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.     

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.     

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 effect of eye opening and closing on the result of facial wrinkle assessment

Background/purpose: Since there is no standard protocol that specifies the opening or closing of eyelids in wrinkle assessment, the eyelid position of subjects at the time of assessment varies from study to study. This study aimed to reveal the effect of eye opening and closing on the result of wrinkle assessment. The study also attempted to analyze the age-, site-, and ethnicity-dependent variations in the effect.
Methods: Open- and closed-eyed photographs were obtained from 87 Japanese women of ages ranging from 21 to 73 years, and also from 80 American women comprising of Asians, Caucasians, Africans and Hispanics in their 30s. Their wrinkle intensities were scored separately at nine facial sites using a five-point photo scale. The obtained scores were compared between open- and closed-eyed photographs. The differences were then compared across age- and ethnic-groups.
Results: In Japanese subjects, a significant difference was found at the forehead wrinkle in all age groups, and also at the glabella, nasal root and eye corner in the middle and old age groups. In American subjects, significant differences were found at the forehead, nasal root, eye-corner, and upper and lower eyelids. The differences were more prominent in the Hispanic and Caucasian Americans than in the Asian and African Americans.
Conclusion: These results suggest that the eyelid position should be considered as a variable in wrinkle assessment.     

Evaluation of anti‐wrinkle effects of a novel cosmetic containing niacinamide

Niacinamide is known to have effectiveness on sallowness, wrinkling, red blotchiness and hyperpigmented spots in aging skin. In this study, we have evaluated the anti‐wrinkle effects of a new cosmetic containing niacinamide. A randomized, placebo‐controlled, split face study was performed in 30 healthy Japanese females who had wrinkles in the eye areas. The tested cosmetic containing 4% niacinamide was applied on wrinkles of one side for 8 weeks, and a control cosmetic without niacinamide on another site. Anti‐wrinkle effects were evaluated with two methods: (i) doctors’ observation and photographs based on the guideline of the Japan Cosmetic Industry Association; and (ii) average roughness of skin surface (Ra value) using skin replica. This cosmetic showed marked and moderate improvement in 64% of the subjects with a significant difference as compared with the control site (P < 0.001). Wrinkle grades in the tested area significantly reduced more than pre‐application (P < 0.001) and the control (P < 0.001). Reduction in Ra value on the tested area was more than pre‐application (P < 0.01) and the control site (P < 0.05) with significant differences Only one subject stopped the study with minimal irritation. These results indicated that the tested lotion was well tolerated and may be an optional preparation for the treatment of wrinkles in the eye areas.     

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.     

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.     

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.     

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.     

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.     

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.     

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.     

Botulinum toxin A in the treatment of the wrinkles in the upper third of the face

The practice of botulinum toxin injections is unavoidable in the correction of facial aging. In effect botulinum toxin allows to erase dynamic wrinkles, by transient and reversible muscular relaxation. This is the best wrinkle treatment for the upper part of the face: glabellar lines, horizontal forehead lines and crow's feet. This technique requires a good understanding of facial muscular anatomy, in order to correctly apply the basics of injection. Every patient is unique and only a big experience will allow to refine and personalise injections.     

Retinaldehyde/hyaluronic acid fragments: a synergistic association for the management of skin aging

Background Retinaldehyde (RAL) was proven effective in treating photodamaged skin. Topical treatments with specific intermediate‐size hyaluronate fragments (HAFi, 50–400 kDa) have been shown to stimulate keratinocytes proliferation and epidermal hyperplasia. The aim of this open, multicentric, international study was to assess the efficacy of the combination RAL–HAFi in the correction of skin photoaging. Patients/Methods Either RAL 0.05%–HAFi 0.5% (Eluage^® cream; group 1) or RAL 0.05%–HAFi 1% (Eluage^® antiwrinkle concentrate; group 2) or both products (group 3) were applied daily to the 1462 subjects during 90 days. Overall photoaging severity was evaluated in the three groups by the dermatologists at D0, D30, and D90 based on the Larnier’s scale. Wrinkles and/or furrows and clinical signs of aging were evaluated using a 4‐point scale. The skin microrelief of the crow’s feet, evaluated by optical profilometry, was performed in subjects from group 3. Results The 3‐month application significantly improved overall photoaging through decrease of the Larnier’s score in the three groups (P < 0.001). At D90, significant improvement of wrinkles was shown in groups 2 and 3 [forehead wrinkles (?19% and ?10%, respectively, P < 0.001), nasolabial folds (?20% and ?16%, P < 0.001), crow’s feet (?27% in the two groups, P < 0.001), and perioral wrinkles (?34% and ?23%, P < 0.001)]. Clinical signs of photoaging on the entire face improved significantly in groups 1 and 3 [elasticity (?32% and ?33%, respectively, P < 0.001), hyperpigmentation (?34% and ?31%, P < 0.001), and ptosis (?18% and ?22%; P < 0.001)]. Results were confirmed using an optical profilometry technique. Products were very well tolerated. Conclusion This clinical study showed the efficacy and value of the RAL–HAFi combination in the management of aging skin in a large cohort of patients.     

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.     

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.     

Novel anti‐wrinkle effect of cosmeceutical product with new retinyl retinoate microsphere using biodegradable polymer

Background: The novel hybrid retinoid, retinyl retinoate, is a synthetic material that was designed to reduce the side effects of retinoic acid and to increase the stability of retinol. The formulation of the retinyl retinoate, however, is required to enhance skin permeation, and thus to increase the anti‐wrinkle effect. Aim: To identify the efficacy of retinyl retinoate microsphere using biodegradable polymer as an anti‐aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles. Methods: The retinyl retinoate microsphere was prepared using the biodegradable polymer; polylactic acid (PLA). We also conducted two clinical studies with a total of 44 Korean women for 12 weeks. In the first clinical study, 20 patients completed a 12‐week trial of cream A [3% PLA‐retinyl retinoate (2%) microsphere] applied twice daily to the face. In the second clinical study, 24 patients completed a 12‐week trial of cream B (0.06% retinyl retinoate) applied twice daily to the face. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and Visiometers every 4 weeks. Results: The PLA‐retinyl retinoate microsphere was more effective for the permeation of retinyl retinoate than retinyl retinoate in itself. The cream A, which contains 3% PLA‐retinyl retinoate (2%) microsphere, showed a statistically significant improvement in facial wrinkles (P<0.05) in 20 volunteers after only 4 weeks of application in a clinical trial test. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for cream A was 6.05%, 8.03% higher than that of cream B which contains 0.06% retinyl retinoate, after 4 weeks. Conclusion: Retinyl retinoate has a potent anti‐wrinkle activity, and the PLA‐retinyl retinoate microsphere could be a useful cosmeceutical product for anti‐aging purposes.     

Heparanase activation induces epidermal hyperplasia,angiogenesis, lymphangiogenesis and wrinkles

Please cite this paper as: Heparanase activation induces epidermal hyperplasia, angiogenesis, lymphangiogenesis and wrinkles. Experimental Dermatology 2010; 19 : 965–972. Abstract: To clarify the difference between cutaneous responses to single and repeated barrier disruption, changes of epidermal gene expression were examined by using RT‐PCR. In repeatedly barrier‐disrupted skin, heparanase was specifically up‐regulated in epidermis. In addition, there was a marked decrease in heparan sulfate (HS) chains of perlecan in basement membrane at the dermal–epidermal junction (DEJ) compared with singly disrupted skin. HS chains form a reservoir for heparan sulfate‐binding growth factors. In repeatedly barrier‐disrupted skin, expression of vascular endothelial growth factor‐A (VEGF‐A), an angiogenic factor, was induced in epidermis, whereas thrombospondin‐1 (TSP‐1), an angiogenesis inhibitor, was down‐regulated, and concomitantly blood vessels were elongated and enlarged in dermis. Expression of VEGF‐C, a lymphangiogenesis factor, was augmented in epidermis of repeatedly barrier‐disrupted skin, concomitantly with an increase in the number and size of lymphatic vessels. Topical application of a synthetic heparanase inhibitor, 1‐[4‐(1H‐benzoimidazol‐2‐yl)phenyl]‐3‐[4‐(1H‐benzoimidazol‐2‐yl)phenyl]urea, to skin after barrier disruption significantly suppressed wrinkle formation, degradation of HS chains in the basement membrane, epidermal hyperplasia and the changes of blood and lymphatic vessels. These results suggest that chronic barrier disruption activates heparanase and induces gene expression changes, leading to increased growth factor interaction between epidermis and dermis, and facilitating various cutaneous changes, including wrinkle formation.     

Three clinical studies showing the anti-aging benefits of sodium salicylate in human skin

Background Anti‐aging effects of high concentrations of salicylic acid (SA) peels are commonly known. Like all acids, SA can produce somatosensory and visible irritation to the skin and as such may be unsuitable for subjects with sensitive skin. Aims To provide evidence that sodium salicylate (SS) obtained from neutralization of 1% SA by sodium hydroxide can deliver significant anti‐aging benefits. Methods The effects of SS were examined using three approaches: (1) evaluating its effects on stimulating the synthesis of fibrillin and collagen‐1 in vivo; (2) examining its efficacy by using Fast Optical in vivo Topometry (FOITS) in a double‐blind, placebo‐controlled clinical study; (3) determining its effects on both expert and naïve grader assessement of wrinkles in a double‐blind, placebo‐controlled study. Results In the first study SS produced significant increases of the fibrillin and collagen‐1 anti‐aging biomarkers compared with the untreated skin control. A commercially available retinol cream delivered similar effects to SS. In the second study using FOITS we showed that the SS formulation significantly reduced wrinkle depth (Rz) and skin roughness (Ra) after 4 and 8 weeks of daily application vs. placebo (Rz: ?8.2 ± 1.40% and ?11.4 ± 1.07%; Ra: ?7.8 ± 1.33% and ?11.9 ± 0.61%; P < 0.01). In the third study reductions in wrinkle depth were observed by expert assessment at both 4 and 8 weeks for the SS‐containing formulation compared to its placebo (P < 0.05). Equally, non‐expert graders recorded the SS formulation superior to its placebo. Conclusion Although the mechanism of action is not completely understood, we believe the benefits of SS are derived from its intrinsic stratum corneum exfoliation effects. All three studies demonstrate the significant anti‐aging effects of SS that are especially suitable for subjects with sensitive skin.     

Fractional photothermolysis for the treatment of facial wrinkles – searching for optimal treatment parameters in a randomized study in the split‐face design

Background: Fractionated photothermolysis (FP) is used for the treatment of facial wrinkles. Objectives: Investigation of effects of different FP treatment parameters in the treatment of facial wrinkles. Patients and methods: In a randomized split‐face controlled study 11 patients received 3 FP sessions in 4‐week intervals. Keeping the total energy input for each facial side constant, one side was treated with 6 mJ/MTZ with relatively high MTZ density (up to 2,625 MTZ/cm²) and the contralateral side with 70 mJ/MTZ with lower MTZ density (up to 230 MTZ/cm²). Follow‐up (FU) visits were performed 1, 3, and 6 months after the last treatment. The cosmetic evaluation was done by the patient self‐assessments and by assessment of standardized photographs by 3 independent, blinded investigators. Post‐treatment side effects were documented daily in a patient diary up to 7 days after the procedure. Results: After 6 months, the patient self‐assessments indicated significant improvements (p < 0.005) in wrinkle severity from 5.2 ± 1.5 to 3.8 ± 1.3 and 3.7 ± 1.3 for 6 and 70 mJ/MTZ, respectively, but without significant difference between the energy levels. In contrast, the photographic evaluation by the blinded investigators showed that wrinkle severity was rated significantly better at the sites treated with 70 mJ/MTZ than at the sites treated with 6 mJ/MTZ (p < 0.01). Treatment with 70 mJ/MTZ was significantly more painful than treatment with 6 mJ/MTZ. The typical local reactions to FP, erythema and edema, were also significantly more intense after 70 mJ/MTZ and lasted longer. Conclusions: FP with higher energy per MTZ at constant total energy input is more effective in the treatment of facial wrinkles than lower energy. The gain in effectiveness is, nonetheless, accompanied by an increase in adverse reactions. The treating physician may use this information to adjust treatment to the preferences of the individual patient.