Combination of Fractional Radiofrequency and Thermo-Contraction Systems for Facial Skin Rejuvenation: A Clinical and Histological Study.

BACKGROUND: Radiofrequency energy systems are popular options in the treatment of skin laxity and wrinkles. Fractional radiofrequency devices (FRFs) have increased the efficacy and safety. The thermo-contraction (TC) system is also a novel technology that can promote a marked lifting effect. OBJECTIVES: This trial was done to assess the safety and efficacy of a combination treatment using the FRF system and TC for facial skin rejuvenation. METHODS: Fifteen female volunteers (mean age, 47.07 ± 8.83 years) received 3 FRF and 6 TC bipolar treatments in 3 weeks. Assessment methods included wrinkle grading by independent investigator using Glogau wrinkle scoring, objective measurement of depth, area, and volume of right nasolabial fold (using the VisioFace CSI software), thickness and echo-density of the dermis (using high-frequency ultrasound), and measurement of the skin biophysical parameters before and 3 months after last treatment. Histological assessment was also performed on 5 volunteer participants. RESULTS: The clinical evaluation showed a significant improvement in Glogau wrinkle scoring after 3 months (P value, 0.041). The area and volume of nasolabial folds were also significantly reduced (P values, 0.026 and 0.031, respectively). Skin ultrasound showed a significant increase in echo-density of the dermis, which was confirmed by histological findings of an increase in dermal collagen content. Adverse reactions were all transient and mild in severity, and subjects were "moderately satisfied" with the treatment (Likert scale, 3.6 out of 5). CONCLUSIONS: The results of this trial showed that a combination therapy by FRF and TC bipolar systems is efficient and safe for facial skin rejuvenation.

Nasolabial angle at rest and upon smiling.

PURPOSE: The objectives of this study were 1) to determine the mean and SD of the nasolabial angle (NLA) and the linear measure pronasale (Prn)-A' at rest and upon smiling and 2) to determine the difference between smile and rest in participants with normal occlusion and facial harmony. MATERIALS AND METHODS: The sample consisted of 40 white Brazilian participants (20 of each gender) aged 20 to 30 years and with normal occlusion, a pleasant profile, and facial harmony. The measures NLA and Prn-A' were analyzed in profile photographs at rest and during smile, with a millimeter ruler in front of the profile during use of the Dolphin software. The statistical analysis included dependent t tests to compare the rest and smiling variables. RESULTS: The mean of the NLA at rest was 104.93°; it was 110.67° during smile; and the difference between them was statistically significant, with a mean of 5.74°. The mean of the linear variable Prn-A' at rest was 23.25 mm, whereas during smile it was 24.04 mm, and the difference between them was statistically significant, with a mean of 0.79 mm. CONCLUSIONS: The variability in the NLA and Prn-A' at rest and upon smiling was found to be significant in a normal sample, and it should be considered as a diagnostic tool in the treatment planning for sagittal dentoskeletal deformities.

Effect of subdermal 1,444-nm pulsed neodymium-doped yttrium aluminum garnet laser on the nasolabial folds and cheek laxity.

BACKGROUND: Wrinkle formation usually accompanies skin aging. In particular, accentuated nasolabial folds and loss of elasticity are early signs of skin aging. The use of 1,444-nm pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers has increased in popularity. OBJECTIVE: To evaluate the safety and efficacy of a novel 1,444-nm pulsed Nd:YAG laser in the treatment of NLF and cheek laxity using subdermal laser therapy. METHODS: Ten Korean patients with moderate to severe NLF were enrolled. Each received a single treatment session with a 1,444-nm Nd:YAG laser. Two blinded physicians evaluated clinical improvement by rating comparative photographs on a 5-point scale. Efficacy was also assessed by measuring elasticity and roughness. Skin biopsies were performed on five volunteers before treatment and 3 months after treatment. RESULTS: The 1,444-nm Nd:YAG laser effectively promoted clinical improvement of NLF and cheek laxity (p < .05). Significant differences in elasticity and roughness were observed (p < .05). Epidermal proliferation was stimulated as demonstrated by increases in epidermal thickness and Ki-67 expression (p < .05). Quantitative image analyses of pre- and post-treatment biopsies revealed that collagen fibers increased from baseline (p > .05). Transforming growth factor beta and heat shock protein-70 messenger RNA levels quantified using real-time reverse transcriptase polymerase chain reaction increased significantly from baseline (p < .05). CONCLUSION: The 1,444-nm Nd:YAG laser is an effective treatment modality with minimal complications for the treatment of NLF and cheek laxity, but further research with a larger group of patients is needed to confirm these findings.

Cervicofacial rhytidectomy without notorious scars: experience of 29 years.

OBJECTIVES: Presentation and evaluation of results of the surgical technique of cervicofacial rhytidectomy used by the senior author (F.P.), using the classification of facial aging to determine the stage of pre- and postsurgical age. METHODS: The surgical technique was used in 1,181 patients operated on in the past 29 years, starting in 1983. We analyzed retrospectively 318 patients operated on between the years 2001 and 2008, of whom 71 patients met the selection criteria. Postoperative follow-up period was from 6 months to 5 years. RESULTS: All patients in stage I showed clinically visible rejuvenation postoperatively. Significant improvement in facial rejuvenation in stages II and III of aging was shown, with a postoperative change of stage. CONCLUSION: The technique of cervicofacial rhytidectomy with short flap, facial superficial musculoaponeurotic system (SMAS) imbrication, cervical SMAS plication, inconspicuous incisions, and postauricular z-plasty allows for successful and sustainable results over time, with short recovery time and minimal complications. The classification of facial aging pre- and postsurgery has been useful for the assessment of surgical results.

Validated assessment scales for the lower face.

BACKGROUND: Aging in the lower face leads to lines, wrinkles, depression of the corners of the mouth, and changes in lip volume and lip shape, with increased sagging of the skin of the jawline. Refined, easy-to-use, validated, objective standards assessing the severity of these changes are required in clinical research and practice. OBJECTIVE: To establish the reliability of eight lower face scales assessing nasolabial folds, marionette lines, upper and lower lip fullness, lip wrinkles (at rest and dynamic), the oral commissure and jawline, aesthetic areas, and the lower face unit. METHODS AND MATERIALS: Four 5-point rating scales were developed to objectively assess upper and lower lip wrinkles, oral commissures, and the jawline. Twelve experts rated identical lower face photographs of 50 subjects in two separate rating cycles using eight 5-point scales. Inter- and intrarater reliability of responses was assessed. RESULTS: Interrater reliability was substantial or almost perfect for all lower face scales, aesthetic areas, and the lower face unit. Intrarater reliability was high for all scales, areas and the lower face unit. CONCLUSION: Our rating scales are reliable tools for valid and reproducible assessment of the aging process in lower face areas.

Involvement of upper cheek sagging in nasolabial fold formation.

BACKGROUND: Nasolabial folds are a well-known feature of aging, but the mechanism of their formation remains unclear. OBJECTIVES: To clarify the mechanism of nasolabial fold formation, we established grading criteria for severity and explored the influence of dermal elasticity and subcutaneous adipose mass. We also investigated the involvement of facial morphological changes, such as wrinkling and sagging. METHODS: Faces of 108 healthy Japanese female volunteers (age range: 20-60) were photographed at the angle of 45°, and a six-grade photograph-based grading scheme for nasolabial fold severity was established and evaluated. In 70 Japanese female volunteers (middle-aged: 30-50), dermal elasticity was measured with a Cutometer MPA 580® and subcutaneous adipose layer thickness was measured by ultrasound using a Prosound alpha 5®. RESULTS: Nasolabial fold severity was significantly and positively correlated with age in subjects in their twenties to sixties (R = 0.777, P < 0.001). Nasolabial folds were drastically reduced, or disappeared, when the facial position was changed (subjects lay down instead of sitting) to reduce sagging; only 13.8% of subjects showed fixed wrinkles at the positions of the nasolabial folds after the facial position change. Nasolabial fold severity in middle-aged volunteers was significantly and negatively correlated with dermal elasticity parameters, i.e., net elasticity excluding viscoelastic creep (Ur/Ue), overall elasticity including creep and creep recovery (Ua/Uf), ratio of elastic recovery to total deformation (Ur/Uf), and the negative value of the amount of deformation that did not recover to the original state [-Uf-Ua)], all of which were significantly and negatively correlated with age. Subcutaneous adipose layer thickness was significantly and negatively correlated with dermal elasticity parameter Ua/Uf, and also significantly and positively related to nasolabial fold severity (R = 0.285, P < 0.017). CONCLUSIONS: Nasolabial fold severity increases with decreasing dermal elasticity and with increment of the subcutaneous adipose layer. These changes might induce sagging formation in the upper cheek area, promoting fold formation at the border between the inner and outer nasolabial areas.