Relationship between the echogenicity of subcutaneous tissue and the depth of eye corner wrinkles

Background/purpose: A close relationship was found between the internal structure of subcutaneous tissue and wrinkle depth in our previous study of human forehead. The present study examined the relationship in the eye corner. Methods: One hundred and seventy‐three Japanese subjects were divided into four age groups (21–28 years, 35–41 years, 47–59 years and 65–75 years). The maximum wrinkle depth (R_max) of an eye corner wrinkle was obtained. On an ultrasound image, which was captured by scanning perpendicular to the wrinkle, we set a 12.5‐mm‐wide region of interest (ROI) by aligning the deepest point of the wrinkle at its center and then obtained the ratio of the area exceeding an echogenicity threshold to the total area as the echogenicity. Results: No correlation was found between the R_max and echogenicity. The relationship was further analyzed by dividing the ROI into two: one above and the other below the deepest point of the wrinkle. A negative correlation was detected in the lower ROI of the oldest group. The difference in echogenicity between the upper and the lower ROIs of the oldest group showed a positive correlation with the R_max. Conclusion: These results suggest that the subcutaneous tissue structure is related to wrinkle depth.     

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.     

Efficacy of anti-aging products for periorbital wrinkles as measured by 3-D imaging

Background The periorbital area is a key wrinkle‐prone region, where the first signs of aging usually appear. Aims To demonstrate the ability of new anti‐aging moisturizing products to improve overall smoothness and wrinkle depth appearance in the periorbital region via the Fast Optical in vivo Topometry of Human Skin (FOITS). Methods Two double‐blind, randomized, controlled, split‐face studies (n = 42, Study 1; n = 35, Study 2) were conducted in women 30–70 years old with moderate to distinct periorbital wrinkles. Subjects applied 0.5 g of individual products to half their face twice daily for 4 weeks. Four test products containing niacinamide, the peptides Pal‐KT and Pal‐KTTKS, and carnosine were used and included a daytime SPF 30 lotion also containing antioxidants, a night cream, an eye cream also containing caffeine, and a wrinkle treatment containing retinyl propionate. The wrinkle treatment was only tested in Study 2. The FOITS technique was used to measure changes in periorbital R_a (mean roughness) and R_z (average maximum roughness) at 2 and 4 weeks. Results In Study 1, the daytime SPF 30 lotion, night cream, and eye cream significantly improved crow’s feet smoothness after 4 weeks relative to no treatment. After 4 weeks, the daytime SPF 30 lotion and night cream, but not the eye cream, were significantly better than no treatment at improving R_z. In Study 2, the night cream, eye cream, and wrinkle treatment, but not the daytime SPF 30 lotion, significantly improved both R_a and R_z after 4 weeks. To increase power and precision of estimates, a meta‐analysis was performed; the pooled data showed all three products were significantly better than no treatment at improving R_a and R_z after 4 weeks. Conclusions Four weeks of treatment with these products was shown to improve the smoothness of periorbital skin and to reduce the apparent depth of larger wrinkles.     

Supraciliary wrinkles and botulinum toxin A

Background. Injection of botulinum toxin into certain areas of face that carry a high risk of ptosis (danger zone) needs caution in application. An example is the lateral forehead, particularly the lower portion. Aim. In this study, we evaluated the efficacy and safety of treating supraciliary wrinkles in the lower lateral forehead by injections of botulinum toxin at the temporal hairline, keeping a reasonable distance from danger zone. Methods. In this randomized clinical trial, 40 women (mean age 35 years) were selected and divided into two groups, A and B. both groups were treated with botulinum toxin to treat wrinkles in the frown area, as well as frontal lines and lateral canthus lines. Group B received extra injections at each temporal line for treatment of supraciliary wrinkles. Results. There was a significant difference in total wrinkle number and mean number of wrinkles between the two groups after injections (paired t‐test, P < 0.01). No ptosis was seen in either group. Conclusions. Injection of botulinum toxin type A through the temporal hairline to correct supraciliary wrinkles seems to be safe and effective.     

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.     

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.     

Evaluation of effects of platelet-rich plasma on human facial skin

Abstract

Introduction: Platelet-rich plasma (PRP) has been used for rapid healing and tissue regeneration in many fields of medicine. This study was conducted to evaluate the effects of PRP application procedure on human facial skin. Methods: PRP was applied thrice at 2-week intervals on the face of ten healthy volunteers. It was applied to individual's forehead, malar area, and jaw by a dermaroller, and injected using a 27-gauge injector into the wrinkles of crow's feet. Participants were asked to grade on a scale from 0 to 5 for general appearance, skin firmness–sagging, wrinkle state and pigmentation disorder of their own face before each PRP procedure and 3 months after the last PRP procedure. While volunteers were evaluating their own face, they were also assessed by three different dermatologists at the same time by the same five-point scale. Results: There was statistically significant difference regarding the general appearance, skin firmness-sagging and wrinkle state according to the grading scale of the patients before and after three PRP applications. Whereas there was only statistically significant difference for the skin firmness–sagging according to the assessment of the dermatologists. Conclusion: PRP application could be considered as an effective procedure for facial skin rejuvenation.     

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.     

A clinical study on the usefulness of autologous plasma filler in the treatment of nasolabial fold wrinkles

Background: Recently, the efficacy of autologous plasma filler for the reduction of facial wrinkles has been demonstrated. Objective: The aim of our study is to validate the efficacy and safety of autologous plasma filler in treating nasolabial fold wrinkles. Material and methods: Twenty Korean patients with moderate-to-severe nasolabial fold wrinkles were enrolled. The patients were treated with one session of autologous plasma filler. The wrinkle improvement effects were evaluated at 1-week, 4-week, 8-week, and 12-week after the treatment. Three assessment methods were applied. First, two independent dermatologists assessed cosmetic results using a 5-point wrinkle assessment scale. Second, global aesthetic improvement score was used for assessment of the final cosmetic results. Third, patient satisfaction was surveyed. Also, the adverse effects associated to treatment were observed. Results: Mean age of the patients was 44.5 years. The average 5-point wrinkle assessment scale score was significantly improved at 1, 4, 8, and 12 weeks after treatment, comparing to before treatment (p < 0.01). The patients’ average global aesthetic improvement score also indicated better cosmetic outcomes. Conclusion: The clinical improvement with sufficient patients’ satisfaction and no significant adverse events demonstrated that novel autologous plasma filler could be considered as efficient and safety treatment option for nasolabial fold wrinkles.     

Multi-polydioxanone (PDO) scaffold for forehead wrinkle correction: A pilot study

Background: Forehead wrinkles are the result of contracture of the frontalis muscle and the skin aging process. Currently, hyaluronic acid filler and botulinum toxin are the main materials used for correction of these wrinkles. In addition, polydioxanone (PDO) thread has also been applied for this treatment. Objective: In order to evaluate the efficacy and safety of multi-PDO scaffold in animal and human skin, we tested PDO insertion in rat and mini-pig models and human volunteers with forehead wrinkles. Methods: A stent-shaped multi-PDO scaffold was inserted under the panniculus carnosus of rat dorsal skin and the subcutaneous layer of mini-pig dorsal skin and forehead wrinkles in three human volunteers. Results: Histological analysis at 12 weeks revealed evidence of de novo collagen synthesis, which was consistent with clinical results on photo evaluation. Conclusion: Stent-shaped multi-PDO scaffolds may be another effective and safe treatment modality for reduction of forehead wrinkles.     

Nd:YAG laser combined with IPL treatment improves clinical results in non‐ablative photorejuvenation

BACKGROUND: Intense pulsed light (IPL) sources have been reported in non‐ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI).

METHODS: Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II–IV, wrinkle types I–III, participated in the study. The IPL system was applied with the yellow (570?nm) cut‐off filter, 30?J/cm², single pulse, followed by the Nd:YAG at 120?J/cm², double pulse (7?ms per shot with 20?ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross‐section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II–IV, wrinkle types I–III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients.

RESULTS: The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups.

CONCLUSIONS: The addition of the Nd:YAG laser to the IPL regimen in non‐ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.     

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.     

Locking the line of convergence by botulinum toxin type A for the treatment of dynamic forehead wrinkles

Background

Treatment of horizontal forehead lines with botulium toxin type A is a common procedure that helps achieve a youthful and rejuvenated look. Adequate knowledge of the anatomy and an individualized treatment approach is the key to successful treatment outcome.

Aim

To evaluate the cosmetic outcome following treatment of dynamic forehead wrinkles by locking the line of convergence using botulinum toxin type A.

Patients and Methods

Fifty female patients with dynamic forehead wrinkles were included. The line of convergence was identified, and injection points were determined. Patients received injections of botulinum toxin type A in the upper part of the frontalis along the line of convergence. Patients were evaluated before injection and the response was evaluated after 2 weeks and after 3 months of injection.

Results

Post-treatment significant decrease in dynamic wrinkle scale was detected. The distance between the medial and lateral canthi and their corresponding lower brow margins on maximum brow elevation was also significantly decreased after treatment. Meanwhile, the validated brow positioning score revealed no significant change in the resting brow position when pre-and post-treatment scores were compared.

Conclusions

Treating forehead wrinkles by injecting botulinum toxin along the line of convergence is an effective technique that requires less overall amount of toxin, improves the appearance of the wrinkles and minimizes the risk of development of side effects.     

Evaluation of a combined laser‐radio frequency device (Polaris WR) for the nonablative treatment of facial wrinkles

Nonablative wrinkle reduction or skin tightening is desired by individuals who, ideally, hope to have the skin improvement associated with chemical or laser ablative techniques but without the undesirable recovery process. Electro‐optical synergy (ELOS) technology that combines radio frequency (RF) and diode laser energy (900?nm) was used to treat 15 patients in this IRB sanctioned study. Energy settings were based on the depth of wrinkles (the greater the depth and concentration of wrinkles, the higher the RF setting) and ranged from 50–100?J/cm² RF and 15?J/cm² for the optical, laser component. Patients received three full‐face treatments, and results were evaluated by comparison of standardized photographs and patient questionnaire given prior to each treatment and one month after the third treatment. The primary investigator and three other “blinded” physicians evaluated these photographs using Fitzpatrick's wrinkle classification to assess the improvement, if any, between the initial and final visit. Eight patients completed the study. Explanation for the exclusion of the remaining six patients were: one decided to have surgery, two felt the treatment was too painful, and three moved out of the area. Following treatment, all patients had mild swelling (resolved <48?hours) and skin hyperemia (resolved <24?hours). Results observed one month after the last treatment in eight patients demonstrated an average of 25% reduction in skin wrinkles (range 14%–32%). There were no adverse side effects. The major concern of the patients was the discomfort associated with the treatment. As part of an FDA investigation to assess efficacy, long‐term follow‐up was not a part of this study protocol.     

Imaging of the skin and subcutaneous tissue using classical and high‐frequency ultrasonographies in anti‐cellulite therapy

Background: The development of ultrasonography allowed for skin imaging used in dermatology and esthetic medicine. By means of classic and high‐frequency ultrasonographies, changes within the dermis and subcutaneous tissue can be presented. Objective: The aim of this study was to show the possibilities of applying classic and high‐frequency ultrasonographies in esthetic dermatology based on monitoring various types of anti‐cellulite therapies. Methods: Sixty‐one women with cellulite were assigned to two smaller groups. One group was using anti‐cellulite cream and the second group was a placebo group. The ultrasound examination was carried out before the initiation and after the completion of the treatment and evaluated epidermal echoes, the thickness of the subcutaneous tissue and the dermis, dermis echogenicity, the length and surface area of the subcutaneous tissue fascicles growing into the dermis, and the presence or absence of edemas. Results: After the completion of the treatment, a statistically significant difference was observed. The most useful parameters were as follows: the thickness of the subcutaneous tissue, echogenicity, the surface area and length of the subcutaneous tissue, as well as the presence of edemas. The discussed changes were not observed in the placebo group. Conclusion: Classic and high‐frequency ultrasonographies are useful methods for monitoring anti‐cellulite therapies.     

Influence of subcutaneous adipose tissue mass on dermal elasticity and sagging severity in lower cheek

Background: Subcutaneous adipose tissue lies just beneath the dermal layer, but the interaction between the two is not well understood. Recently, we showed that the subcutaneous adipose layer affects dermal properties in an obese rodent model. Objective: To explore the influence of the subcutaneous adipose layer on dermal properties and morphology in humans. Methods: Subcutaneous adipose mass was measured by ultrasound using a Prosound alpha 5^®, dermal elasticity was measured using an in vivo suction skin elasticity meter (Cutometer MPA 580^®), and sagging severity were evaluated morphologically using photograph‐based grading criteria at the lower cheek in 70 Japanese female volunteers (age; 31–59, BMI; 17.1–36.2). The correlations among the results were examined. Results: Thickness of the subcutaneous adipose layer was significantly and negatively correlated with dermal elasticity parameters, i.e., elastic deformation, elastic deformation recovery, extensibility, total deformation recovery, ratio of viscoelasticity to elastic distention and overall elasticity, including creep and creep recovery. Furthermore, we investigated their influence on facial morphology, such as sagging. The subcutaneous adipose mass was significantly and positively correlated with sagging severity at the lower cheek (R=0.442, P<0.001), and there was a significant negative correlation between dermal elasticity and sagging severity (R=?0.358, P<0.01). Conclusion: These results indicate that increment of subcutaneous adipose mass impairs dermal elasticity, which in turn exacerbates sagging severity.     

Evaluation of effectiveness of tranexamic acid as mesotherapy in improvement of periorbital wrinkling in a trial study

Background

Tranexamic acid is used to treat pigmented disorder in dermatology for a long time however there are limited data for effectiveness of tranexamic acid for rejuvenation and improvement of wrinkle. Here we want to find the effectiveness of tranexamic acid as mesotherapy in improvement of periorbital wrinkle in a clinical trial study.

Methods

Patients with melasma who were treated with 4 session of tranexamic acid mesotherapy at intervals on 1 week were evaluated with Visioface device before starting and 1 month after last course of treatment. The outcomes including volume, area, area percent, and depth were measured by Visioface device.

Results

Mean of periorbital wrinkles volume before and after procedure were 89 271 and 74 639 pixel³ (px³), respectively. Very significant difference with p-value of <0.001 was detected at volume of patient wrinkles before and after treatment. Moreover, the mean of area (and area percent) of their periorbital wrinkles before and after therapeutic method were 8481 Px³ (1.131%) and 7184 Px³ (0.646%), respectively, with significant differences (both have p-value of <0.001).Mean of periorbital wrinkles depth at before and after treatment were 9.8 and 9.6, respectively, without remarkable difference (p-value was 0.257).

Conclusion

Tranexamic acid mesotherapy significantly leads to reduced volume and area of wrinkles. Injection of tranexamic acid as mesotherapy seems to be effective in improvement of periorbital wrinkling.     

Ultrasound imaging demonstration of the improvement of non‐ablative laser remodeling by concomitant daily topical application of 0.05% retinaldehyde

BACKGROUND: Retinaldehyde has been proven to be effective in the reduction of facial wrinkles. It has also demonstrated its usefulness when used before and after laser skin resurfacing.

OBJECTIVE: A monocentric, comparative, randomized, double‐blind study was performed to evaluate the efficacy of retinaldehyde versus excipient in combination with non‐ablative laser remodeling treatment.

METHODS: A total of 16 female patients (mean age 45 years) were enrolled for neck line and forehead rhytid treatment. They were randomly assigned into two groups. The RAL group (eight patients) was treated with a non‐ablative laser (1540?nm Er:glass, 10?J/cm² per pulse, three pulses, 2?Hz repetition rate, 4?mm spot, +5°C cooling) and daily topical application of 0.05% retinaldehyde immediately after the first laser treatment and up to 3 months after the fifth treatment. The CTRL group (eight patients) was treated under similar conditions, except with a daily application of excipient. The thickness of the skin (forehead and neck) was measured by ultrasound imaging before the first treatment, 1 month after the third treatment, 1 month after the fifth treatment and 3 months after the fifth treatment.

RESULTS: An increase of dermal thickness was observed for all patients treated by laser (groups RAL and CTRL) on the forehead and neck. However, the increase was greater for the RAL group (retinaldehyde) when compared with the CTRL group (excipient). Three months after the fifth treatment, the increase in dermal thickness (%) was, respectively, 5.27 versus 1.13 for the forehead and 10.54 versus 3.57 for the neck. The difference between groups was statistically significant in favor of the retinaldehyde group for the forehead (p<0.05) and of limited significance for the neck (p=0.08).

CONCLUSION: When considering the reduced number of patients in each group, the statistical analysis demonstrates an evident advantage of using retinaldehyde versus excipient. This study demonstrates that irradiation with a 1540?nm Er:glass laser can be potentiated with concomitant daily topical application of 0.05% retinaldehyde.     

Botulinum toxin A: a 9‐month clinical and 3D in vivo profilometric crow's feet wrinkle formation study

OBJECTIVE: The objective of this study was to determine the duration of the effects of a defined dose of BTX‐A on crow's feet formation wrinkles.

MATERIALS AND METHODS: Twenty‐five patients each received one injection of 12 units of BTX‐A in the orbicularis oculi muscle on both sides of the face. The results were evaluated at 3, 6 and 9 months. Standardized photographs were taken of the wrinkle formations at rest at each step of the 9‐month period following the treatment, and the wrinkles were then rated on photographs by blinded observers. Three‐dimensional (3D) in vivo profilometry was also used to quantify the degree of improvement.

RESULTS: Both the self‐assessments by the patients themselves and the objective assessments of the 3D profilometry study provided similar results, but the independent observer assessment results were slightly more optimistic. There was a statistically significant difference observed between baseline and the evaluations at both 3 and 6 months.

CONCLUSION: BTX‐A is a safe and effective method for treating crow's feet wrinkles. In both the observer assessment and the 3D skin profilometric assessment, a clear improvement was shown at 6 months.