Split-face histological and biochemical evaluation of tightening efficacy using temperature- and impedance-controlled continuous non-invasive radiofrequency energy

Background: Bipolar radiofrequency (RF) is capable of heating dermal collagen fibers and inducing skin tightening by collagen remodeling. Objective: To substantiate safety and improvement of skin laxity following skin heating with a novel temperature- and impedance-controlled non-invasive radiofrequency (RF) device by histological and biochemical evaluations. Methods: A split-face study was performed on 4 subjects who underwent 8 weekly RF sessions on one side of their face, leaving the other side an untreated control and then underwent facelift procedure. Clinical evaluation by photographs was done prior to the surgical procedure. Ex vivo fragments were harvested from both sides and compared. Morphometric analysis of dermal collagen fibers, collagen synthesis, and elastin synthesis evaluations were compared in triplicates. Results: Facial skin tightening was apparent in split-face photographs. A significant increase of 7.9% in dermal collagen content, and a significant increase of 34.7% in collagen synthesis were demonstrated in the treated samples. No statistically significant effect on elastin synthesis was detected. Conclusions: Skin tightening following treatment with non-invasive RF has proven histologically and biochemically to derive from increase in dermal collagen synthesis and content.     

A pilot study of the efficacy of the POLARGEN® ultrahigh-frequency electric field (40.68 MHz) radiofrequency device in the treatment of facial contouring

Background: Various radiofrequency (RF) devices are used to treat skin laxity and face contouring, but few studies have examined ultrahigh-frequency (UHF) electric field (40.68 MHz) RF devices. Objective: To evaluate the efficacy and safety of a UHF electric field (40.68 MHz) RF device for skin tightening and face contouring. Methods: Ten patients each underwent four sessions of UHF electric field RF device treatment at 2-week intervals. Clinical improvement was evaluated with the patient satisfaction score using a six-point scale, and clinical photographs taken at every visit and 2 months after the RF treatment were assessed. Skin biopsies were obtained from one patient before the first treatment and immediately after the last treatment. Adverse reactions were recorded at every follow-up visit. Results: All patients were women with a mean age of 51.7 ± 7.2 years. The mean satisfaction score was 4.5 ± 0.9 immediately after the last treatment session. Cheek, jawline, and neck enhancement and tightening were apparent in all patients. Side effects were minimal, and there were no burns or major complications. Conclusions: The UHF electric field RF device was effective for skin tightening and facial contouring, without significant adverse reactions.     

A novel non-invasive radiofrequency dermal heating device for skin tightening of the face and neck

Background: Loose, lax skin is a common cosmetic complaint. Previous non-invasive skin tightening devices had modest efficacy and were associated with pain or downtime. New technologies may allow for effective skin tightening with a series of radiofrequency (RF) treatments with no downtime. Objective: To evaluate the efficacy and safety of a novel bipolar RF device for skin tightening. Methods: Fifteen consecutive female patients were enrolled in the case series; 14 completed the study and were included in the analysis. The device under investigation is a novel, bipolar RF device allowing for achievement and maintenance of optimal dermal temperatures to stimulate collagen remodeling and skin tightening. Patients underwent a series of 4–6 weekly treatments. Three blinded, experienced cosmetic physicians evaluated paired pre-treatment and post-treatment photographs and determined the associated improvement, if any. Results: All patients (14/14) were determined to have a clinical improvement, as the pre-treatment and post-treatment photographs were correctly identified by the evaluators. It was observed that 21% (3/14) of patients had significant improvement, 50% (7/14) had moderate improvement, and 29% (4/14) had mild improvement. No pain, side effects, or adverse events were observed. Conclusions: This novel bipolar RF device represents a safe, effective treatment option for non-invasive skin tightening.     

A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating

BACKGROUND: There have not been any published studies on the use of radiofrequency (RF)–light‐based technologies for the treatment of cellulite. Only preliminary results have recently been reported (ASDS Proceedings, September 2004).

OBJECTIVE: This two‐center study investigated the safety and effectiveness of combined energies for cellulite treatment using the VelaSmooth? system.

METHODS: Thirty‐five female subjects with cellulite and/or skin irregularities on the thighs and/or buttocks were treated with the VelaSmooth device. Patients received from eight to 16 treatments twice weekly. All patients maintained their normal lifestyle, and diet and fluid consumption. The circumference of the right and left medial thighs was measured at both baseline and approximately 4 weeks after the last treatment. During the last follow‐up visit, the physician graded the level of improvement in skin smoothing and/or cellulite improvement using pre‐ and post‐treatment photographs. Three patients provided biopsy specimens for histological assessment.

RESULTS: All study patients showed some level of reduction in thigh circumference after 8 weeks of treatment; indeed, 70% of all patients showed such a reduction after 4 weeks of treatment. Also, 100% of all patients showed some level of improvement in skin texture and cellulite. The mean decrease in circumference was 0.8 inches. Some patients demonstrated reductions of more than 2 inches. There were minimal complications associated with treatment.

CONCLUSION: This preliminary study demonstrates that the VelaSmooth system can have a beneficial effect on cellulite appearance. Further studies are needed to better define the mechanisms by which RF and light energies affect subdermal tissues and develop a method of quantified cellulite analysis.     

Combination of microneedle radiofrequency (RF), fractional RF skin resurfacing and multi-source non-ablative skin tightening for minimal-downtime,full-face skin rejuvenation

Background: In the recent years, there is a growth in demand for radiofrequency (RF)-based procedures to improve skin texture, laxity and contour. The new generation of systems allow non-invasive and fractional resurfacing treatments on one platform. Objective: The aim of this study was to evaluate the safety and efficacy of a new treatment protocol using a multisource RF, combining 3 different modalities in each patient: [1] non-ablative RF skin tightening, [2] fractional skin resurfacing, and [3] microneedling RF for non-ablative coagulation and collagen remodelling. Methods: 14 subjects were enrolled in this study using EndyMed PRO^? platform. Each patient had 8 non-ablative treatments and 4 fractional treatments (fractional skin resurfacing and Intensif). Results: The global aesthetic score was used to evaluate improvement. All patients had improvement in skin appearance. About 43% had excellent or very good improvement above 50%, 18% had good improvement between 25 and 50%, and the rest 39% had a mild improvement of < 25%. Downtime was minimal and no adverse effect was reported. Conclusions: Our data show significant improvement of skin texture, skin laxity and wrinkle reduction achieved using RF treatment platform.     

Effectiveness of combined use of targeted pressure energy,radiofrequency, and high-intensity focused electromagnetic fields to improve skin quality and appearance of fat and muscle tissue in different body parts

Background

Inevitable signs of aging are especially noticeable in middle to elder age when stretch marks, loose skin, cellulite, and body-contour changes naturally appear.

Aims

To verify efficacy of high-intensity focused electromagnetic field (HIFEM), radiofrequency (RF), and Targeted Pressure Energy (TPE) combination treatment to address unfavorable changes in skin, fat, and muscle tissue.

Methods

The device simultaneously emitting monopolar RF and TPE energies was consecutively combined with simultaneous HIFEM+RF procedure in 32 subjects (21–64 years, 17.4–33.5 kg/m²) for treatment of thighs (N = 15; back, inner, or front), buttocks/saddlebags (N = 7), abdomen (N = 8), and upper arms (N = 2). All patients underwent four weekly, combined treatments of 30-min HIFEM+RF procedure followed by 15–30 min RF+TPE, depending on treatment area. Circumferential measurements, digital photographs, subject satisfaction, and comfort questionnaires were assessed up to 3-months post-treatment.

Results

Majority of participants found treatments comfortable, no adverse events occurred. Subjects showed substantial improvement in all treated areas from 1-month follow-up. Combination of HIFEM+RF, monopolar RF, and TPE resulted in significant circumference decrease. Generally, more pronounced results were seen at 3 months when subjects showed −5.2 cm on abdomen, −3.0 cm on thighs, and −5.5 cm on saddlebags, respectively. Ninety-four percent of subjects were satisfied with treatment results, most noticed improvement in cellulite, skin laxity, and muscle definition.

Conclusions

Results showed high patient satisfaction and efficacy in improving body contour and skin quality. Combining simultaneous HIFEM+RF procedure with simultaneous monopolar RF+TPE treatments considerably enhanced body contour and skin tissue. The procedure proved versatile and may effectively treat multiple body parts.     

Use of micro-focused ultrasound with visualization to lift and tighten lax knee skin

Abstract

Introduction: Public interest in noninvasive, aesthetic treatments for the rejuvenation of appearance continues to grow. The following prospective, open-label, nonrandomized trial was conducted to evaluate the safety and efficacy of micro-focused ultrasound with visualization (MFU-V) for achieving lift and tightening of lax skin above the knee. Materials and methods: Healthy adult women (N = 30) with mild- to moderate bilateral skin laxity above the knees were enrolled. MFU-V was applied to a grid of eight 25 mm² squares above each knee. MFU-V was first applied using a 4 MHz, 4.5 mm transducer followed by a 7 MHz, 3.0 mm transducer. Approximately 480 treatment lines applied to each knee. The primary efficacy endpoint was lifting and tightening of lax skin above the knee as determined by the principle investigator using the Physician Global Aesthetic Improvement Scale (PGAIS). Results: Among 28 evaluable subjects, 24 subjects (86%) showed improved lifting and tightening of knee skin laxity at 90- and 180-day follow-up visits. Three subjects showed no change and the appearance of one subject worsened. There were no adverse events or evidence of skin injury. Conclusion: Similar to its safety and efficacy for tightening facial skin and reducing wrinkles, MFU-V is an effective, noninvasive method for reducing skin laxity and improving the appearance of skin above the knee. ClinicalTrials.gov Identifier: NCT01708434.     

Use of a novel combined radiofrequency and ultrasound device for lipolysis,skin tightening and cellulite treatment

Introduction: Skin laxity and excessive subcutaneous fat are growing cosmetic concerns. The objective of this study is to evaluate the efficacy and safety of a novel radiofrequency and ultrasound workstation for lipolysis, circumference reduction, treatment of skin laxity and cellulite. Materials and methods: Two hundred seventy-five (235 women and 40 men) patients were enrolled into the study. Each patient received 3 treatment sessions, each session comprising Ultrasound and Radiofrequency treatments, at two-week intervals. Some received treatment for the abdomen, some for the thighs and some for both. Efficacy was assessed accordingly by measuring changes in abdominal circumference, thigh circumference and appearance of cellulite. Any adverse effect was noted. Result: Paired t-test between measurements at baseline and 4 weeks after 3rd session was significant amongst all the groups, showing that most patients showed improvement in abdominal and/or thigh circumferences. No significant adverse effects were noted during or after the treatment. Conclusion: A combination of alternating hot and cold module Ultrasound and Radiofrequency technologies is a safe and effective modality for lipolysis and to treat skin laxity and cellulite.     

Effects of cellulite treatment with RF,IR light,mechanical massage and suction treating one buttock with the contralateral as a control

Background and objectives: A system that combines bipolar radio frequency (RF) and intense infrared light (IR) together with mechanical massage and suction has recently been reported as being efficient for cellulite treatment. The present split study was designed to evaluate the efficacy of such a system through various treatments of cellulite located on the buttocks. Methods: Ten patients were enrolled for 12 sessions of 30 minutes each performed over one buttock, the other buttock serving as an untreated control. Sessions were conducted twice a week for a period of 12 weeks. Clinical photography and profilometry were carried out to assess textural changes before (baseline) and 2 months after the final treatment. Histopathology was performed at baseline, 2 hours after the first session, and just before the 12th session and 2 months thereafter. Results: All patients noted improvement in the treated buttock before the final session, which was maintained at the 2‐month assessment. Improved skin appearance was noticed after the first session and was maintained throughout the study. All patients were satisfied with the results and requested further treatment in order to balance the results in both buttocks. Random histological analyses suggested dermal firmness, fibre compaction and tightening of skin layers, including the subcutis, as possible reasons for the effects achieved. The authors recognize that the small number of participants limits the statistical power of the study. Conclusions: Treatment sessions with the combined RF, IR light and mechanical massage and suction system were complication free, produced improvements in the overall cellulite appearance and skin condition, suggesting that further treatment sessions for maintenance could sustain patient satisfaction index (SI) and lead to lasting results. Based on the good results in the limited trial population, further studies with larger patient populations are warranted.     

Efficacy of multipolar radiofrequency with pulsed magnetic field therapy for the treatment of abdominal cellulite

Introduction: Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. Methods: A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. Results: Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. Conclusion: This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.     

A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating.

BACKGROUND: There have not been any published studies on the use of radiofrequency (RF)-light-based technologies for the treatment of cellulite. Only preliminary results have recently been reported (ASDS Proceedings, September 2004).OBJECTIVE: This two-center study investigated the safety and effectiveness of combined energies for cellulite treatment using the VelaSmoothtrade mark system.METHODS: Thirty-five female subjects with cellulite and/or skin irregularities on the thighs and/or buttocks were treated with the VelaSmooth device. Patients received from eight to 16 treatments twice weekly. All patients maintained their normal lifestyle, and diet and fluid consumption. The circumference of the right and left medial thighs was measured at both baseline and approximately 4 weeks after the last treatment. During the last follow-up visit, the physician graded the level of improvement in skin smoothing and/or cellulite improvement using pre- and post-treatment photographs. Three patients provided biopsy specimens for histological assessment.RESULTS: All study patients showed some level of reduction in thigh circumference after 8 weeks of treatment; indeed, 70% of all patients showed such a reduction after 4 weeks of treatment. Also, 100% of all patients showed some level of improvement in skin texture and cellulite. The mean decrease in circumference was 0.8 inches. Some patients demonstrated reductions of more than 2 inches. There were minimal complications associated with treatment.CONCLUSION: This preliminary study demonstrates that the VelaSmooth system can have a beneficial effect on cellulite appearance. Further studies are needed to better define the mechanisms by which RF and light energies affect subdermal tissues and develop a method of quantified cellulite analysis.     

Clinical evaluation of non-ablative radiofrequency facial rejuvenation

OBJECTIVE: To evaluate the clinical efficacy of non-ablative cutaneous radiofrequency (RF) facial rejuvenation. DESIGN: Prospective study with longitudinal follow-up of a validation cohort set in an urban, private practice of an ambulatory facial plastic surgery center in southern California. METHODS: A consecutive sample was enrolled of 35 healthy adults with moderate facial aging, manifested by skin laxity, rhytids, and ptosis (brow, midface, jowls). Following intravenous sedation anesthesia, the study area was treated with 115-144 J/cm² using the non-ablative RF device (ThermaCool TC^TM). The main outcome measures were the objective measurement of brow height, investigator evaluation of skin parameters, a patient satisfaction questionnaire, and standardized photography, at fixed time intervals. RESULTS: At 12 weeks, a statistically significant increase in mean vertical brow height of 1.6-2.4 mm was observed in patients treated exclusively with the RF device (p&lt;0.0001). All skin parameters (laxity, wrinkles, clarity, pore size) were improved. Complications and side effects were minimal. Patients were uniformly satisfied. CONCLUSIONS: The ThermaCool TC RF system represents a promising non-invasive method of obtaining moderate facial rejuvenation in the appropriately selected patient. Long-term results are pending.     

Combined treatment for skin laxity of the aging face with monopolar radiofrequency and intense focused ultrasound in Korean subjects

Background: Although various minimal invasive approaches are available for aging skin laxity, they alone may not lead to notably satisfactory results. Objective: To evaluate the effectiveness and safety of combination regimen with monopolar radiofrequency (MRF) and intense-focused ultrasound (IFUS) in facial lifting and tightening. Methods: Twenty-two Korean participants with aging face received a sequential single session of MRF and IFUS treatment. Objective and subjective assessments for improvement were performed at the 20-week post-treatment. Safety profiles were also recorded, and skin biopsies were taken at baseline and follow-up visit. Results: Based on the objective assessment for the overall facial skin tightening and laxity, 19 patients (90%) demonstrated “moderate” or better improvements (more than 25%) compared with baseline. Specifically, improvements of skin laxity and sagging, and droopy jaw line were more noticeable compared with that of superficial skin texture (P < 0.05). Subjective satisfactions were generally consistent with objective findings, and no serious adverse effect was observed. Histologic evaluation showed increased dermal collagen fibers throughout the dermis after treatments (P < 0.05). Conclusion: Combination treatment of MRF and IFUS has cumulative benefits for skin lifting and tightening with satisfactory safety profiles in Asian subjects.     

Beauty from within: Improvement of skin health and appearance with Lycomato a tomato-derived oral supplement

Backround

Healthy and a youthful appearance is a common desire of the aging population. “Beauty from within” involves using nutrition and nutraceuticals to support skin function for reducing and reversing signs of aging such as wrinkles, pigmentary changes, skin laxity, and dullness. Carotenoids possess strong antioxidant and anti-inflammatory activities and are effective in improving skin barrier and could thereby stimulate “beauty from within” by providing endogenous support to reduce the expressions of aging.

Aim

This study was designed to determine whether 3-month supplementation with Lycomato would improve skin condition.

Method

A panel of 50 female subjects used Lycomato capsules as nutritional supplements for 3 months. Skin status was observed via questionnaires for the assessment of skin condition and expert visual grading of facial markers such as wrinkles, tonality, roughness, laxity, and pore size. Skin barrier was assessed using transepidermal water loss (TEWL). Measurements were obtained before treatment and after 4 and 12 weeks of use.

Results

Results indicated a statistically significant improvement (p < 0.05) in skin barrier as measured by TEWL after 12 weeks of consuming the supplement. There was also a significant improvement in skin tonality, lines and wrinkles, pore size, and skin firmness as observed by expert evaluation as well as subject self-assessment.

Conclusion

Based on the confines and conditions of this study, oral supplementation with Lycomato resulted in significant improvement in skin barrier. Visual appearance of lines and wrinkles, skin tonality, pores, smoothness, and firmness were considerably improved, and these improvements were found to be substantially discernible by the subjects.     

Clinical and histopathological results following TriPollar™ radiofrequency skin treatments

Introduction: Skin laxity, wrinkles and cellulite are common aesthetic problems associated with the aging process. These symptoms are due to the weakening and thinning of dermal connective tissue and the enlargement of hypodermal fat cells. The aim of this study was to evaluate the safety and efficacy of the TriPollar RF technology in reducing fat and collagen regeneration. Methods: Twelve healthy patients underwent weekly treatments on different body sites using the TriPollar technology. Treatment areas were photographed and measured and patient satisfaction was monitored. One abdominal patient consented to a series of TriPollar treatments prior to her scheduled abdominoplasty. A controlled histopathology analysis was performed on skin samples taken during the abdominoplasty procedure. Results: Histopatho-logical examination revealed marked differences between treated and non-treated abdominal skin areas. An increase of 49% in dermal thickness, focal thickening of collagen fibers and focal shrinkage of fat cells was shown following TriPollar treatments. Average patient satisfaction indicated clear satisfaction with the clinical results achieved. Conclusion: The TriPollar is a safe and effective non-invasive technology leading to skin tightening and body shaping. Histology results indicate changes at the dermal and fat layers following TriPollar treatments resulting in increased collagen regeneration and stimulated fat metabolism.     

Intra‐ and inter‐observer reliability of the application of the cellulite severity scale to a Spanish female population

Background ‘Hexsel, dal’Forno and Hexsel Cellulite Severity Scale’ (CSS) was developed to evaluate cellulite with an objective and easy to apply tool. Objective Study CSS intra‐ and inter‐observer reliability in a Spanish female population by evaluating patients’ cellulite through photographs of their overall gluteofemoral zone as opposed to its creators who distinguished between buttocks and thigh. Methods Cellulite Severity Scale was applied to 27 women, evaluating gluteofemoral cellulite, differentiating between left and right. Evaluations were made by three expert examiners each at three times with a 1‐week separation. Variables were the five CSS dimensions (number of evident depressions; depth of depressions; morphological appearance of skin surface alterations; grade of laxity, flaccidity, or sagging skin; and the Nürnberger and Müller classification scale), and the overall CSS score. Cronbach’s alpha, intra‐class correlation and item total correlation were analysed. Results Cronbach’s alpha values were 0.951 (right) and 0.944 (left). In the intra‐observer reliability analysis, intra‐class correlation coefficient ranged from 0.993 to 0.999 (P < 0.001) and in the inter‐observer analysis were 0.937 (right) and 0.947 (left) (P < 0.001). Item total correlation showed all dimensions to be needed except grade of laxity, flaccidity or sagging skin (0.959 right; 0.955 left). Conclusion Cellulite Severity Scale has excellent reliability and internal consistency when used to evaluate cellulite on the buttocks and back of the thighs considered together. Nevertheless, the dimension grade of laxity, flaccidity or sagging skin does not contribute positively to the final consistency of the scale. This dimension needs to be analysed in greater depth in future studies.     

Forthcoming Meetings

Background/objectives: To determine the efficacy of the 1100–1800?nm infrared device for facial and cervical skin tightening. Methods: Ten female patients, with a mean age of 56.5 years, received two treatments 1 month apart with a chilled tip infrared device (Titan; Cutera, Brisbane, CA, USA). Individuals were examined and photographed prior to treatment and at 1 and 3 months post‐treatment. Three treatment‐independent evaluators compared the photographs and graded them on a standardized scale applied to seven regions subdividing the face and neck. After evaluating the photographs, the difference in pretreatment and post‐treatment scores was expressed as a percentage. The patients also rated their results. Results/conclusion: The greatest tightening was achieved over the malar region, the upper neck and the body of the mandible. In these areas the average tightening was 10%, 10%, and 12% respectively. The patients reported a 32% improvement in the appearance of their cheeks and a 20% visible improvement in their necks. Overall, they were pleased with the result of this non‐surgical skin tightening.     

A two-center, double-blinded, randomized trial testing the tolerability and efficacy of a novel therapeutic agent for cellulite reduction

Introduction Cellulite is the unsightly dimpling and nodularity found on the thighs and buttocks of many postadolescent women. Unfortunately, poor understanding of its pathophysiology coupled with very few scientifically based studies have left us with limited treatment options that are tolerable and effective. Purpose To review current concepts of the etiology and nature of cellulite and summarize available treatment options. To evaluate a novel, pathophysiologically based, topical agent for treatment. Materials and methods A total of 40 women with a moderate degree of cellulite (20 from each of the two research centers) entered a double‐blinded, randomized trial where an anticellulite cream was applied on a nightly basis to the affected sites for four continuous weeks. Each subject was randomized to receive active cream on either the right or left leg, with the contralateral side serving as placebo control. Bioceramic‐coated neoprene shorts were worn overnight to enhance penetration of the topical agents by occlusion. High‐quality digital photography was taken before treatment and after 4 weeks, with tangential full‐spectrum lighting. Five blinded, independent physician reviewers assessed the photographs for improvement. Subject questionnaires were completed to assess tolerability and efficacy. Results Of the 34 subjects who completed the study, 62% (21/34) noticed an overall improvement in their cellulite, with 62% (13/21) reporting greater improvement in the thigh that received active product. All 34 subjects found the shorts and creams easy and pleasant to use. Overall, the average measured decrease in thigh circumference was 1.9 cm (range: 0.1–4.5) with active product, and 1.3 cm (range: 0.1–3.0) with placebo. Upon review of the pre‐ and poststudy photographs, dermatologist evaluators found thighs treated with active product showed greater improvement than thighs treated with placebo in 68% of subjects. Conclusions The active topical agent used in this study was found to be effective in reducing the appearance of cellulite. All subjects tolerated the formulation well with no adverse effects. The success of this research validates the pathophysiologic concepts used to formulate the topical compound. This study both increases our understanding of the nature of cellulite and establishes a tolerable, effective product to treat it.     

The aging neck: A diagnostic approach to surgical and nonsurgical options

Abstract

Background: The neck is a prominent indicator of aging. Loss of subcutaneous fat, prominence of platysmal banding, jowling along the mandibular border, and excessive skin laxity due to loss of collagen and elastin are common conditions that are treated. Laser technology provides additional benefits when treating the first two anatomical layers of the neck. Methods: A 7-category classification system of anatomic skin layers of the lower face was developed. Based on the classifications treatments include the use of laser, ultrasonic technology, and toxins. Results: A classification system offering surgical and nonsurgical treatments including a 1440-nm laser fiber with a specifically designed tip to allow targeted energy delivery managed through a thermal sensing device. Conclusions: Treatment options correlate with the presence and severity of conditions. Categories 1 and 2 have only a fat excess condition. Laser application alone, without skin intervention, is utilized. The amount of fat with subsequent aspiration follows guidelines of categories 2 through 5. The 1440-nm laser helps in all treatments. The surgeon may elect to address skin tightening with surgical tightening in categories 6 and 7. Modalities such as toxins and focused ultrasound can be used to address muscle laxity.     

Nerve injury associated with high‐intensity focused ultrasound: A case report

Skin laxity is a common cosmetic concern in middle‐aged women. High‐intensity focused ultrasound (HIFU) is one of noninvasive modalities that provides safe and effective improvement in skin laxity and tightening with minimal adverse effects. Concerning an extensive use of HIFU for facial rejuvenation, dermatologists should be aware of potential adverse effects of HIFU treatment. We herein present a case of 33‐year‐old Thai female with facial nerve injury after HIFU treatment for skin laxity.