Real-World, Retrospective, Multicenter, Observational Study on the Use of the First Liquid AbobotulinumtoxinA in Italy.

INTRODUCTION: Randomized controlled trials (RCTs) suggested that liquid formulation of botulinum toxin type A (aboBoNT-A) is safe and effective, but data confirming these characteristics in a real-life heterogenous set of patients are currently lacking. This study aimed to assess the efficacy and safety of the ready-to-use aboBoNT-A solution in adults with moderate-to-severe glabellar wrinkles. METHODS: In this real-life, multicenter, retrospective, observational study, healthy adults were treated at baseline only with aboBoNT-A solution on the glabellar area and followed up for 24 weeks. Re-treatment after 20-24 weeks could also be combined with other aesthetic procedures. Family history of immune-mediated inflammatory diseases (IMIDs) was not an exclusion criterion. Patient-reported outcomes (patient's satisfaction and injection-related pain) and physician-reported outcomes (Physician Global Assessment, PGA) were collected. RESULTS: Of the 542 patients enrolled in the study, 38 had IMID family history. Injection-related pain was reported in 128 (23.62%) as mild (pain VAS = 1.34 ± 0.87) mainly by non-botulinum toxin treatment-naïve women under 50 years of age. At 48 h, physicians rated the clinical result as "improved" in 64% of patients, conversely 264 patients (48.71%) self-evaluated as "satisfied"/"very satisfied". At 4 weeks a touch-up (< 10 units) was performed in 11 (2.03%) patients and 98.2% were "highly satisfied". Re-treatment was performed in 330 (61.45%) patients, mainly botulinum-experienced, at 20 weeks and in 207 (38.55%), mainly botulinum naïve, at 24 weeks. A total of 403 (74.35%) patients were re-treated with the three-point technique and 201 (37.08%) also received hyaluronic acid filler in the lower central face and middle third. There were no cases of de novo IMIDs. CONCLUSIONS: Real-world data confirmed that aboBoNT-A is a fast, efficient, durable, reproducible, and easy-to-use drug which is also well tolerated in patients with family history of IMID.

Attitudes, Concerns, and Expectations of Consumers of Aesthetic Medicine and Surgery During the COVID-19 Outbreak: An Italian Online Survey.

As a consequence of the coronavirus disease 2019 (COVID-19) emergency, Italian physicians working in the field of aesthetic medicine and surgery considered appropriate to stop their activity in order to preserve patients' safety. This drastic measure obviously had an important impact on the medical aesthetic market causing growing concerns. To catch the current attitudes of the Italian consumers toward the aesthetic medicine and surgery, a medical advisory board devised an online survey; 216 clinicians finally participated in this survey and sent the online link through e-mail. A total of 8080/8640 (93.5%) questionnaires were returned, while 70 were removed. Approximately 49.0% (n = 3944) did not feel influenced in their desire for aesthetic treatments in spite of the pandemic emergency. Being influenced was not correlated with the uneven situation experienced on the Italian territory (r = -0.30, P = 0.196); 45.4% (n = 3636) declared to be ready for rescheduling their visit, and 60.5% (n = 4844) declared that they want to allocate the same amount of resources as before. The most missed aesthetic treatment was the face (71.1% [n = 5696]). Approximately 47.0% (n = 3759) and 46.0% (n = 3679) will come back to their physician without any request or with the need for an explanation about the security protocols, respectively. Approximately 40% (n = 3314) declared that their physical appearance affects their mood fairly, 27.0% (n = 2168) strongly or very strongly, and 71.3% (n = 5708) declared physical and/or psychological decline. Looked at together, the results give us some optimistic predictions, and, therefore, the authors are confident that their patients will come back to their clinics without any particular issues. However, ensuring patient safety must be our paramount task.

Picosecond laser versus historical responses to Q-switched lasers for tattoo treatment.

BackgroundTattooing is increasingly common among adolescents and young adults. This study explores the clinical efficacy of picosecond laser for the correction of tattoos. Literature suggests that 25-47% of the population have had a tattoo at some point in their life (1). The incidence is slightly higher in adults 18-35 years (22-47%) compared to college students (18-25 years of age(1, 2). Recent surveys report 25% of tattooed adults expressing regret, while 4% of tattooed students had already undergone some form of tattoo-removal procedure (3). A common request for tattoo removal includes poorly executed tattoos, avoidance of stigmatization, trauma, socially inappropriate, and employment. Several procedures have been proposed to remove tattoos including cryosurgery, thermal cautery, or surgical resection (4). A major disadvantage of these methods is that they are all highly operator dependent, and carry a very high risk of residual scarring, residual pigment being left behind "ghosting" (3). In addition, some opt to cover the unwanted tattoo with another design, which results in layered tattoos that are substantially harder to manage. Laser surgery, in skilled hands, is an effective method for tattoo removal and traditionally, this is performed with Quality-Switched Laser, where energy liberatred in the nanosecond range results in a selective photothermal effect (5). Picosecond laser is a more recent innovation that results in energy released in a picosecond timescale (a time interval 1000 times shorter).One potential disavantage of laser therapy for the effacement of cutaneous tattoos is the length of treatment and associated cost, which might dissuade the patient from following through to completion of treatment, limiting potential benefits whilst still being exposed to risk of harm. (5, 6). Recent studies suggest that picosecond laser result in substantially reduced treatment times, whilst achieving an identical or more effective end result (7-9). However, these studies are limited by very small sample size and follow-up.

Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus Recommendations.

BACKGROUND AND OBJECTIVES: There is currently intense multidisciplinary interest and a maturing body of literature regarding laser treatments for traumatic scars, but international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the tremendous potential of laser techniques, offer recommendations for safe and efficacious treatment, and promote wider patient access guided by future high-quality research. STUDY DESIGN/MATERIALS AND METHODS: An international panel of 26 dermatologists and plastic and reconstructive surgeons from 13 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the laser treatment of traumatic scars. A three-step modified Delphi method took place between March 2018 and March 2019 consisting of two rounds of emailed questionnaires and supplementary face-to-face meetings. The panel members approved the final manuscript via email correspondence, and the threshold for consensus was at least 80% concurrence among the panel members. RESULTS: The manuscript includes extensive detailed discussion regarding a variety of laser platforms commonly used for traumatic scar management such as vascular lasers and ablative and non-ablative fractional lasers, special considerations such as coding and laser treatments in skin of color, and 25 summary consensus recommendations. CONCLUSIONS: Lasers are a first-line therapy in the management of traumatic scars and contractures, and patients without access to these treatments may not be receiving the best available care after injury. Updated international treatment guidelines and reimbursement schemes, additional high-quality research, and patient access should reflect this status. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Double phase treatment with flashlamp-pumped pulsed-dye laser and long pulsed Nd:YAG laser for resistant port wine stains in adults. Preliminary reports.

BACKGROUND: Flashlamp-pumped pulsed (FLPP) dye laser still represents the standard treatment for the majority of port wine stains (PWSs), but the results on thick PWSs remain unpredictable, and many of these lesions fail to completely respond. Our aim was to report on the results obtained on unresponsive PWSs to standard laser treatments, by using a double phase laser treatment strategy using two laser passes in the same session. METHODS: Eleven adult patients with facial PWS resistant to dye laser were enrolled. Laser sessions were scheduled every 8 weeks, and each of them consisting of two laser passes. In phase one, two different laser wavelengths (595 nm and 1064 nm) were delivered consecutively to each affected area. In the second phase, the PWS was treated using a pulse stacking technique with the 1064 nm Nd:YAG. RESULTS: One patient was lost to follow-up. Among the remaining ten, 5 (50%) patients showed an excellent improvement (>75%), 3 (30%) patients showed a good improvement (51-75%), and 2 (20%) patients had no or minimal improvement (0-25%). CONCLUSIONS: Our results suggest that the combination of different wavelengths in the same session can be helpful for PWSs resistant to standard laser treatments. However, in most patients two treatment phases were necessary.

A novel 1565 nm non-ablative fractional device for stretch marks: A preliminary report.

BACKGROUND: Striae Distensae (SD) is a very common dermatologic condition. We evaluated the effectiveness and safety of a novel non-ablative fractional 1565 nm laser (ResurFX) on the appearance of SD. MATERIALS AND METHODS: Twelve Caucasian subjects with various stages of SD received three non-ablative laser treatments. Each treatment consisted of two different laser settings, in order to achieve a demarcated dense impact together with a diffused deep impact. Three months after the last treatment, SD improvement was assessed by blinded and non-blinded reviewers using clinical images and 3D image analyses. RESULTS: Good clinical improvement (between 51% and 75%) was observed in all patients. Most patients showed improvement of > 50% in the volume of depressions and in lesion color (91.7% and 83.3% of patients, respectively). The average pain during treatment was generally defined as tolerable and the average downtime was 4 days. Transient erythema and severe edema were noted immediately after the procedure, but long-lasting or severe adverse effects were not observed. All patients noted a good improvement and were satisfied with the treatment and the results. CONCLUSIONS: The treatment with the 1565 nm ResurFX laser resulted in improved pigmentation, volume, and textural appearance of SD.

Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation.

Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24 months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO2 resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2 years after the procedure.