Collagen induction therapy for the treatment of upper lip wrinkles

Upper lip wrinkles are very common and impair the quality of life of many people due to their perceived unsightly appearance. Several options are available today for their treatment. A new therapeutic option, called collagen induction therapy (CIT), seems to be effective and safe for the treatment of upper lip wrinkles. The aim of this study is to demonstrate the efficacy and safety of CIT in the treatment of upper lip wrinkles. Ten female subjects, aged 50-65 years old, with upper lip wrinkles were enrolled. Each patient was treated with a specific tool in two sessions. Using a digital camera, photographs were taken of all the patients to evaluate the depth of the wrinkles and a silicon-print technique was used to obtain a microrelief impression of the wrinkles. Data of the cutaneous casts were analyzed by computerized image analysis. Analysis of the patients' photographs, supported by the sign test, and of the degree of irregularity of the surface microrelief, supported by Fast Fourier Transform and by wrinkle image processing, showed that, after only two sessions, the wrinkles' severity grade in most patients was greatly reduced. The present study confirms CIT as an effective and safe technique to improve upper lip wrinkles.     

Improvement in skin wrinkles using a preparation containing human growth factors and hyaluronic acid serum

Background: Skin aging is accompanied by wrinkle formation. At some sites, such as the periorbital skin, this is a relatively early phenomenon. Objective: We evaluated the anti-wrinkle effect of a preparation containing human growth factor and hyaluronic acid serum on periorbital wrinkles (crow's feet). Materials and methods: In total, 23 Korean women (age range: 39–59 years), who were not pregnant, nursing, or undergoing any concurrent therapy, were enrolled in this study. All the patients completed an 8-week trial of twice-daily application of human growth factor and hyaluronic acid serum on the entire face. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and visiometer analysis every 4 weeks. The standard wrinkle and roughness parameters used in assessing skin by visiometer were calculated and statistically analyzed. Results: Periorbital wrinkles were significantly improved after treatment, with improvements noted both by physician's assessment and visiometer analysis. Conclusion: Topical application of human growth factor and hyaluronic acid was beneficial in reducing periorbital wrinkles.     

The efficacy of glycolic acid for treating wrinkles: analysis using newly developed facial imaging systems equipped with fluorescent illumination

The clinical characteristics of photodamaged skin, such as coarse and fine wrinkling, can not be quantitatively evaluated from ordinary photographic records. The purpose of this study was to assess the efficacy of glycolic acid (GA) peeling on facial wrinkling, using computer assisted image analysis. This was accomplished with reproducible imaging techniques, which allowed precise repositioning of the subject's face in front of the camera. Two parameters, the change in wrinkle number and the change in wrinkle length were assessed. Although the clinical improvement of wrinkles correlated with both parameters, wrinkle length more precisely reflected the degree of clinical wrinkles, because the wrinkle number appeared to increase as some shallow wrinkles divided into multiple smaller wrinkles during their improvement. Comparison of responses by different age groups showed that the reduction of total wrinkle length was observed in the order of: 50s>30s and 40s>60s>over 70>under 30. The lack of response by subjects over 70 might be due to the nature of their wrinkles being mainly coarse wrinkles rather than fine ones. We next compared the effect of GA by concentration (35, 50 or 70%), but found no significant differences. As the concentration of GA used for treatment was determined by each subject's erythema reaction, our present result suggests that erythema elicited by GA correlates with improvement of wrinkles and that these two phenomena can be induced by a common pathway of GA treatment. This quantitative analysis clearly shows the efficacy and limitation of GA treatment of wrinkles, and might help to disclose the precise mechanisms of GA effects on the skin structure and function.     

Novel Treatment of Neck Wrinkles with an Intradermal Radiofrequency Device

Neck wrinkles commonly develop owing to the aging process. However, recently, the number of patients with neck wrinkles has been increasing. Also, an increasing number of young patients have presented with this condition, possibly because of the effect of the head-down posture that they adopt when using their computer or smartphone. We report two cases of young adults with a prominent neck wrinkle. In case 1, a 29-year-old woman with a neck wrinkle was treated with six intradermal radiofrequency (RF) procedures. Her neck wrinkle was significantly improved with the RF treatment. In case 2, a 32-year-old woman with a wrinkle and generalized light brownish tiny papules on the neck was treated with three intradermal RF procedures simultaneously with 30% glycolic acid peeling. Her wrinkle and skin tone were improved dramatically. We conclude that intradermal RF has a considerable efficacy for reducing neck wrinkles.     

An observational study of a 24 mg/mL hyaluronic acid with pre-incorporated lidocaine for lip definition and enhancement

Background Lip enhancement using fillers improves appearance by increasing fullness, enhancing lip definition, and reducing fine lines and wrinkles around the lips. Aims To investigate a 24 mg/mL hyaluronic acid (HA) with pre‐incorporated lidocaine gel for lip definition and enhancement, medium‐deep lines, and oral commissures. Patients/Methods Eleven injectors enrolled 57 patients (96% women; aged 18–60+ years) requesting lip definition and enhancement. Prospective data were captured using an Injector Patient Case Assessment Form and Patient Questionnaire. Results Ninety‐five percent of injectors found the gel ‘very easy’ to inject, with 82% finding it “very easy” to massage/sculpt. Combined injector and patient pain assessment revealed little treatment discomfort. Ninety‐nine percent of injectors reported improved aesthetic effect compared to baseline. Post‐treatment, 99% of injectors rated the lips as “smooth.” All patients reported improved lip appearance and smoothness, and 96% were satisfied with the treatment experience. Compared to previous lip treatment, all patients reported their lips felt better, 57% rated the aesthetic effect as better, and 84% rated satisfaction as better than previous treatments. Ninety‐eight percent of patients and injectors would recommend treatment to others. Conclusions High levels of injector and patient satisfaction were found after use of this 24 mg/mL HA with pre‐incorporated lidocaine for lip definition and enhancement.     

Carbon dioxide laser treatment promotes repair of the three-dimensional network of elastic fibres in rat skin

BACKGROUND: We have previously reported that ultraviolet (UV) B irradiation induces a loss of linearity in the three-dimensional structure of dermal elastic fibres, which results in the reduction of elastic properties of the skin and leads to wrinkle formation. We further reported that repair of wrinkles by all-trans retinoic acid is accompanied by recovery of the linearity of elastic fibres. Carbon dioxide (CO2) lasers are widely used for treating wrinkles in cosmetic surgery. OBJECTIVES: To perform CO2 laser treatment of wrinkles induced in rat skin by UVB irradiation and to evaluate changes in the three-dimensional structure of dermal elastic fibres during wrinkle repair. METHODS: Wrinkles were induced in the hind limb skin of Sprague-Dawley rats by UVB irradiation (130 mJ cm-2 three times weekly for 6 weeks), followed by CO2 laser treatment (11.3 J cm-2). The surface appearance of the skin was evaluated by replica observation 6 and 10 weeks after CO2 laser treatment followed by measurement of mechanical properties using a Cutometer. Subsequently, perfusion fixation and digestion with formic acid were performed and elastic fibres were observed by scanning electron microscopy (SEM). Image analysis of SEM micrographs was carried out to evaluate the linearity in the three-dimensional structure of elastic fibres. RESULTS: Six weeks after CO2 laser treatment, all parameters of skin mechanical properties in the UVB-irradiated group recovered to levels of the control non-irradiated group, accompanied by repair of wrinkles and a significant increase in linearity of the three-dimensional structure of elastic fibres. CONCLUSIONS: These findings indicate that CO2 laser treatment has a therapeutic potential to repair wrinkles to non-irradiated levels through recovery of the three-dimensional structure of elastic fibres.     

Relationship between the echogenicity of subcutaneous tissue and the depth of forehead wrinkles

Background/purpose: Subcutaneous tissue is rarely studied in research on wrinkles. We used diagnostic ultrasonography to produce images of subcutaneous tissue of the forehead, one of the areas where age‐related wrinkles form. We quantified the resulting echogenicity and investigated its relationship with wrinkle depth. Methods: One hundred and seventy‐three Japanese subjects were divided into four age groups (21–28 years, 35–41 years, 47–59 years, 65–75 years). Maximum wrinkle depth (R_max) was measured in the forehead. On an ultrasound image, which was captured by scanning perpendicular to the deepest wrinkle, we set a 12.5‐mm‐wide region of interest by aligning the deepest point of the wrinkle at its center and then obtained the ratio of the area exceeding this threshold to the total area as the echogenicity. Results: R _max increased and the echogenicity decreased with age. A negative correlation was found in the oldest group but was not found in other groups, presumably due to individual differences in the echogenicity among younger subjects. Conclusion: This study suggests that the internal structure of subcutaneous tissue, as observed by ultrasonography, is related to wrinkle depth. The relationship between wrinkle depth and echogenicity of subcutaneous tissue is particularly pronounced in the elderly.     

The Fabi-Bolton chest wrinkle scale: a pilot validation study

Up until now, no objective scale has existed to evaluate chest wrinkles and assess the efficacy of treatment. This study was designed to validate a new photonumeric wrinkle assessment scale using standardized photographic methodology to obtain reference photographs. Multiple photographs from 28 volunteer subjects with varying degrees of chest wrinkles were evaluated by a study team of two independent physicians. Photographs of 16 subjects representing the full spectrum of chest wrinkle severity were selected and classified using the Fabi–Bolton (F–B) 5‐point wrinkle scale (1 = wrinkles absent; 2 = shallow but visible wrinkles; 3 = moderately deep wrinkles; 4 = deep wrinkles, with well‐defined edges; 5 = wrinkles very deep with redundant folds). One representative photograph was chosen by study team consensus for each of the five scale points. A second, independent group of evaluators rated the randomly arranged photographs using the F–B wrinkle scale. The numeric results were then tabulated and compared. The F–B wrinkle scale provided a reproducible and effective method for assessing chest wrinkles with very little interrater variability. The F–B wrinkle scale is a reliable tool for the classification of chest wrinkles and evaluation of therapeutic and cosmetic interventions.     

Morphological study of the relationship between solar elastosis and the development of wrinkles on the forehead and lateral canthus

OBJECTIVE To identify whether there is a relationship between solar elastosis and the development of wrinkles in human skin. DESIGN Wrinkle depth was measured on the forehead and lateral canthus of human cadavers using image analysis. The thickness of the dermis was measured in skin sections obtained around wrinkles and stained with Elastica-van Gieson. SETTING Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. SUBJECTS Fifty-eight male and female cadavers (age range at death, 29-93 years). MAIN OUTCOME MEASURES The ratio of solar elastosis dermal thickness to full dermal thickness (elastosis ratio) was calculated and compared between the deepest point of a wrinkle (wrinkle point) and a point within 1 mm where no wrinkle existed (nonwrinkle point). The relationship between elastosis ratios and wrinkle depths was investigated. RESULTS Advanced solar elastosis was present at nonwrinkle points but was present a little bit at wrinkle points. On the forehead, a positive correlation between elastosis ratios and wrinkle depths was observed at nonwrinkle points but not at wrinkle points. On the lateral canthus, a positive correlation between elastosis ratios and wrinkle depths was observed at nonwrinkle points, as well as at wrinkle points until the wrinkle became deeper than one-half of the original dermal thickness (0.6 mm). Solar elastosis on the lateral canthus ceased developing at this point, but the wrinkle developed further. CONCLUSIONS Solar elastosis tends to commence with the development of a wrinkle until the wrinkle becomes deeper than 0.6 mm. This tendency is less evident at wrinkle points than at nonwrinkle points.     

Influence of age and hormone replacement therapy on the functional properties of the lips

Aims: To investigate the influence of age and hormonal status on some functional properties of the lips of women.
Methods: Lips properties were measured and compared through four groups of women (young with normal menses, aged with normal menses, aged and menopaused, aged, menopaused receiving hormonal replacement therapy). The following parameters were recorded: sebum excretion rate on the forehead. On the lower lip: TEWL, mechanical damping, color, tactile acuity. Moreover, capacitance images of each lips were recorded and the mean capacitance measured.
Results: Changes in TEWL, mechanical damping and tactile acuity appear clearly linked to age while the increase in lip darkness could be due to hormones. Sebum excretion rate is also clearly linked to hormonal status. Surprisingly, no changes of lips capacitance were detected vs. age or hormonal status. This study confirms that upper lip is more hydrated than the lower one.
Conclusion: Most of the parameters measured on the lips have similar variations than the same parameters measured on the skin. Only sebum and color appear being dependant on the hormonal status.     

The filtrum remodelling with combined Er:YAG CO 2 laser resurfacing

BACKGROUND: Upper lip wrinkles develop with aging and they can be successfully treated with laser resurfacing. The treatment eliminates the wrinkles and, ideally, should also recover the aesthetic configuration. METHODS: This report includes 32 patients treated for wrinkles of the upper lip with the Derma? K. The first pass was done using 29 J/cm 2 , 5 Hz, 3 mm collimated spot size, plus the CO 2 laser 5 W, 50% duty cycle, 50% overlapping. Following this pass, Derma? K was reprogrammed to emit only with the Er:YAG at 1.4 J/cm 2 , 10 Hz, approximately 50% overlapping and with a beam diameter of 3 mm. Then, several passes were done where wrinkles could still be seen, focusing on the area corresponding to the filtrum . Biopsies were taken to examine possible particular implications of underlying muscle and its role in the recovery of anatomic aesthetics of young lip characteristics when using the proposed technique. RESULTS: Using Derma? K resurfacing with extra passes of the Er:YAG at relatively low density, at the aforementioned area, it was possible to achieve the recovery of the aesthetic youthful appearance of the upper lip. Also, the shape of the filtrum recovered its youthful appearance together with the cupid's bow shape. Histology samples collected at the end of resurfacing showed that the laser thermal effect was also related to muscle fibres due to the proximity of this layer to the dermis because of the narrow subcutaneous fat layer. CONCLUSION: The combination of Er:YAG and CO 2 laser of Derma? K has potential to enhance the results of resurfacing for elimination of wrinkles of the upper lip. Moreover, the fact that only one laser pass of high energy density is used permits clear and secure control of treatment, preventing complications and obtaining good results.     

Effect of a preparation containing a fucose-rich polysaccharide on periorbital wrinkles of human voluntaries

BACKGROUND: Skin aging is accompanied by wrinkle formation. At some sites, as the periorbital skin, this is a relatively early phenomenon, variable from one woman to the other and even between the right and left eye. PURPOSE: We tested the effect of a preparation with fucose-rich oligo- and polysaccharide (FROP-3) on periorbital wrinkles (crow's feet) on a team of voluntaries. METHOD: The efficiency of a preparation containing as active principle a fucose-rich polysaccharide in a base-cream for the treatment of temporal periorbital wrinkles on 20 voluntary women was tested as follows: the women applied the cream twice a day for 4 weeks. Negative replicas were taken on the periorbital skin before and after 4 weeks of application of the cream. The results were evaluated by semi-automated morphometry on the plastic replicas and expressed as the 'wrinkle-factor' obtained by multiplying total wrinkle length in millimeters by the average wrinkle width. RESULTS: After 4 weeks of treatment, there was a significant improvement of the periorbital wrinkles for the majority of the voluntary team who tested the cream. On the 29 periocular wrinkles examined 65% showed an improvement at the end of the treatment. In two cases, the improvement was 100% on one eye (disappearance of the crow's feet) and of 75% and 79% on the other eye. On six eyes, there was no significant change after the end of the treatment, and on four eyes a worsening was observed. The age-dependent modifications showed that improvement was independent of age and was the result of individual skin reactions to the cream. The occurrence and the severity of crow's feet is highly individual, and differs from one side of the face to the other for the same person. These strong individual variations explain the highly variable results, not only from one woman to the other but also comparing one side of the face to the other for the same person. CONCLUSION: Under the effect of 4 weeks of treatment with the FROP-3-containing cream, most of the voluntaries had their periorbital wrinkles attenuated and some women showed a total regression of crow's feet on one of their eyes.     

Retinyl retinoate,a novel hybrid vitamin derivative,improves photoaged skin: a double‐blind,randomized‐controlled trial

Background: All‐trans‐retinoic acid (RA) and all‐trans‐retinol (ROL) are not widely used as anti‐wrinkle agents due to their irritancy and photo‐stability, respectively. Therefore, the safety and photo‐stability in the development of RA or ROL derivatives have been an important issue. Aim: To identify the efficacy of retinyl retinoate as an anti‐aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles. Methods: The clinical study was a prospective, double‐blind, randomized, and controlled study with a total of 11 Korean women. At every 4 weeks, the effectiveness was assessed with a global photodamage score, photographs, and image analysis using replicas and visiometers. The dermal distance and intensity was also evaluated using Dermascan C. Results: A statistically significant improvement in facial wrinkles (P<0.05) in eleven volunteers was observed in a clinical trial. The successive application of 0.06% retinyl retinoate cream for 3 months showed decreased depth and area of wrinkles in comparison with 0.075% retinol cream. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for retinyl retinoate cream were 22% higher than that of retinol cream after 12 weeks. A statistically significant increase was observed after 8 and 4 weeks for dermal distance and dermal intensity, respectively (P<0.05). Conclusions: Retinyl retinoate had characteristic features of new anti‐aging agents, and effectively improved facial wrinkle conditions.     

Skin ageing: clinical and histopathologic study of permanent and reducible wrinkles

Wrinkles are modifications of the skin associated with cutaneous ageing and develop preferentially on sun-exposed skin. The aim of the study was to analyse the clinicopathological features of wrinkles, among the different types of skin relief modifications. Despite its importance in dermato-cosmetology and skin ageing, few studies have been specifically devoted to wrinkles. In the present study, we analyzed the histological features of the pre-auricular wrinkle compared to retro-auricular skin, obtained from sixteen patients undergoing facial surgery; skin samples were immediately processed for routine histology and histochemical staining. Four types of skin depressions could be defined according to their depth: folds, permanent wrinkles, reducible wrinkles and skin micro-relief. Two different types of pre-auricular wrinkles were observed: (i) permanent wrinkles which were conserved after sampling and, (ii) reducible wrinkles which required in vivo staining to be visible at histology. Histological analysis of the epidermis and dermis of the skin forming the pre-auricular wrinkle revealed a normal skin morphology, identical to that of the skin immediately adjacent to the wrinkle. This was particularly striking for the reducible wrinkles which could not be individualized in the absence of in vivo staining. Both types of wrinkles comprised skin modifications observed in sun-exposed skin, however, in the upper dermis, permanent wrinkles showed a more pronounced accumulation of basophilic fibers, i.e. actinic elastosis, than reducible wrinkles did. These data suggest that the development of wrinkles could be secondary to actinic elastosis and to the disappearance of microfibrils and collagen fibers at the dermal-epidermal junction.     

The severity of wrinkling at the forehead is related to the degree of ptosis of the upper eyelid

Background: Most studies on wrinkle formation have focused on changes in the dermal condition that promote the fixation of transiently formed wrinkles. Little is known about the age‐dependent changes in transient wrinkle formation in response to altered facial expression or the mechanism leading to fixed wrinkle formation. Objective: To clarify the mechanism of wrinkle formation at the forehead, we investigated the factors that influence the severity of transient wrinkling and the relationship of transient with fixed wrinkles, using a newly established method to evaluate transient wrinkle formation. Methods: Transient wrinkles were generated by requesting subjects to gaze in an upward direction. Foreheads of the subjects with or without an upward gaze at a fixed angle were photographed and the severity of wrinkles at the forehead was graded from 0 to 5 in 50 healthy Japanese female volunteers in their 20s, 40s, or 60s. Skin elasticity was measured using a Cutometer^®. Frontalis muscle activity and ptosis of the upper eyelid were estimated by measuring movement of the eyebrow during upward gazing and the position of the upper eyelid of the open eye, respectively. Results: Wrinkles formed transiently at the forehead by upward gazing were highly reproducible in each subject. Their severity increased with aging and was highly correlated to that of fixed wrinkles (R=0.81, P<0.001). Therefore, this method appears to be suitable for studying the mechanism of transient wrinkle formation and the relationship between transient and fixed wrinkles at the forehead. The severity of transient wrinkles was correlated with elevation of the eyebrow during upward gazing (R=0.69, P<0.001), but not with dermal elasticity. This suggests that transient wrinkles are induced by increased frontalis muscle activity during upward gazing. Frontalis muscle activation was negatively correlated with upper eyelid position (R=−0.37, P<0.05), which descended with aging, meaning ptosis of the upper eyelid, and negatively correlated with the severity of transient wrinkles induced by upward gazing (R=−0.43, P<0.05). Furthermore, the upper eyelid position was also negatively correlated with the severity of fixed wrinkles (R=−0.44, P<0.05). Conclusion: These results suggest that ptosis of the upper eyelid is associated with increased activation of the frontalis muscle during upward gazing and increased severity of transient and fixed wrinkling at the forehead.     

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser–IPL combination treatments in hand skin rejuvenation

Objective: Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser–intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction. Materials and Methods: Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session. Results: The patients’ ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001). Conclusion: In rejuvenation of photoaged dorsal skin of the hand, IPL–Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.     

Lip sun protection factor of a lipstick sunscreen.

BACKGROUND AND OBJECTIVE: There is a well-documented need for effective human UVA and UVB photoprotection. Since there are important anatomical variations, the sun protection factor (SPF) of a lipstick sunscreen was measured on the anatomical site intended for use. METHODS: The SPF tests were performed according to Federal US and European COLIPA guidelines. Prior to performing a test on the lip, the minimal erythemal dose (MED) of the unprotected back skin was determined. Subsequently, the sunscreen SPF was measured on the anatomical target site (lip). The evaluator was blinded with respect to scoring the SPF of each sunscreen treatment. Individual test sites were assigned to one of the following treatment conditions: (1) no treatment (MED of unprotected skin); (2) test formulation; (3) reference standard. RESULTS: The MED on unprotected back skin was found to be 25% lower than on unprotected lip skin. The SPF of the lipstick sunscreen was measured 2 units lower than the SPF determined in the classical way on the back skin. CONCLUSION: It was hypothesized that the higher MED of the lower lip compared with back skin was due to the adaptation of this tissue to the continuous exposure to UV radiation.     

Unusual wrinkle formation after temporary skin fixation followed by UVB irradiation in hairless mouse skin

Abstract Generally, many wrinkles form on the human face, and temporary wrinkles eventually become permanent. We evaluated the effects of temporary skin fixation on wrinkle formation after UVB irradiation using the back skin of hairless mice. In the group treated with UVB irradiation immediately after production using cyanoacrylate resin of an artificial groove parallel to the midline, wrinkles formed parallel to the midline, an uncommon direction for wrinkle formation in this mouse model. These wrinkles did not disappear even when the skin was stretched. No such changes were observed in the group in which only the temporary groove alone was produced without UVB irradiation. In 3-D surface parameter analysis, all roughness parameters in the group treated with UVB irradiation immediately after production of an artificial groove were significantly increased relative to the age-matched control group. In contrast, no differences were observed between the group in which only the temporary groove alone was produced without UVB irradiation and age-matched controls. The results of this study suggest that both a temporary groove in the skin and UVB irradiation are necessary for wrinkle formation in the back skin of hairless mice.