The efficacy of intradermal injection of type A botulinum toxin for facial rejuvenation

The aim of this study is to evaluate the efficacy for effectiveness of type A botulinum toxin intradermal injection for facial rejuvenation. Forty female subjects were randomly divided into two groups: BoNTA group and control group. In BoNTA group, each subject's facial skin was treated with intradermal injection of BoNTA, and subjects of the control group were treated with intradermal saline solution injection. Subjects receiving one session of treatment and evaluations were conducted at baseline, four weeks, and twelve weeks after treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), erythema, and melanin index. BoNTA group showed higher physician's global assessment score, subject satisfaction score, roughness, skin hydration, skin elasticity, and lower TEWL compared to that of control group at 12 weeks post‐treatment. No significant difference was found among erythema and melanin index at baseline, four, and twelve weeks after treatment among the two major groups. In conclusion, intradermal BoNTA injection can be considered as an effective method for facial rejuvenation.     

外用脂肪干细胞培养上清液对二氧化碳点阵激光焕肤术后伤口愈合的影响

目的探讨局部外用脂肪干细胞培养上清液在二氧化碳点阵激光焕肤术后伤口愈合过程中的作用。方法9名受试者的双侧前臂内侧分别接受二氧化碳点阵激光治疗。随机选择受试者一侧前臂激光治疗处外敷脂肪干细胞培养上清液,另一侧则外敷DMEM细胞培养基。分别在上述处理后第1,4,7,14,21天检测受试部位经皮水分丢失、皮肤颜色及皮肤弹性。结果经过局部外用脂肪干细胞培养上清液一侧的红斑指数、黑色素指数和经皮水分丢失均显著低于对照侧。而皮肤弹性与对照侧差异无统计学意义。结论局部应用脂肪干细胞培养上清液是促进二氧化碳点阵激光焕肤术后伤口愈合和减少不良影响的一种有效方法。     

Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: A randomized,split-face,evaluator-blinded,placebo-controlled,comparative trial

Background: The effect of topical silicone gel has been studied to prevent scars from burn, postoperative wound and to treat hypertrophic scars. No previous studies have been done to evaluate the efficacy of topical silicone gel on atrophic acne scars. Material and methods: Nineteen patients were treated with three sessions of ablative Er:YAG laser with 1-month intervals. Following each laser treatment, the randomlyassigned silicone gel or placebo was applied in split-face manner. Objective assessments, which included roughness, smoothness, hydration, transepidermal water loss were measured at baseline and prior to each treatment. Subjective assessments by dermatologists and subjects were done at baseline and 1 month after last laser treatment. Results: The laser treatments were well tolerated and resulted in clinical improvements. Topical silicone gel treatment resulted in significantly less roughness at weeks 4 and 12 compared with placebo (p < 0.05). Conclusion: Adding topical silicone gel to ablative Er:YAG laser treatment may provide additional benefits in improving acne scars.     

Combined use of microfocused ultrasound and a calcium hydroxylapatite dermal filler for treating atrophic acne scars: A pilot study

Background: An unfortunate consequence of severe acne is scarring, which can have serious psychosocial consequences. Available methods for treating acne scars have varying degrees of effectiveness. Objective: This nonrandomized, retrospective pilot study assessed the safety and effectiveness of combining microfocused ultrasound with visualization (MFU-V; Ultherapy^®) and a calcium hydroxylapatite dermal filler (CaHA; Radiesse^®) for treating atrophic acne scars. Methods: Healthy subjects 35–55 years old with moderate-to-severe facial acne scars were enrolled. MFU-V was applied bilaterally using two transducers with focal depths of 3.0 and 1.5 mm. Using a cross-hatch pattern, 75 treatment lines were applied 2–3 mm apart. Immediately afterward, the same areas were injected with 1.5 mL of CaHA diluted with 1.5 mL of lidocaine 2% without epinephrine. Scar severity changes were assessed by two independent physicians using the Goodman Acne Scar Scale at post-treatment Day 90. Subject satisfaction was assessed with a questionnaire. Results: Treated subjects (N = 10) achieved significant overall improvement in baseline acne scar severity (P = 0.002). When stratified by severity, a clear trend was apparent with the greatest improvement observed among subjects with severe scars. Subjects were very satisfied (n = 9) or satisfied (n = 1) with their aesthetic results. No adverse events were observed. Conclusions: Combining MFU-V and diluted CaHA is effective for treating atrophic acne scars.     

Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: A split-face comparative study

Objective: To evaluate the efficacy and side effects of 1550-nm fractional Er:Glass laser in treating atrophic acne scar. Materials and methods: Thirty Chinese patients aged 18–65 with atrophic acne scars on both cheeks received a split-face treatment, one side with four sessions of treatment with fractional 1550-nm Er:Glass laser at 20-day interval and the other with topical asiaticoside cream application three times daily as control. Clinical response and side effects were evaluated by a dermatologist three weeks after each treatment and again 12 weeks after the last laser treatment. In addition, self-evaluation of satisfaction by the patients was done at the end of treatment. Results: The study found that mean scores decrease after treatment was 5.65 ± 4.34 for the treated side and 1.23 ± 3.41 for the control side. The improvement in acne scars after the fractional Er:Glass laser 1550-nm treatment was more significant than the control side (p = 0.0001). The side effects were mainly local skin irritation and erythema, which disappeared within one week. Conclusion: The research results show that the fractional 1550-nm Er:Glass laser is an effective and safe treatment device for atrophic acne scars.     

Comparison of the skin biophysical parameters of Southeast Asia females: forehead–cheek and ethnic groups

Background Regional and ethnic (racial) differences in skin properties are well known. However, regional and racial studies are limited and have studied skin properties using an insufficient number of subjects and limited ethnic groups, except in the case of some recent studies. Objective The aim of this study was (1) to compare the skin biophysical parameter among the large scale of Southeast Asia females group and (2) to compare skin properties of the forehead and cheek. Methods We measured and compared seven skin biophysical parameters, such as skin hydration, sebum, skin pH, melanin index, erythema index, skin elasticity and transepidermal water loss (TEWL), of the forehead and cheek of a large population of Indonesian (n = 200), Vietnamese (n = 100) and Singaporean females (n = 97). Results At the point of site difference, there were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and skin elasticity) in Indonesian females. In Vietnamese and Singaporean women, they were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and TEWL). At the point of ethnic difference, the Indonesian women had the highest skin pH and melanin index between the different ethnic groups. Vietnamese women had the highest skin hydration and TEWL in the forehead, whereas Singaporean women had the highest skin elasticity. Conclusion The skin biophysical parameters are different between the forehead and cheek among Southeast Asian females. It also reveals that the biophysical parameters are different in same racial group.     

Laser treatment for facial acne scars: A review

Background and Objectives: Acne scarring is a widely prevalent condition that can have a negative impact on a patient’s quality of life and is often worsened by aging. A number of options are available for the treatment of acne scarring, including retinoids, microdermabrasion, dermal fillers, and surgical techniques such as subcision. The aim of this review is to evaluate the different laser modalities that have been used in peer-reviewed clinical studies for treatment of atrophic acne scars, and summarize current clinical approaches.

Materials and Methods: A Medline search spanning from 1990 to 2016 was performed on acne scarring. Search terms included “atrophic acne scars,” “ablative’’, “nonablative,” “fractional,” “nonfractional,” “neodymium,” “alexandrite,” “pulsed dye” lasers, and results are summarized.

Results: Various types of lasers have been evaluated for the treatment of atrophic acne scars. While they are efficacious overall, they differ in terms of side effects and clinical outcomes, depending on patients skin and acne scar type. A new emerging trend is to combine lasers with other energy-based devices and/or topicals.

Conclusion: Evaluation of the literature examining acne scar treatment with lasers, revealed that clinical outcomes are dependent on various patient factors, including atrophic acne scar subtype, patient skin type, treatment modality, and side-effect profile.     

Protective effects of fermented honeybush (Cyclopia intermedia) extract (HU-018) against skin aging: a randomized,double-blinded,placebo-controlled study

Background: Oxidative stress and photodamage resulting from ultraviolet radiation exposure play key roles in skin aging. Fermented Cyclopia intermedia, which is used to brew honeybush tea, exerts antioxidant and anti-wrinkle effects by inhibiting reactive oxygen species production and downregulating matrix metalloproteinase activity. Objectives: This randomized, double-blinded, placebo-controlled study aimed to evaluate the efficacy and safety of fermented honeybush (Cyclopia intermedia) extract (HU-018) for skin rejuvenation. Methods: 120 Korean subjects with crow’s feet wrinkles were randomized to receive either low-dose extract (400 mg/day), high-dose extract (800 mg/day), or placebo (negative control, only dextran) for 12 weeks. Wrinkles were evaluated using JANUS^® and PRIMO pico^®. Skin elasticity, hydration and transepidermal water loss were measured. Results: Global skin wrinkle grade was significantly improved in both low-dose and high-dose groups compared to placebo group, as well as for skin hydration and elasticity. Both the low- and high-dose groups showed significantly decreased TEWL compared to the placebo group. There were no adverse effects during the entire study period. Conclusion: Our data indicate that HU-018 is effective for improving skin wrinkles, elasticity, and hydration. Therefore, daily supplementation with fermented honeybush could be helpful for protecting against skin aging.     

Pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for the treatment of atrophic skin disorders

Background: Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. Methods: Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). Results: One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. Conclusions: The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.     

The effects of Antimicrobial Peptides and Hyaluronic Acid compound mask on wound healing after ablative fractional Carbon Dioxide laser resurfacing

Background: Fractional carbon dioxide laser resurfacing (FxCR) is a routine treatment of Dermatology while many patients suffered the damage of skin barrier function after FxCR.

Objective: To evaluate the benefits of antimicrobial peptides (AMPs) and hyaluronic acid (HA) compound mask on wound healing after FxCR on human and mouse skin.

Methods: Twenty-four subjects were treated with FxCR on the bilateral cheeks. AMPs and HA compound mask was applied on the FxCR-treated area of left cheek. The erythema index (EI), melanin index (MI), transepidermal water loss (TEWL) of FxCR-treated areas on both cheeks were measured. By HE staining, immunohistostaing and western blotting, we analyzed epidermal thickness, FLG, IVL expression and protein levels of cramp in FxCR treated dorsal mice skin.

Results: The EI, MI, and TEWL in the AMPs and HA compound mask-treated area of left cheek were significantly lower than those in the untreated area of right cheek. Topically application of AMPs and HA compound mask reduced thickening of mouse skin and also result in an increase in the production of FLG, IVL and cramp.

Conclusion: Application of AMPs and HA compound mask is an effective method for enhancing wound healing after FxCR, by reducing transient adverse effects such as erythema, hyperpigmentation, and increased TEWL.     

Efficacy and Safety of Treatment with Fractional 1,064-nm Picosecond Laser with Diffractive Optic Element for Wrinkles and Acne Scars: A Clinical Study

BackgroundFractional picosecond lasers is effective for the treatment of wrinkles or acne scars.ObjectiveTo investigate the safety and efficacy of treatment with a fractional 1,064-nm picosecond laser with a diffractive optic element for facial wrinkles and acne scars.MethodsThis prospective open-labeled trial comprised 22 subjects with facial wrinkles or acne scars. Subjects received three laser treatments with a fractional 1,064-nm picosecond laser at 3-week intervals. The efficacy and safety were evaluated at every visit and 2 months after the final treatment (14 weeks from the first treatment session). Global photographic assessments were performed by three blinded dermatologists and the subjects. Skin profilometry was performed using three-dimensional digital photographs; viscoelasticity was measured.ResultsThe overall mean global improvement scores assessed by the dermatologists at weeks 3, 6, and 14, were 1.8±1.46, 2.5±1.88, and 3.5±1.84, respectively, and those assessed by the subjects were 2.7±2.08, 4.1±2.24, and 5.0±2.52, respectively. Skin profilometry showed significant improvements in the skin wrinkles, texture, depressions, and pores. The gross elasticity and skin firmness significantly improved by 10.96% and 9.04%, respectively. The major adverse reactions were erythema, pruritus, and petechiae, which disappeared within 2~3 days.ConclusionThe fractional 1,064-nm picosecond laser is an effective and safe therapeutic modality for skin rejuvenation.     

Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III–IV: A pilot study

Background: Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. Materials and methods: A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2–5 (mean 3.3) sessions 4–6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients’ satisfaction rate was also evaluated. Results: The treatment was well tolerated by all patients without any anesthesia. The downtime was 2–3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. Conclusion: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.     

Assessment of effects of an additional dietary natural mineral water uptake on skin hydration in healthy subjects by dynamic barrier function measurements and clinic scoring

BACKGROUND/AIMS: The skin protects the body's organs and tissues from damage and physical, chemical and bacteriological injuries. It also prevents the transcutaneous loss of water. The present study was conducted to assess the effects of additional dietary natural mineral water uptake on skin hydration and cutaneous well-being in subjects with dry skin. METHODS: Eighty subjects (44 women and 36 males, mean age 56+/-5.6 years) were included in the study, randomised per forearm and stratified by gender. Skin surface hydration, transepidermal water loss (TEWL), sorption-desorption test, skin colour, thickness and micro-relief were evaluated on the forearms. Clinical scoring of dryness, roughness and elasticity was performed by a dermatologist. RESULTS: An improvement of skin hydration was observed after additional water uptake, statistically modifying the hydration level as well as TEWL, the water-binding capacity of the uppermost layers of the stratum corneum. Improvements of softness, smoothness and skin-moisturising effect were perceived by healthy subjects, and skin micro-relief was improved. CONCLUSION: We suggest that natural mineral water supplementation may be used in order to improve the hydration of skin dryness as a complementary cosmetic approach.     

Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars

Ablative laser resurfacing is an effective treatment for atrophic acne scars. However, it often induces complications such as edema, prolonged erythema, scarring and hyperpigmentation. Therefore, a new concept of laser treatment called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation treatment of atrophic acne scars. This study was designed to prospectively evaluate the use of a technique similar to fractional photothermolysis using only the standard CO₂ laser without the fractional laser device in the treatment of atrophic scars and demonstrates it as a safe, effective and economical treatment option. Clinical improvement was achieved in all 35 patients with minimal adverse effects.     

Efficacy and safety of a single treatment using a 10,600-nm carbon dioxide fractional laser for mild-to-moderate atrophic acne scars in Asian skin

BackgroundAblative laser therapy with carbon dioxide is effective for acne scars; however, the long downtime limits its use, especially in types III and IV skin. The fractional ablative 10,600-nm carbon dioxide laser system reportedly maximizes efficacy and minimizes side effects. The goal of this study was to evaluate the efficacy and safety of an ablative 10,600-nm carbon dioxide fractional laser system in a single treatment session on atrophic acne scars in Asian patients.MethodsTwenty-five patients with atrophic acne scars were enrolled. The laser fluences were delivered using the Deep FX mode. Comparative photographs were taken with VISIA complexion analysis. Physician evaluation and patient satisfaction were graded on a four-point scale.ResultsAt follow-up 1 month after treatment, four patients showed 51–75% improvement, 16 had 26–50% improvement, and five had minimal or no improvement. At 3 months, two patients had excellent results (76% and 100% improvement). Postinflammatory hyperpigmentation was present in six of the 25 (24%) patients; by 3 months' follow-up, this had faded in five of six cases.ConclusionA single treatment with the carbon dioxide fractional laser system is effective for acne scars in Asian patients, with minimal and acceptable side effects.     

Different Cosmetic Habits Can Affect the Biophysical Profile of Facial Skin: A Study of Korean and Chinese Women

BackgroundPrevious studies on the age-, climate, and skin care habit-related changes of biophysical parameters have mainly focused on Caucasians, and studies on Asians are in paucity.ObjectiveThis study was aimed to investigate the variations of cutaneous biophysical parameters in Chinese and Korean women (northeast Asians) and to assess the association between those parameters and age, climate, and cosmetic habits.MethodsA cross-sectional study included 361 healthy Chinese and Korean women between 18 and 49 years of age in 4 cities (Guangzhou, Nanjing, and Shijiazhuang in China, and Suwon in Korea). We measured skin surface temperature, hydration, transepidermal water loss (TEWL), sebum, elasticity, skin pore, wrinkle, and skin tone (brightness) using non-invasive instruments. Demographic profiles and cosmetic habits were assessed using a questionnaire.ResultsSkin elasticity and tone decreased, and pore size and wrinkle increased with age. Subjects in Suwon (Korean) showed higher hydration level, lower TEWL and lower sebum, less severe wrinkle and brighter skin than those in the 3 cities in China. After adjusting for age and region, using sunscreen everyday, wearing base makeup daily, and using moisturizers improved hydration, TEWL, and elasticity significantly.ConclusionWomen in Suwon (Korea) were found to have a better profile of biophysical parameters than women in the 3 Chinese cities, which might be attributed to cosmetic habits, besides age and climatic factors. The fact that appropriate cosmetic habits are associated with favorable skin biophysical parameters underscores the importance of daily skin care routine in preserving skin functions.     

Fractional Photothermolysis for the Treatment of Striae Distensae in Asian Skin

Background:Striae distensae (SD) are dermal scars characterized by linear atrophic depressions. Fractional photothermolysis (FP) is an effective modality for the treatment of cutaneous scars. Objective:To evaluate the safety and efficacy of FP for the treatment of SD in Asian skin. Methods:Six female volunteers aged between 20 and 35 years with chronic striae albae phase SD on both buttocks were enrolled. SD lesions on the right buttock were irradiated with a 1550-nm FP laser and patients were followed every 4 weeks for a total of 8 weeks. Outcome assessments included serial photographs, erythema index and melanin index tracking, skin elasticity, histologic examination, and the patients’ subjective satisfaction scores. Results:FP treatment was associated with a substantial improvement in the appearance of SD at 8 weeks post-treatment. The erythema index and melanin index of the treated SD lesions tended to converge with those of the control skin at 4-week follow-up. Skin elasticity was found to be partially normalized after FP. In addition, there was a significant increase in epidermal thickness, collagen, and elastic fiber deposition after FP as demonstrated by histologic examination. Adverse effects of FP included mild and transient pain and hyperpigmentation. Conclusion:FP can reduce SD by stimulating new collagen and elastic fiber synthesis. In addition, repetitive treatments might constitute an effective approach to improving the treatment of SD.     

Clinical studies of the treatment of facial atrophic acne scars and acne with a bipolar fractional radiofrequency system

Few clinical studies have examined the utility of bipolar fractional radiofrequency (FRF) therapy as a treatment for atrophic acne scars and active acne in people with darker skin. This study was designed to compare the safety and efficacy of bipolar FRF therapy as a treatment for atrophic acne scars and acne vulgaris. Twenty‐three Japanese patients with atrophic acne scars and mild to severe acne on both cheeks were treated with a bipolar FRF system (eMatrix; Syneron, Yokneam Illit, Israel). Five treatment sessions were carried out at 1‐month intervals, and the patients were followed up for 3 months after the final treatment. Assessments of scar severity and the number of acne lesions and 3‐D in vivo imaging analysis were performed. Evaluations of the treatment outcomes and their effects on the patients’ quality of life (QOL) were also carried out. We demonstrated that the improvement in scar volume was marked in the patients with mild scars and was at least moderate in 23 (57.5%) of the treated areas. With regard to the number of acne lesions, the treated areas exhibited significantly fewer lesions compared with the baseline at each time point (P < 0.05). The patients’ assessments of the treatment outcomes and their QOL indicated that both had improved significantly by the end of the study. Furthermore, significant reductions in the patients’ sebum levels, skin roughness and scar depth were observed. Bipolar FRF treatment significantly improved the atrophic acne scars and acne of Japanese patients and had minimal side‐effects.     

Effect of mesotherapy with nanochip in the treatment of facial rejuvenation

ABSTRACT

Objective: To observe the clinical effect of mesotherapy with nanochip for facial rejuvenation.

Methods: 24 volunteers with aging skin were treated with a polycomponent formulation – NCTF® BOOST 135 HA for 5 times (once weekly for 3 times and successively biweekly for 2 times). Photographs were taken by VISIA at baseline, and after 1, 4, 10 weeks, while global scores for photoaging (GSP), improvement scores, volunteers’ satisfaction, parameters describing the properties of the skin, and adverse effects were assessed during each follow-up period.

Results: Total 20 volunteers completed the treatment. Evaluation of the whole face showed that GSP, skin texture (ophthalmic wrinkles, dermal thickness, and intensity of collagen fibers of skin), and skin brightness (Lab value) significantly improved at 4 weeks compared to baseline, while the difference between 4 and 10 weeks was not statistically significant. No evident improvement was observed in pigmented spots, telangiectasia, skin tightening, trans-epidermal water loss (TEWL), and skin hydration. Slight erythema, pain was the most common side effect.

Conclusion: Mesotherapy with nanochip can improve skin texture and brightness, but the effect is not permanent. It is recommended that the treatment be used as a complementary method for patients with facial rejuvenation needs.     

Patterns and associations of structural and functional cutaneous responses during loading at heel and sacral skin in aged females: A reanalysis of clinical study data

Aim of the studyThe aim of this study was to explore possible interrelationships and cutaneous response patterns at the heel and sacral skin due to prolonged loading.Materials and methodsSkin stiffness, elasticity, roughness and transepidermal water loss, stratum corneum hydration, erythema, and temperature of n = 20 aged females (mean age 69.9 years) were measured before and after 90 and 150 min loading in supine position. Delta values were calculated and correlated using Spearman's rho. Strengths and directions of associations and similar patterns were subsequently identified for the heel and sacrum areas.ResultsAt the sacral area decreased stiffness (Uf) was associated with increased TEWL and there was a positive relationship between mean roughness (Rz) and erythema. At the heel there was a positive association between TEWL and decreasing stiffness (Uf).ConclusionsOur results indicate a dynamic interaction between skin changes during loading and different physiological response patterns for sacral and heel skin. There seems to be close association between transepidermal water loss and stiffness changes during loading.