Prospective Open-Label Study of Botulinum Toxin Type B (Myobloc) at Doses of 2,400 and 3,000 U for the Treatment of Glabellar Wrinkles

BACKGROUND: A previous open-label study evaluated botulinum toxin type B (BTX-B; Myobloc) for the treatment of glabellar wrinkles and showed that it is safe and effective at a dose of 1,800 U. The duration of effect at this dose was approximately 8 weeks, and it was felt that higher doses would result in a longer duration of effect. OBJECTIVE: This is a prospective open-label study to assess the safety, efficacy, and duration of response following BTX-B injection at doses of 2,400 and 3,000 U for the treatment of glabellar frown lines. METHODS: A total of 39 patients were enrolled: 16 patients received 2,400 U. Eighteen patients received 3,000 U, and 5 patients received saline injections (control group). Doses were divided equally among six sites. RESULTS: All subjects had rapid improvement of interglabellar rhytides, with full response seen within 2 to 3 days. The duration of effect was 9.6 and 10.4 weeks with 2,400 and 3,000 U, respectively. Five subjects (two in the 2,400-U group and three in 3,000-U group) reported adverse events related to the BTX-B injection. Three subjects complained of mild pain at the injection site, and two subjects complained about lid droop/ptosis (one with the occurrence of headache). CONCLUSIONS: BTX-B injection is safe and effective for the treatment of glabellar wrinkles. It has a very rapid onset of action, and increasing the dose appears to prolong the duration of response. At 3,000 U, the duration of response was 10.4 weeks and was associated with minimal adverse effects. Adverse events were mild and were similar to those seen in previous studies with BTX-A. Additional studies evaluating BTX-B at higher doses are recommended to prolong the duration of response in the treatment of glabellar wrinkles.     

Aesthetic considerations for treating the Middle Eastern patient: Thriving in Diversity international roundtable series

Background

The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment.

Aims

The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices.

Patients/Methods

In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022.

Results

The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for  commonly treated areas in this population (forehead, infraorbital area, and jawline).

Conclusions

Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice.     

The Utilization of a New Yellow Light Laser (578 nm) for the Treatment of Class I Red Telangiectasia of the Lower Extremities

BACKGROUND: A dual-wavelength approach is necessary in order to achieve consistent results when utilizing lasers and intense pulsed light sources to treat red and blue lower extremity vessels. In this regard, short-wavelength technologies (500-800 nm) may be employed to treat red telangiectasia of less than 2 mm on the lower extremities. OBJECTIVE: To demonstrate a new yellow light laser utilizing a copper bromide medium and its potential efficacy in the treatment of red lower extremity telangiectasia of less than 2 mm. METHODS: Forty-six women (mean age 37 years) were treated in two private practice settings with a 578 nm yellow light laser with a circulating cooling window (1-4 degrees C). Class I red telangiectases of the thighs 1.5 mm or less in diameter were considered for treatment. Patients were treated with up to three treatments at 6-week intervals on a 5 cm2 surgical area of vessels utilizing a fluence of 50-55 J/cm2. Results were analyzed by macrophotographic imaging, double-blinded observer evaluation/optical chromatography, and a patient evaluation scale. RESULTS: An average of 1.7 patient treatment sessions produced significant clearing of 75-100% in 71.8% of patients. The mean erythema index showed significant lightening (51-65a+) in the study population. Finally, 76.1% of patients reported great satisfaction with the results of their treatment session. CONCLUSION: A new 578 nm copper bromide (CuBr) yellow light laser produces excellent results in eradicating red telangiectases of the lower extremities that are less than 2 mm in diameter.     

Clinical Trial of a Novel Filler Material for Soft Tissue Augmentation of the Face Containing Synthetic Calcium Hydroxylapatite Microspheres

BACKGROUND: The ideal injectable filler should yield great, long-lasting results, be biocompatible, reliable, safe, easy to use, and inexpensive. Radiesse (Bioform Inc., Franksville, WI) is a synthetic calcium hydroxylaptic filler that has all of the above qualities. OBJECTIVE To evaluate the effectiveness of Radiese as an injectable filler. METHODS: Eighty-two patients who underwent facial soft tissue augmentation using Radiese from April 2003 to 2004 were enrolled in this study. Pre-filled sterile syringes were used to inject the material into the soft tissues of the face. At the 3 month and six month visits, the physicians and the patients were asked to evaluate the result. RESULTS: Eighty-two patients were injected with Radiesse. The most common area of injection was the melolabial folds. All patients were evaluated during the 3 month follow up visit. There was an overwhelmingly positive response to the look and feel of the implant, averaging 4.6 on a grading scale from 1 to 5, for the patients as well as the injecting physicians. Similar responses were found at the 6 month follow up visit. CONCLUSION: Preliminary data indicate that Radiesse is easy to use and effective with little or no associated morbidity.     

Combination Radiofrequency and Light Energies: Electro-optical Synergy Technology in Esthetic Medicine

Background:. In the past decade, there has been an astonishing insurgence in the number and variety of commercially available nonablative resurfacing devices. This is related in part to a continually increasing market demand for noninvasive cosmetic procedures that are associated with minimal recovery time and fewer complications than the traditional carbon dioxide (CO2) laser.
Objective:. The goal of nonablative devices is to selectively heat the target tissues without injuring surrounding tissue. This article reviews the mechanism, results of clinical studies, and treatment parameters for a combination optical and radiofrequency (RF) energies system.
Methods and Materials. To see modest clinical improvement, the patient often requires a series of treatments over the course of several months (sometimes up to 18 months).
Results. Preliminary studies with combination optical and RF energies have shown promising results in different dermatologic applications, including skin rejuvenation, hair removal, and leg vein treatment.
Conclusion. A new technology that integrates bipolar RF and optical energies, ELOS (Syneron Medical Ltd, Yokneam, Israel), is based on the premise of a synergistic activity between the two forms of energy. The bipolar RF component enables the use of lower levels of the optical component, reducing the risk from optical energy and potentially improving its use across different skin types and hair colors. The optical component is believed to drive the bipolar RF energy to concentrate where the optical energy has selectively heated the target.     

Nonablative Wrinkle Treatment of the Face and Neck Using a Combined Diode Laser and Radiofrequency Technology

BACKGROUND: Nonablative laser systems that integrate optical and conducted radiofrequency (RF) energies are a novel technology for the treatment of wrinkles. OBJECTIVE: This two-center study investigated the safety and effectiveness of combination diode laser (900 nm) and RF for the treatment of wrinkles and skin texture. METHODS: Patients with grade II to IV wrinkling on the face, according to the Glogau classification system, were treated with a combination diode laser and RF using a fluence of 30 to 50 J/cm2 and RF energy of 80 to 100 J/cm3. Patients received up to three treatment sessions at 2- to 3-week time intervals. Wrinkle assessments using the Glogau scale were conducted at baseline and at 3 months following the last treatment. In addition, patients and physicians graded the level of improvement using pre- and post-treatment photographs. RESULTS: Twenty-three subjects completed all three treatment sessions. Of these participants, more than 50% had a greater than 50% improvement in the appearance of wrinkles. All subjects reported a noticeable improvement in skin smoothness and texture. CONCLUSION: This preliminary study demonstrates that the combination of diode laser and RF energies decreases the appearance of wrinkles and improves skin texture.     

Hand recontouring with calcium hydroxylapatite (Radiesse)®

The aging hand is a common area of concern for many patients. Until recently, adequate treatment options have been hampered by pain of injecting into the dorsum and, post-injection, by the absence of longevity of treatment. In this article, we describe the off-label use of the soft tissue filler calcium hydroxylapatite (CaHA; Radiesse) for hand rejuvenation. The product is inherently biocompatible and, when placed in soft tissue, induces neocollagenesis.
An alternative injection mixture of CaHA combined with lidocaine is described, as well as the novel "bolus" injection technique. The CaHA-lidocaine emulsion reduces the pain of injection to nearly none at all, improves the rheology of the procedure, and allows for deposition of the product into the correct plane of tissue. The volume of CaHA injected as well as the amount of lidocaine used for the mixture vary according to physician preference. In our practice, 1.3 mL of CaHA combined with 0.5 mL lidocaine per hand usually appears to be sufficient to improve the appearance of the atrophic dorsum of the hand.
Side-effects of CaHA (Radiesse), particularly in this off-label application, are minimal and of short duration. The aesthetic result is immediate and generally persists for longer than 6 months. As a treatment option, hand rejuvenation with CaHA (Radiesse) is a very gratifying procedure both to the patient and to the physician.