Device-Induced Neocollagenesis: Profibrotic Response or True Neocollagenesis?

BACKGROUND AND OBJECTIVES: Many light and radiofrequency-based rejuvenation devices have claimed to increase collagen production in the skin dermal tissue. However, there has not been enough scientific evidence to prove whether the result is just a profibrotic response or not. We aimed to find the optimal skin rejuvenation device that shows true neocollagenesis. STUDY DESIGN/MATERIALS AND METHODS: We evaluated dermal collagen thickness and gene expression of procollagen type 1, 3, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-ß (TGF-ß) resulting from different energy-based devices in a rat model in vivo. The wound-healing response was evaluated histologically and by real-time polymerase chain reaction (RT-PCR) at immediate, 1st, 2nd, 4th, 8th, and 12th week after the initial procedure. RESULTS: At the 12th week, the most relevant changes of the dermal thickness were found in specimens after treatment with electrosurgical unit, fractional CO2 and 1064 nm Q-switched Nd:YAG. Procollagen 1 and 3 were also found to be the highest in electrosurgical unit, fractional CO2 , and microneedle radiofrequency. Dramatic changes of MMP-3 and TGF-ß were remarkable at the early observation but went back to normal level at 12th week. The ratio of procollagen 1 and 3 was found to be the lowest with Q-Switched Nd:YAG 1064 nm and fractional CO2 . CONCLUSION: Electrosurgical unit resulted in most significant changes, but due to irreversible thermal damage and extremely high procollagen results it is considered as a profibrotic response. Fractional CO2 and Q-Switched Nd:YAG 1064 nm are applicable to face skin rejuvenation treatment considering thickening of dermal tissue and lower procollagen 1:3 ratio similar to the neocollagenesis purpose. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Clinical efficacy of 1,444nm Nd:YAG laser for xanthelasma palpebrarum.

Xanthelasma palpebrarum (XP) does not regress spontaneously and most patients complain of cosmetic discomfort. This study presents the results of treatment of XP using 1,444 nm Nd:YAG laser. We aim to evaluate the clinical efficacy of a 1,444 nm Nd:YAG laser in XP. Twenty-eight patients with XP treated with 1,444 nm Nd:YAG laser were analyzed retrospectively. A physician scored the results based on the reduction of the initial lesion area under six categories. The results were scored as follows: no effect (0% clearing of xanthelasma area), some response (1-24% clearing), moderate response (25-49% clearing), marked response (50-74% clearing), satisfactory result (75-99% clearing), and excellent result (100% clearing). Twelve patients (42.8%) showed excellent clearance and 10 patients (35.7%) had clearance greater than 75%. Overall, 24 patients (85.7%) showed improvement higher than 50%. Half of the patients (14 patients) ended the treatment with satisfactory results with one treatment session. Including seven patients who ended the treatment after two laser sessions, 21 patients (75%) reported satisfactory results and ended the treatment after 1 to 2 laser sessions. XP treatment with 1,444 nm Nd:YAG laser showed promising results. We believe it can be an effective and safe treatment modality for XP.

"New classification of late and delayed complications after dermal filler: Localized or Generalized?"

Background: As filler injections have become very common procedures worldwide, the number of complications has increased. However, there is a lack of systematized studies and precise classification of late and delayed complications. This study aimed to suggest new and reliable classifications and to characterize the clinical manifestations of late and delayed complications after filler injections.Methods: This retrospective study analyzed patients and suggested a new classification of delayed adverse effects related to filler injection. Several demographic and clinical findings were analyzed. Patients were classified into two types according to their clinical presentation: Type I (Localized) or Type II (Generalized).Results: Twenty-five patients were evaluated during a clinically active adverse event suspected to be related to fillers. The most common injected filler substance was hyaluronic acid (HA, 68.8%). 76% of the patients were classified with Localized complications. In the Generalized complications group, systemic symptoms were more common (p=0.002), the treatment response was poor (p=0.010), and fewer patients showed complete remission (p=0.007) than in the Localized complications group.Conclusions: We propose a simple new classification method for late and delayed complications after dermal filler: Localized and Generalized. We expect that this new classification could help provide appropriate treatment and predict patient prognosis.

Prospective Evaluation of Atrophic Acne Scars on the Face With Needle-Free High-Pressure Pneumatic Injection: Quantitative Volumetric Scar Improvement.

BACKGROUND: Atrophic acne facial scars still pose a treatment challenge. Needle-free high-pressure pneumatic injection has recently been introduced; however, few studies exist regarding its effectiveness. OBJECTIVE: To evaluate the efficacy and safety of pneumatic injection for treating atrophic acne scars using a 3-dimensional optical profiling system. METHODS AND MATERIALS: A pneumatic injection device with a 0.2-mm nozzle diameter, 50% pressure power, and 85-µL injection volume was used. The degree of depression was examined and analyzed using a 3-dimensional optical profiling system and clinical photographs. The patients also evaluated any side effects. Each subject underwent a single treatment session and was followed up after 1 and 2 months. RESULTS: A total of 13 atrophic acne scars from 10 Korean men and women aged 20 to 29 (mean age 25.8 ± 2.4) years were studied. The mean scar volume values were 0.964, 0.741, and 0.566 mm, respectively, at baseline, 1 month, and 2 months after the injection. Scar volumes after 2 months were significantly different compared with baseline volumes. However, there was no significant difference between the baseline and 1-month volumes. CONCLUSION: Treatment with pneumatic injection is safe and effective in reducing atrophic acne facial scars; it results in quantitative improvement in scar volumes.

Effect of the Recombinant Human Epidermal Growth Factor Ointment on Cutaneous Surgical Wounds Compared to Antibiotic Ointment.

BACKGROUND: Applying antibiotic ointment after skin surgery can decrease infection and improve scar. Epidermal growth factor (EGF) is known to be able to promote the growth and movement of epidermal cells to stimulate wound healing. Recombinant human EGF (rhEGF) ointment can be used in wet closed dressing to promotes wound healing and prevent complications by maintaining a wet environment. OBJECTIVE: To compare the efficacy of rhEGF ointment and conventional antibiotic ointment after cutaneous resection. METHODS: Patients who had excision procedures in two or more sites were enrolled. Each wound was assigned to the rhEGF group or the antibiotic ointment group. Wounds were subjected to Physician Global Assessment (PhGA), Patient Global Assessment (PGA), and Patient satisfaction assessment (PSA). The length and area of wounds, and melanin and erythema index (MI and EI) were also assessed for these wounds. RESULTS: Among 11 patients with a total of 20 pairs of resection sites, PhGA, PGA, MI, and EI showed no significant difference between rhEGF and antibiotic ointment groups. However, changes in length and area of wounds showed significant differences between the two groups. CONCLUSION: RhEGF ointment showed similar short-term cosmetic results with antibiotic ointment, and improved surgical results in regards of the wound size. Applying rhEGF could reduce the use of antibiotic ointments for cutaneous clean (class I) wound surgery.

Successfully Treated Severe Acne Using Selective Electrothermolysis in a Patient with Nephrotic Syndrome.

Acne is very common in adolescents and young adults. Although there are various conventional treatment modalities, some patients are prone to side effects and need alternative options. A 22-year-old male patient who were treated with high dose systemic steroid for his nephrotic syndrome, encountered severe acne on his face and neck. Since the patient's medical condition was unable to administer systemic agent, he was treated with the selective electrothermolysis device. The sebaceous gland targeting treatment by selective electrothermolysis with microneedle radiofrequency device, had minimal adverse effect and the skin lesions improved dramatically. The patient was satisfied and did not want further treatment.