Body Harmonization: The Definition of a New Concept.

Body Harmonization (BHA) is an innovative concept in aesthetics area based on a set of advanced injectable techniques that have shown promising results for body shaping. This is based on procedure combinations indicated to treat body aesthetic dysfunctions, such as localized fat, stretch marks, blemishes, flaccidity, buttocks remodeling, lean mass gain and muscle definition. This study aims to define the clinical concept of BHA, its applications and the main protocols used based on injectable pharmacotherapy. For this purpose, we performed a retrospective review of proven efficient injectable procedures with advanced results for the treatment of body aesthetic disorders, in addition to relying on data obtained from previous clinical experiences. Based on these data, we describe how different compounds can act for treatment of the main body aesthetic dysfunctions, such as lipolytic compounds and collagen biostimulators. In addition, the main application techniques and treatment protocols for each of these dysfunctions were defined. Minimally invasive injectable procedures offer an effective therapeutic option for patients who do not intend to undergo surgical interventions.

Platelet-Rich Plasma in Dermatology: New Insights on the Cellular Mechanism of Skin Repair and Regeneration.

The skin's recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin's innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP's advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)-a unique dermal cell population-have shown promising potential for tissue regeneration in various organs, including the dermis. TCs' participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.

Efficacy and Tolerability of HydraFacial Clarifying Treatment Series in the Treatment of Active Acne Vulgaris.

Objective: This 12-week, multicenter, open-label study investigated the efficacy and tolerability of the HydraFacial Clarifying Treatment for improving skin appearance in patients who present with acne vulgaris. Methods: Twenty eligible adult patients with mild-to-moderate acne were enrolled at one of two treatment sites in the United States and were to undergo six HydraFacial Clarifying Treatments, one every two weeks for 12 weeks. Treatment occurs in three steps: cleansing and peeling; suction to extract dead skin cells, sebum, and debris; and application of blue LED light. Acne severity was graded by investigators and by patients using the Global Acne Severity Score (GASS). Results: The proportion of patients with no acne or almost clear skin (GASS ≤1) at baseline versus final treatment increased from 20 to 65 percent per investigator assessment (p=0.0027), and from 5 to 55 percent per patient self-report (p=0.0016). At final treatment, more than 80 to 100 percent of both investigators and patients agreed or strongly agreed there was an improvement in skin appearance across multiple assessment parameters. Treatments were generally well tolerated. Limitations: Due to the nature of the treatment, blinding of neither investigators nor patients was feasible. Conclusion: The results presented here suggest that a series of six HydraFacial Clarifying Treatments improves overall skin appearance in patients with active acne.

An Analysis of Aesthetic Concerns Identified by Video Conferencing.

Background During and after the coronavirus disease 2019 (COVID-19) pandemic, there was a significant increase in the demand for aesthetic procedures nationwide. We believe that one of the factors contributing to this increase was the use of video conferencing apps. Therefore, the purpose of this study was to analyze the aesthetic concerns that were identified by video conferencing. Methodology In Saudi Arabia, an observational, cross-sectional study was conducted from February to April, 2022. An online survey was used to assess the aesthetic concerns raised by video conferencing. The survey addressed multiple aspects, including demographic data, information on video call utilization, the attentional focus of the participants during video calls, and new appearance concerns identified on video calls. Results The survey successfully captured 432 adult participants. More than 85% of participants disliked at least one character of their appearance during video conferencing. The skin color type (based on the Fitzpatrick scale), time spent on video calls, and visual focus during the virtual meeting were significantly correlated with self-perception of new disliked features. Conclusion Video conferencing showed a significant statistical correlation with identified disliked facial/body features in both genders. People with skin color type III were less likely to perceive a disliked feature through video conferencing applications. The likelihood of having a disliked feature was significantly higher among individuals who spent up to one hour per day using video calls. Additionally, those who mainly paid attention to their face or body during virtual meetings were more likely to have disliked features.

Introduction and overview of radiofrequency treatments in aesthetic dermatology.

In this introductory article to this special supplement in radiofrequency (RF), we aim to summarize the scientific foundation of RF therapy and its role in aesthetic dermatology. Monopolar, bipolar, and multipolar RF systems are described in detail, along with the different delivery methods such as stamping, dynamic or continuous movement, fractional, fractionated (FR) needling, and non-contact devices as well as the minimally invasive platforms that use subdermal probes. The characteristics of different tissues and the technical parameters that influence the effect of RF therapy, such as the penetration of energy, are summarized. This article expands on the various treatment applications for these devices and the mechanism of action behind skin and adipose tissue remodeling, and also discussed are safety concerns, treatment endpoints, and specific considerations when using RF therapy to provide effective treatment outcomes with reduced patient downtime.

Look Better, Feel Better, Live Better? The Impact of Minimally Invasive Aesthetic Procedures on Satisfaction with Appearance and Psychosocial Wellbeing.

Background: Patients pursue cosmetic procedures to improve physical appearance as well as self-esteem and confidence, which translates into better quality of life. As aesthetic providers, it is important to understand the improvement in quality of life that can be achieved from various aesthetic procedures, best measured by patient reported outcomes (PROs), such as the validated FACE-Q. Objective: This review summarizes FACE-Q outcomes after nonsurgical dermatological facial cosmetic procedures. Methods: A review of relevant clinical terms was performed on the PUBMED database. All abstracts were reviewed; articles were included based on relevancy; bibliographies of selected articles were reviewed; and supplemental articles were added accordingly. Results: The current literature has 31 articles using the FACE-Q to measure quality of life, focusing on satisfaction with appearance, psychological wellbeing, social wellbeing, age appraisal, and recovery early life impact (i.e. disruption of the procedure on daily life activities) after minimally invasive aesthetic facial procedures. Clinical studies focused on treatment with dermal fillers for mid-face rejuvenation, chin/lower-face enhancement, lip enhancement, botulinum toxin-A for glabellar lines, combined filler and botulinum toxin-A, and other. Nearly all FACE-Q domains improved following minimally invasive cosmetic procedures. Absolute changes in FACE-Q psychological wellbeing and age appraisal were greatest with combined treatments compared to single treatments. Limitations: Limitations included varying follow-up times, lack of control groups, and publication bias for positive findings. Conclusion: To maximize patient satisfaction and retention, providers should consider a combined treatment approach, to improve patient psychological wellbeing and age appraisal, and ultimately quality of life.

The role of the adjuvant aesthetic therapy in the lives of patients with psoriatic disease.

Introduction: Psoriasis is a chronic inflammatory disease of the skin, which greatly impairs the patients' self-esteem and consequently leads to a deterioration in their quality of life. Numerous therapeutic options available, when combined, enable to maintain a satisfactory control of the psoriatic lesions. Aesthetic dermatology also provides physicians with tools for targeting the disease symptoms, such as mesotherapy, sonophoresis and chemical peels. Aim: The main aim of the study was to quantify the effect of psoriasis on patients' lives, particularly their self-esteem and everyday life. Moreover, a follow-up survey was used to assess the patients' knowledge on professional and at-home care treatments. Material and methods: The sample consisted of 45 inpatients admitted to the Dermatology Clinic of the Heliodor Swiecicki Clinical Hospital of the Poznan University of Medical Sciences due to a psoriasis flare-up. Data were collected through the DLQI questionnaire, survey, personal interview and physical examination. Results: A vast majority of the respondents reported a strong negative impact of the disease on their self-esteem and this impact was stronger among women. Furthermore, almost all of the patients denied ever receiving aesthetic treatments. Conclusions: In accordance with previous research, this study also shows that skin imperfections drastically influence the perception of a patient in the society, therefore acknowledging and combining appropriate therapeutic methods should be a matter of vital importance.

Safety and efficacy of microneedling technology in the treatment of acne scars.

BACKGROUND: Current options for the reduction of acne scarring (eg, ablative laser resurfacing) are associated with considerable side effects and limitations in terms of patient population. Percutaneous collagen induction via microneedling poses an alternative treatment method due to its low rates of reported adverse events and side effects. OBJECTIVE: To assess the safety and effectiveness of microneedling treatments in reducing acne scars. METHODS: A total of 22 patients (18 females and 4 males) with a mean age of 38 ± 7.6 years were assessed regarding the appearance of facial acne scarring. Acne scars were assessed via the Acne Scar Assessment Scale (ASAS) and the Goodman and Baron acne scar grading scale before and after two/three treatments. Additionally, the post-interventional development of side reactions, adverse events, and patient-reported outcomes (eg, pain/discomfort, skin redness) was reported. RESULTS: Compared to baseline, the mean ASAS value was improved statistically significantly on average by 1.41 and 1.46 after the second treatment as assessed by the independent raters and the patients, respectively. In patients who received a total of three treatments, a statistically significant mean improvement in ASAS value of 1.35 and 1.66 compared to baseline was assessed by the independent raters and patients, respectively. No unexpected adverse events were reported. The severity and rate of side reactions decreased over the course of this study. CONCLUSION: Microneedling treatments can pose a safe and effective option in the reduction of acne scarring. In this study, microneedling helped achieving a significant reduction of acne scars while showing high patient safety.

The impact of COVD-19 on North American dermatology practices.

COVID-19 continues to affect the delivery of healthcare services, as practices across North America gradually re-open with new safety measures and practice guidelines. Specifically in dermatology, clinical care is delivered in close physician-patient proximity through physical examination and the use of additional diagnostic and therapeutic procedures. We designed a 10-question survey to better understand how COVID-19 has impacted the delivery of care in North American dermatology practices. Survey questions explored themes including changes in patient volumes, the use of virtual visits/teledermatology, the frequency of aesthetic and surgical procedures, and other related topics. We invited 102 board-certified dermatologists working in a variety of medical, aesthetic, surgical, and mixed practices, to participate in our survey hosted through Qualtrics XM. These dermatologists were selected based on their geographic location and our ability to access their contact information. Each dermatologist received an individualized e-mail and survey link; however, all survey responses were anonymized. In 2.5 weeks after survey invitations were sent, the survey was viewed and completed by 71 and 54 dermatologists, respectively. The second wave of e-mails was sent to the remaining 48 dermatologists who had not yet completed the survey, after which 15 participants both viewed and completed the survey. In total, 69 responses were recorded with an overall response rate of 67.6%. We report decreased patient volume capacity, fewer aesthetic and surgical procedures, and an increase in the use of virtual medicine among board-certified North American dermatologists. However, this represents a reflection on perspectives at a single time point in a rapidly evolving situation. Understanding the full scope of the impact that COVID-19 continues to have on dermatologic care is paramount to effectively serve our patients.

A Standardized Evaluation Method for Assessing Patients With Genital Dyschromia.

Objective The population's ever-growing concern with genital aesthetic dysfunctions reflects an increasing demand in the field of intimate aesthetics. For this reason, as well as the lack of a standardized evaluation, this paper aims to develop a form that facilitates the initial investigation of aesthetic genital dysfunctions.  Methods An evaluation form for female and male genital dyschromia was developed between July and November 2018. Following initial development, the form was evaluated for quality and was updated by a panel of specialists (a psychologist, two pelvic dysfunction physiotherapists, and two dermato-functional physiotherapists) via email and through a content validity questionnaire. The face validity of the form was assessed by five physiotherapy and medical students who were randomly selected. The students answered a questionnaire evaluating the proposed form. The reliability of the form was established through the test-retest procedure by evaluating its reproducibility over time. Results The "Genital Dyschromia Evaluation Form'' (composed of identification, anamnesis, and physical examination sections) was approved by the specialist panel. They suggested questions to be added in the anamnesis (dermatological lesions or fungal and bacterial infections) and physical examination (hyperemia, edema in the perianal and internal thigh region) sections. As for the image analysis, an increase in quality, resolution, and sharpness was suggested. Lastly, for the cutaneous phototype evaluation, the DoctorSkinFototipo® digital analyzer device was chosen since it is small, portable, easily positioned on the genital area, and can be readily cleaned between patients.  Conclusion The "Genital Dyschromia Evaluation Form" is a questionnaire approved by specialists and could represent a suitable option for health professionals.

A Descriptive Study on the Applications of Plasma Exeresis in Dermatology.

BACKGROUND: Plasma exeresis is an aesthetic procedure used for the non-surgical treatment of a variety of skin problems. This technology allows for the improvement of skin imperfections and wrinkles and can be used to treat certain dermatological disorders. OBJECTIVE: The purpose of this descriptive study was to describe the demographics and postprocedural recovery experiences of patients who underwent plasma exeresis at a single clinic over a period of eight months. Additionally, data on patient satisfaction with the treatment was recorded. Methods: A descriptive, cross-sectional study was conducted. Participants in the study included all individuals who underwent plasma exeresis at the Tsioumas Clinic in Greece over a period of eight months from September 2018 to April 2019. Frequency distribution tables were used to describe the types of cases and the number of patients who underwent plasma exeresis treatment each month. RESULTS: A total of 710 patients underwent plasma exeresis within 124 actual working days during the study period. Of these, 73.4% (n=528) were women, and 25.6% (n=182) were men. The most cases were recorded in January, March, November, and February, representing 15.5 percent, 15.4 percent, 15 percent, and 14 percent of the total cases, respectively. Over 33 percent and 18 percent of patients were treated in the upper and lower eyelids, respectively. With regard to patient satisfaction, more than 52.9 percent of the patients reported being extremely satisfied with the plasma exeresis treatment. CONCLUSION: The results from our study demonstrate that plasma exeresis is most popular in our clinic from November to March, and the upper and lower eyelids were the most frequently treated areas during the eight-month study period. While not all patients who were originally treated were able to be reached to report their level of satisfaction, the majority of the proportion of patients that were able to be contacted reported being satisfied with the treatment. Future research with more objective efficacy measurements are needed to support our findings.

The changing paradigm of an aesthetic practice during the COVID-19 pandemic: An expert consensus.

Until vaccination for the SARS-CoV-2 becomes a reality, it appears that the infection is here to stay. With many countries lifting lockdown restrictions, aesthetic clinics have started reopening with strict standard operating procedures in place. It is pertinent that the physician today understands the infection, disinfection measures, and personal protective equipment to reduce chances of viral transmission and provide safe clinical settings for oneself, the staff and the patients. An online meeting of eight experts in the field of aesthetic dermatology was convened, which particularly focussed on PPE in detail, risk categorization of aesthetic procedures, preprocedure recommendations, and generalized and specialized SOP's for aesthetic procedures. These recommendations were aimed to bridge the gap between published guidelines and clinical practice and are by no means fully conclusive, but signify learnings over the past few months in an active clinical aesthetic practice.

Platelet-Rich Plasma: A Comprehensive Review of Emerging Applications in Medical and Aesthetic Dermatology.

Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.

Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic.

BACKGROUND: Amid the coronavirus disease 2019 (COVID-19) pandemic, dermatologists must be prepared to restructure their practice of procedural dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has presented several challenges and has ushered in several changes in practice such as teledermatology, with many physicians adopting virtual consultations and treatments. Performing procedures in the times of COVID-19 pandemic presents challenges such as risk of transmission to doctors and staff due to potential aerosolization, release of virus droplets during the procedures, and risk of virus transfer through the instruments both in the peri- and postoperative period. This can have several medical, administrative, and legal implications. OBJECTIVES: This document aimed to outline best practices that can be followed in this scenario to perform cutaneous surgeries and procedures to ensure safer skin surgery. RECOMMENDATIONS: Standard precautions include social distancing of at least 1 m, hand hygiene, appropriate use of personal protective equipment (PPE), safe injection practices, sterilization and disinfection of medical devices, environmental cleaning, and respiratory hygiene. It is generally advisable to see patients only by appointments. Each clinic should have a special area at entry for screening patients and providing sanitizers and masks. Procedures, which are of short duration, performed on nonfacial areas are considered as low risk and require donning surgical mask. Procedures involved with minimal invasiveness and bleeding, short duration procedures on the face such as injectables, chemical peels, and aerosol-generating procedures on nonfacial areas are considered moderate risk. These procedures need apron with head cover, N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and plume-regenerating procedures (such as ablative lasers on the face), prolonged surgeries on head (such as hair transplantation), intraoral, and intranasal procedures are considered high risk. These procedures must be carried out with full body cover with surgical gown, head cover, N95 mask, face shield, double gloves, and smoke evacuator. Physicians should be aware of local epidemiological situation and adhere to the relevant guidelines issued by the relevant governmental agencies.

Safer Practice of Aesthetic Dermatology during the COVID-19 Pandemic: Recommendations by SIG Aesthetics (IADVL Academy).

The COVID-19 pandemic caused by the SARS-CoV-2 virus, has changed the homeostasis of the medical world. In this critical phase, in addition to the general recommendations issued by World Health Organization (WHO) for medical practitioners and health care givers, certain other precautions and safe care practices need to be emphasized which are unique to each branch of medicine. Aesthetic dermatology is no exception. With aesthetic treatments on the rise, it is pertinent to formulate safe practices for aesthetic dermatology to protect the doctor, health staff and the patients from getting exposed during this phase and in the aftermath of the pandemic. Recommendations for surgical and dental procedures advice to defer such procedures. This can be extrapolated to aesthetic dermatology also, but once health care services start, there should be some safety recommendations to be followed until we have definitive management or a vaccine for it.

Dermatology in Ancient Rome: Medical ingredients in Ovid's "Remedies for female faces".

BACKGROUND: In Roman medicine, face packs, plasters, unguents, and peelings were part of the therapy of dermatological diseases, but also served cosmetic purposes. Ancient medical textbooks inform us about the ingredients for these applications. Beyond medical literature, other genres contain information about dermatological applications. The Roman poet Ovid (43 BC-17 AD) wrote a didactic poem recording five recipes for topical applications for female faces (Medicamina faciei femineae). Researchers debate the relation of Ovid's poem to Roman medicine: Does the poem contain therapeutical or cosmetical information, or is it mere belles lettres? AIMS: The objective of the paper is to conduct a medico-historical classification of Ovid's poem by determining whether the ingredients of Ovid's recipes were thought to be effective by the authors of Roman medical textbooks. METHODS: First, translation and identification of the ingredients were carried out. Second, comparison of the ingredients' functions regarding the therapy of dermatological diseases in two important Roman medical textbooks was realized. For this purpose, several commentaries on the text of Ovid were used and a keyword search in Roman medical textbooks was performed. RESULTS: Ovid's five recipes contain 23 ingredients. All ingredients can be found in medical textbooks. We find that 14 of these ingredients serve cosmetic purposes, 17 serve the therapy of dermatological diseases, and 13 serve both. CONCLUSION: Ovid's recipes contain drugs that were considered effective by the authors of Roman medical textbooks. These drugs were recommended both for therapeutic and cosmetic purposes by the same authors. Therefore, Ovid's didactic poem is not mere belles lettres, but contains serious medical and cosmetical information. As far as we know, it is the first Roman text that contains dermatological recipes.

Protective effects of astaxanthin on skin: Recent scientific evidence, possible mechanisms, and potential indications.

Astaxanthin is a naturally occurring ketocarotenoid which has been found to have numerous biological functions, with its strong antioxidant property being the prominent feature. The compound has attracted a great amount of interest with respect to its potential utilization in the betterment of human health. In the recent past, astaxanthin has been extensively studied with respect to its possible effect on skin health, with positive results. Astaxanthin has also shown to have anti-inflammatory, immune-modulating, and DNA repair properties, which have further encouraged its usage to maintain skin health and tackle skin damage. In this review article, we highlight the pharmacokinetic profile of the antioxidant in brief and describe the findings of various recent published research articles which studied the effect of astaxanthin in improvement of skin health. We also mention the possible mechanisms which form the basis of the positive dermatological effects of astaxanthin and the potential indications of the antioxidant molecule in cosmetology and dermatology.

The Influence of Modern Social Media on Dermatologist Selection by Patients.

Objective Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people's thinking when deciding which doctor to see for skin-related concerns. Methodology A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis. Results Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes. Conclusion As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend's recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.