Fractional radiofrequency in the treatment of skin aging: an evidence-based treatment protocol.

Fractional radiofrequency (FRF) has recently emerged for the treatment of scars, cellulite and skin rejuvenation. The aim of this paper was to investigate the evidence behind its use in skin aging and evaluate efficacy, safety, and standardization of protocols. The literature was systematically searched and finally 25 full-text articles were included. Two were randomized controlled trials, 3 were comparative studies, and 20 were case series. Most studies were underpowered with low methodological quality. The participants had skin phototype I-VI with variable baseline severity of signs. Fractional radiofrequency using microneedles or electrode pins was performed on the face, neck, and décolletage. There was heterogeneity in outcomes measurement, but the efficacy of FRF was confirmed in all relevant studies. Mainly, the improvement of rhytides and skin tightening were reported. Mild to moderate pain, transient erythema and edema were the commonest adverse events. Hyperpigmentation was also noted in some cases. There was no consistency in the protocols used and in the description of procedures. A clinical impact score was created to assess the studies and to aid the generation of an evidence-based protocol for minimally invasive radiofrequency procedures. However, there is a need for large scale, well-designed trials to better investigate the efficacy and safety of FRF and to produce clear guidelines.

Partial Removal of the Submaxillary Gland for Aesthetic Indications: A Systematic Review and Critical Analysis of the Evidence.

BACKGROUND: Neck aesthetics is an essential feature for a youthful attractive appearance. Deep neck surgery involving partial resection of the submandibular gland (SMG) has been a controversial issue in aesthetic surgery given its challenging technique and potential risks. The aim of this review is to evaluate the safety and efficacy of partial SMG resection in patients undergoing aesthetic neck surgery. METHODS: We undertook a systematic review of the literature and analysis of studies reporting surgical outcomes and complications of partial SMG resection from Medline, Cochrane and Google Scholar databases from 1950 to March 30, 2019. Two independent reviewers conducted titles and abstracts screening and data extraction. Data were analyzed using mixed methods appraisal tool and a clinical impact score. RESULTS: Six studies including 602 patients who underwent 1200 partial SMG resections were included. All studies reported aesthetic improvement according to Ellenbogen aesthetic neck ideals. Hematoma related to partial SMG resection was encountered in one case (0.08%), hematoma related to cervicofacial skin flap was encountered in 26 cases (1.4%), sialoceles happened in 16 cases (1.3%), transient marginal mandibular nerve weakness occurred in 86 cases (4.7%). No mortalities, permanent motor nerve damage or dry mouth were reported. The clinical impact score was positive for five out of the six reports. CONCLUSION: Partial SMG resection in patients undergoing aesthetic neck surgery may represent an effective procedure to enhance neck aesthetics and is associated with minor, self-limiting complications. Future controlled studies with prospective evaluation of aesthetic outcome and patient-reported outcome measures are needed. LEVEL OF EVIDENCE III: 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.

Neuroticism and inflammatory skin diseases: a bidirectional Mendelian randomization study.

Previous observational studies have linked inflammatory skin diseases with mental health issues and neuroticism. However, the specific impact of neuroticism and its subclusters (i.e. worry, depressed affect, and sensitivity to environmental stress and adversity) on these conditions remains underexplored. In this work, we explored causal associations between common inflammatory skin diseases and neuroticism. We conducted a two-sample, bidirectional Mendelian randomization (MR) analysis using data from genome-wide association studies in psoriasis, atopic dermatitis, neuroticism and relevant genetic subclusters conducted on participants of European ancestry. Corrections for sample overlap were applied where necessary. We found that psoriasis was causally associated with increased levels of worry (odds ratio, 95% confidence intervals: 1.011, 1.006-1.016, P = 3.84 × 10-6) while none of the neuroticism subclusters showed significant association with psoriasis. Sensitivity analyses revealed considerable evidence of directional pleiotropy between psoriasis and neuroticism traits. Conversely, genetic liability to atopic dermatitis did not exhibit any significant association with neuroticism traits. Notably, genetically predicted worry was linked to an elevated risk of atopic dermatitis (odds ratio, 95% confidence intervals: 1.227, 1.067-1.41, P = 3.97 × 10-3). Correction for overlapping samples confirmed the robustness of these results. These findings suggest potential avenues for future interventions aimed at reducing stress and worry among patients with inflammatory skin conditions.