutic effect between MRF and laser group was comparable (P = 0.26), whereas microneedling exhibited significant superiority than both laser (P = 0.04) and non-laser treatments (SMD: 0.95, 95% CI 0.52-1.38, P < 0.0001). Occurrence of post-inflammatory hyperpigmentation (PIH) was not obvious in microneedling therapy compared to other treatments, and a statistically difference was observed (P = 0.0003). Microneedling treatment caused significant pain compared with laser therapy (P < 0.00001). CONCLUSION: This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Utilization of intense pulsed light for hair removal in pediatric auricular reconstruction using tissue expander: A retrospective cohort study.

This study aimed to investigate the safety and efficacy of depilation with intense pulsed light (IPL) in congenital microtia patients during their reconstruction treatment. The hairy skin was treated with the M22TM system (Lumenis, German) using a filter of 695 to 1200 mm. A contact prob with a window of 15 cm × 35 mm or 8 cm × 15 mm was used at a radiant setting of 14 to 15 J/cm2 in the non-expander group and 13 to 14 J/cm2 in the expander group, both in a single pulse mode. The efficiency index of hair removal was classified based on the percentage of hair density reduction as excellent (>75%), good (50-75%), fair (25-50%), poor (<25%). The depilation effect was compared between the 2 groups, and any adverse effects were evaluated. A total of 159 patients were included, with 93 patients in the expander group and 66 in the non-expander group. The reduction of the hair density in the expander group after 3 treatments was higher than that in the non-expander group [82.98 (73.47-89.09)% vs 77.84 (71.50-85.34)%; P < .05, Wilcoxon rank-sum test], as well as the efficiency [excellent cases 68 (73.12%) vs 37 (56.06%); P < .05, Chi-square test]. Four cases of folliculitis, 3 cases of blisters, and no instance of expander exposure and cartilage absorption were observed in this study. Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. Depilation in the skin expansion period resulted in better outcomes after 3 treatments, although after 5 treatments no difference between the 2 groups was observed.

Histological damage characteristics and quantitive analysis of porcine skin with non-insulated microneedle radiofrequency.

OBJECTIVE: In recent years, the microneedle radiofrequency (MRF) has been widely used for skin rejuvenation, but histological studies on the immediate trauma caused by different parameters of non-insulated RF microneedles METHODS: The skin of three pigs was treated with different needle depths, pulse widths and energy levels of non-insulated microneedle RF. Samples were collected before, immediately, and 2 weeks after treatment. The immediate histological response of each group was assessed and quantified by hematoxylin and eosin staining, Masson staining and Victoria Blue staining. RESULTS: In the treatment of non-insulated microneedle RF, different energy levels affected mainly the range of thermal damage (p = 0.044), and different needle depths affected mainly the depth of the cavity (p = 0.022). But the width of the coagulation zone width was determined by different factors. There was no significant difference in the histology of immediate damage caused by different pulse widths. Reepithelialization of the epidermis and basic wound repair can be completed within 2 weeks. CONCLUSION: Non-insulated RF microneedle therapy is an effective and safe treatment that can stimulate dermal wound healing with less thermal coagulation and a wide range of reversible thermal damage. However, it should be noted that the set needle depth may not correspond to the actual penetration depth, nor to the actual depth of histologic trauma.

Comparison of Picosecond and Nanosecond Nd:YAG 1064-nm Lasers in the Treatment of Melasma: A Split-Face Randomized Clinical Trial.

BACKGROUND: Melasma is a refractory pigmentary disorder. The picosecond Nd:YAG 1064-nm laser (PSNY) has promise as a better treatment for melasma with few side effects and favorable therapeutic efficacy. The authors evaluated the efficacy and safety of PSNY and the nanosecond Q-switched Nd:YAG 1064-nm laser (QSNY) in patients with melasma. METHODS: Eighteen patients were recruited to receive the two types of laser treatment on split faces. The modified Melasma Area Severity Index was assessed at baseline and the 3-month follow-up visit. The recurrence rate and the patients' self-satisfaction assessment were also evaluated. RESULTS: The two treated sides showed statistically significant decreases in modified Melasma Area Severity Index score after treatment at follow-up compared with baseline ( P < 0.001). There was no statistically significant difference between the modalities ( P = 0.873) or the patients' satisfaction assessment ( P = 0.287). The visual analogue scale pain assessment score showed that the QSNY was more painful than the PSNY counterpart ( P = 0.007). The recurrence rate was the same for the two treated sides (12.5%). CONCLUSION: PSNY is a better choice compared with QSNY with less treatment pain and postprocedure erythema as well as lower potential risk of exacerbation of melasma. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

A Rare Symptom of Secondary Infection After Facial Thread Lift and Its Treatment.

Facial esthetics is concerned with the harmonious beauty of the face. The skin, soft tissues, and bone tissues of the face degenerate as people age. Facial thread lift is a new minimally invasive esthetic technique that uses threads embedded within different tissue layers to reposition and support lax tissues. The authors report a 35-year-old female patient who developed an infection after undergoing facial thread lift, presenting with facial flushing and swelling, fever, and poor sleep, which was tested for Nocardiopsis dassonvillei infection. The patient was later cured by thread removal, local injection of 5-fluorouracil and triamcinolone acetonide. Postthreading infections have been documented in the past, but it is significant to note that, first, this patient's postinfection symptoms were distinct because she experienced both mild local symptoms and serious systemic symptoms, and second, the authors looked into a quick and efficient treatment option.

Evaluation of the safety and efficacy of a fractional picosecond 1064 nm laser for post-acne erythema in adult Chinese patients.

OBJECTIVE: To evaluate the efficacy and safety of fractional 1064 nm picosecond Nd:YAG laser (FPNYL) in the treatment of post-acne erythema (PAE) of adult Chinese. MATERIALS AND METHODS: A total of 22 patients received 1 session of treatment and were followed up at the eighth week. Primary outcomes were measured by the Clinician erythema assessment scale (CEAS). Secondary outcomes included a global aesthetic improvement scale (GAIS) and patients' assessment of satisfaction on a five-point scale. Pain scores and adverse effects were also evaluated. RESULTS: Twenty-two patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatments and follow-up visits. The mean CEAS scores fell from 2.74 ± 0.80 to 1.95 ± 0.75 (p < 0.05). The mean GAIS of PAE improvement was 2.46 ± 0.68. Erythema percentile scores by VISIA increased from 32.63 ± 7.0 to 45.75 ± 11.45 (t = 5.442, p = 0). The patient satisfaction score was 1.86 ± 1.17. The pain scores were 3.27 ± 1.17 for the FPNYL treatment (varied from 2 to 6). There were moderate erythema and oedema, which last for 3.84 ± 0.78 days. There were overall 68.18% (15/22) patients who felt pruritus in different degrees and 27.27% patients who encountered acne eruptions (white head type). No scar, hyperpigmentation or hypopigmentation was found. CONCLUSION: Treatment with fractional 1064 nm picosecond Nd:YAG laser is effective and safe for PAE of Chinese patients.

Occupational health and safety: measurement and analysis of the electromagnetic radiation produced by radiofrequency devices for rejuvenation.

With the ongoing development of cosmetic technology, many different types of radiofrequency (RF) devices are widely used for face and body rejuvenation. These, like many other high-power devices, may emit excessive electromagnetic radiation into the surrounding environment. Long-term exposure to this environment can lead to poor health outcomes; therefore, it is important to measure and analyze the electromagnetic radiation levels for the health and safety of therapists. A handheld electronic electromagnetic radiation measuring instrument was used to measure the electric and magnetic field strengths. All results were analyzed using the R software (R Core Team, 2021-02-15). We found that the monopolar and unipolar RF devices that we measured from, in this study, could produce large amounts of electromagnetic radiofrequency emissions during operation, whereas the microneedle RF (bipolar RF) device emitted relatively lower amounts (P < 0.01). The strength of electromagnetic radiation is related to power and distance; it increases with power and decreases with distance. This study proved that certain RF devices for rejuvenation could cause severe electromagnetic radiofrequency pollution. The occupational health and safety of therapists require more attention, and effective protective measures need to be taken immediately.

Optical characteristics of the skin with dark circles using pump-probe imaging.

Pump-probe imaging was first used for quantitative analysis of melanin in dark circles' skin to improve the ability to diagnose and treat dark circles on human skin. This study aimed to compare the distribution characteristics in melanin of lower eyelid skin tissues and to determine whether pump-probe imaging has potential for the classification of dark circles in vivo. Specimens obtained from 15 patients undergoing blepharoplasty were examined using pump-probe imaging. Furthermore, adjacent slices were respectively treated with hematoxylin-eosin (HE) and ferrous sulfate (FeSO4) staining for cross-references. Subsequently, the melanin content index (MCI) and mean fluorescence intensity (MFI) were quantitatively analyzed by the pump-probe imaging. The distribution of melanin granules in the pump-probe image and FeSO4 staining was consistent. Meanwhile, the tissues of the skin with dark circles and normal skin demonstrated significant differences in MCI and MFI. These differences can be used to distinguish the skin with dark circles from the normal skin. Pump-probe imaging could be used for the analysis of the microstructure and spectral characteristics of melanin granules in skin with dark circles. Significant differences were noted between the pigmented type of dark circles and the other two groups (normal skin and the vascular type of dark circles), while no significant differences were found between normal skin and the vascular type of dark circles.

Treatment of exogenous hyperpigmentary disorders following silver ion-related chemical exposure with 1,064nm Q-switched laser: a 10-year follow-up.

1,064 nm Q-switched laser has been commonly used to treat pigmentation. However, there is still a lack of research on the treatment of hyperpigmentation caused by topical exposure to metallic salts-related chemical oxidation. We reported an Asian female patient who developed pigmentation 1 year on the face and neck after the recovery from a chemical explosion injury. 1,064 nm Q-switched laser were utilized to treat for 10 years. The facial pigment improved obviously after 10 sessions of treatment of 1,064 nm Q-switched laser. No recurrence or adverse events occurred during 10 years of treatment and follow-up, while the progression of lesions on the neck was observed.

Quantitative analysis of collagen after intense pulsed light and erbium-doped yttrium aluminum garnet laser treatment on rabbit skin.

OBJECTIVE: To investigate the effects of intense pulsed light (IPL) and ablative 2.940 nm erbium-doped yttrium aluminum garnet (Er: YAG) laser on dynamic changes in collagen by quantitative analysis of type I collagen (Col I) and type III collagen (Col III), transforming growth factor (TGF), and matrix metalloproteinases (MMPs) in the dermis of rabbits. METHODS: Backs of ten rabbits were divided into four treatment areas: IPL normal energy group, IPL high-energy group, erbium laser normal energy group, and erbium laser high-energy group. HE staining was performed immediately after the first treatment and two weeks after the first treatment. Col I, Col III, TGF-ß1, and MMP-1 were collected by real-time PCR at baseline, 2 weeks after each session, and three months after the entire treatment monthly. RESULTS: HE staining showed that collagen fibers in the superficial layer of the dermis in the four treatment groups were increased and thickened to different degrees. Real-time PCR showed that statistically differences were noted in each checkpoint before and after treatments in the four groups, whereas no significant difference in the change in the four biomarkers was found among the four treatment groups. CONCLUSION: Both the IPL and Er: YAG laser can effectively upregulate collagens, but in this experiment, there was no significant difference in the therapeutic effect among the four irradiation groups. Moreover, the high-energy level group tended to bring more serious epidermal injury.

Subcutaneous tissue necrosis with fat liquefaction, hematoma, inflammatory mass after microwave-based treatment for axillary hyperhidrosis.

Axillary hyperhidrosis (AH) and bromhidrosis are common complaints in Asians for consultation in dermatology. A microwave-based device has gradually become a first option option during this decade because of the safety and efficacy both for AH and osmidrosis. Other complications reported are transient median and ulnar neuropathy and brachial plexus injury with sensory and motor dysfunction. We herein report a rare case of subcutaneous tissue necrosis with fat liquefaction, hematoma that occurred after microwave-based treatment. It took 3 weeks for both sides to recover completely. The case prompt us that one pass treatment for the same treatment area and cooling to relieve the pain for 24 h. Appropriate restriction of movement should be emphasized within 1 month after treatment. Moreover, caution is needed when bumps enlarged rapidly.

[Correction of prominent malar complex by L-type osteotomy].

OBJECTIVE: To present a new method for correction of prominent malar complex by L-shaped osteotomy through an intraoral incision. METHODS: Based on the anatomical characteristics of the malar complex, we designed a new L-shaped osteotomy for malar eminence reduction. The procedure includes oblique incision of the upper part of the mala, vertical incision of the anterior part of the mala and "greenstick" fracture of the zygomatic arches. According to the severity of malar prominence, we resect part of the anterior-inferior part of the mala and lower the malar complex. RESULTS: This method was used in 39 patients with prominent malar complex. Of them, 32 were symmetrical and 7 were unsymmetrical. All the patients obtained good results. CONCLUSION: L-shaped osteotomy for correction of prominent malar complex is a relatively ideal surgical method with the advantages of simpler manipulation, fewer complications, better result, and ensuring the intactness of the structural characteristics of the malar complex.