Topical Nanofat Biocrème Improves Aesthetic Outcomes of Nonablative Fractionated Laser Treatment: A Preliminary Report.

BACKGROUND: Improvements in skin erythema and elasticity have been observed with topical application of platelet-rich plasma after fractional laser (FXD) treatment. Injections of nanofat via small needles into the dermis improves tissue thickness, discoloration and wrinkle depth. OBJECTIVES: The aim of this study was to evaluate improvements in skin following a nonablative FXD treatment combined with the application of a novel topical nanofat biocrème, called neo-U. METHODS: Fifty patients were treated with a nonablative FXD followed by application of a topical nanofat biocrème. Harvested fat was processed into nanofat, which was compounded with a transdermal liposomal delivery vector to produce a topical biocrème. In 2 patients, postauricular skin punch biopsies were performed before and after treatment and examined for histologic changes. Photographs of a historical group treated with only the FXD were compared with photographs of patients treated with a combination of topical nanofat biocrème and FXD. Skin types were evaluated for improvements in nasolabial folds, wrinkles, and skin texture. RESULTS: Findings from postauricular skin biopsies show the skin exposed to FXD with nanofat biocrème had more elastin fibers and a slight increase in the thickness of the epidermis. Patients treated with FXD plus nanofat biocrème had a statistically significant improvement in the degree of wrinkles, nasolabial fold depth, and texture compared with historical controls. CONCLUSIONS: Transdermal delivery of nanofat topical biocrème applied after FXD treatment can serve as a delivery system to improve fine lines, nasolabial fold depth, and overall texture of the tissue to a greater degree than laser resurfacing alone.

Short-Term Clinical Outcomes and Safety Associated With Percutaneous Radiofrequency Treatment for Excessive Sweating.

BACKGROUND: Primary excessive sweating of the axilla affects approximately 3.12% of the US population and has a negative impact on individuals' lives. OBJECTIVES: We report the safety and effectiveness up to 90 days after treating excessive sweating with percutaneous radiofrequency when using a standardized protocol. METHODS: Twenty adult subjects (13 females, 7 males) aged 18-49 years with excessive sweating were enrolled in a single-center, single-treatment unblinded prospective study conducted at the FACES+ Aesthetic Facility. Forty axilla were treated using the ThermiGen ThermiRF device. The Dermatology Quality of Life Index (DLQI), the Hyperhidrosis Disease Severity Scale (HDSS), and the Odor Scale (OS) were used for qualitative assessment. RESULTS: Primary and secondary exploratory evaluations were favorable at 90 days, indicating a significant improvement in quality of life and a significant reduction in both sweating and odor. The DLQI demonstrated an average improvement of 10.8 points at day 30, 10.7 at day 60, and 11.1 at day 90 (P = 0.0001). At day 90, 100% of individuals had ≥50% improvement in their excessive sweating based on the HDSS. At the conclusion of the study, 15 subjects had a ≥1-point drop in their OS, whereas 5 subjects had no change (P = 0.0002). There were no serious adverse events reported during this study. All adverse events were classified as mild and moderate and resolved within 2 months. CONCLUSIONS: The addition of the ThermiRF temperature-controlled radiofrequency device to the algorithm of hyperhidrosis treatments reduces sweating and odor with minimal downtime.

Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients.

BACKGROUND: Fractional lasers were introduced to provide increased safety, while maintaining high efficacy and patient satisfaction. Patients with virtually all Fitzpatrick skin types could be safely treated using a wide spectrum of wavelengths and a broad array of skin conditions, and aging could be addressed. Although safety studies have been reported for ablative CO2 and erbium lasers, surprisingly few data are available on adverse events and complications associated with fractional lasers. OBJECTIVE: We report the frequency of adverse events, skin improvement and complications in a broad range of skin types using a standardized protocol that can be safely tailored to the patient's presenting complaints by varying the laser wavelength and number of treatments. MATERIALS AND METHODS: The medical records of 730 patients (>90% females, age ranged from 50.5. to 59.9 years.) who had been treated at FACES+ Aesthetic Facility were reviewed. Patients were followed from 1 to 10 months and were reviewed to determine the frequency of complications, as well as their frequency, type, cause, treatment and resolution thereof. Patients were categorized by Fitzpatrick skin type (I-IV) to determine whether skin type was related to the frequency of complications. Improvement in skin condition (wrinkles, nasolabial folds and pigment) was rated by a technician before and after treatment using a Likert scale, 0-5, with 0 being no change and 5 being the most improvement. RESULTS: Seven hundred thirty patients underwent procedures using fractional lasers in our center. Procedures were carried out with 3 different laser wavelengths, depending on the condition(s) treated (wrinkling vs. pigmentation issues, etc.) and the patients' desired length of downtime. The fractional Fraxel 1927-nm laser was used in 224 patients [Fitzpatrick skin type I (2.2%), II (38.4%), III (46.0%), IV (12.5%)]; the fractional Fraxel 1550-nm laser was used in 334 [type I (4.5%), II (31.9%), III (50.0%), IV (13.3%)], and the fractional Fraxel CO2 laser was used in 172 [type 1 (4.7%), II (49.7%), III (41.5%), IV (4.1%)]. The Fraxel CO2 laser showed greater improvement in wrinkles and naso-labial fold (p < 0.001). The greatest improvement in pigmentation was seen with the Fraxel 1927-nm laser (p < 0.001). Adverse events and complications occurred in 31 of 730 patients (4.2%). There was no significant difference in the rate of complications among the three treatments (p = 0.26). Complications were generally minor, and all resolved completely with treatment. Complications occurred in 4.0% of patients having the fractional Fraxel 1927-nm laser, 3.3% of patients having the fractional Fraxel 1550 nm and 6.4% of patients having the fractional Fraxel CO2 laser. Complications included 5 herpes simplex virus breakouts, 13 acne eruptions, 1 abrasion, 1 bacterial infection, 9 dermatitis, 1 drug eruption, 4 prolonged erythema, 1 hyperpigmentation, 1 increased swelling and 1 telangiectasia. There was no significant relationship between Fitzpatrick skin type and incidence of complications (p = 0.37). CONCLUSIONS: Fractional lasers in general have reduced complication rates, while maintaining high degrees of patient satisfaction. Since their inception in early 2004, our clinic has utilized fractional lasers to treat patients from a variety of ethnic backgrounds and diverse skin types with an overall complication rate of 4.2%, all of which resolved. Comprehensive care of patients with facial aging is not limited to surgery alone and should include these types of strategies to appropriately and safely address photo-damage and photo-aging. LEVEL OF EVIDENCE IV: 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 .

Regenerative Cells For Facial Surgery: Biofilling and Biocontouring.

Zuk et al in 2001 identified stem and regenerative cells within the stromal vascular fraction of fat. In preclinical studies, these cells appeared to stimulate angiogenesis and reduce inflammation, and soon thereafter, clinical use of stromal vascular fraction (SVF) evolved as researchers such as Rigotti, Coleman, Mojallal, our group, and others demonstrated that fat can be used for both therapeutic and aesthetic indications. The regenerative effects of fat and its contents on facial aesthetics have been shown at the histologic and cellular level. Regeneration of elastin and collagen fibers as well as improvement in capillary density and reduction of inflammation have been reported. We review our current approach to the use of regenerative cells and different types of fat grafts in facial surgery. The fat graft is classified, both from a regenerative point of view as well as a tissue product that can be modified into different tissue characteristics, depending on the area and condition treated. Clinical use of SVF enriched fat, millifat, microfat, and nanofat grafts as well as composite fat grafts are reviewed. Based on clinical experience and evidence to date, it appears that the regenerative effects seen with the use of SVF in aesthetic surgery are modest, but there appear to be definite histologic findings of regeneration. These improvements may not be clinically apparent to a patient when cell enriched fat grafts are compared to fat grafts alone. However, the subtle changes seen in histology may be cumulative over time. Three types of fat grafts are defined: millifat (parcel size 2.4<), microfat (1.2<), and nanofat (400-600 µm). Each are characterized by their injectability ratings and emulsification parcel size as well as amount of sSVF cells. Newer concepts of periosteal fat grafting, buccal fat pad grafting, pyriform aperture fat grafting, intraorbital fat grafting, and nanofat grafting are discussed. Composite fat grafts are presented as a new concept as is biofilling and biocontouring. The use of regenerative cells in facial surgery is evolving rapidly. Our understanding of the anatomic changes that occur with aging has become more precise and our ability to target histologic changes seen with aging has become more effective. Deep fat compartment grafting, superficial fat grafting, nanofat, and SVF are becoming important components of contemporary facial rejuvenation. The use of regenerative approaches in facial rejuvenation is a logical step in changing the paradigm from surgical treatment of aging to a more proactive prevention and maintenance approach that keeps up with changes in the tissues as they age.