High-Intensity, High-Frequency, Parallel Ultrasound Beams for Cellulite of the Buttocks and Thighs.

BACKGROUND: Ultrasound energy can successfully treat fine lines and wrinkles, as well as lift the eyebrow and submentum. Ultrasound waves of high intensity induce thermal injury in the dermis with subsequent tissue remodeling. OBJECTIVE: To examine the utility of a novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams to improve the clinical appearance of cellulite on the thighs and buttocks. MATERIALS AND METHODS: A prospective, multicenter, clinical study investigated this novel ultrasound device using 2 treatments. RESULTS: Sixty-five subjects completed both treatments. The mean age was 46 years, and 100% were women. Fitzpatrick skin types I to VI were represented. Assessments compared 3-month follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 89.2%. For Cellulite Severity Scale rating, there was significant improvement of 1.61 units (p < .001). For cellulite Global Aesthetic Improvement Scale (GAIS), 89.2% had improvement, with a mean of 0.87 units (p < .001). For Laxity Scale rating, there was significant improvement of 0.70 units (p < .001). For skin laxity GAIS, 89.2% had improvement, with a mean of 0.76 units (p < .001). No device-related adverse events occurred. CONCLUSION: A novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams can safely and effectively improve the clinical appearance of cellulite on the thighs and buttocks.

Neck and chest rejuvenation with fractional 1440 and 1927-nm low-powered diode laser.

OBJECTIVES: Ultraviolet light and infrared radiation exposure to the chest and neck can result in photoaging changes, such as rhytids, skin roughness, and dyschromia, which can be treated with nonablative fractionated lasers. The low-powered fractionated 1440 and 1927-nm diode lasers have been shown to safely reduce facial photodamage. This study was conducted to investigate the safety and efficacy of a low-powered 1440 and 1927-nm nonablative fractionated diode laser in addressing photoaging symptoms, such as rhytids, skin roughness, and dyschromia, of the neck and chest. METHODS: In a prospective, single-arm, nonrandomized study, a cohort of 24 adult female patients with photodamage to their neck and chest received four treatments to these areas, administered at 4-week intervals. Treatments consisted of four passes on high settings with the 1440 nm handpiece followed by four passes with the 1927 nm handpiece. Photographs were taken at each study visit. Study investigators graded wrinkle severity, texture, and mottled pigmentation of the treated area at baseline and follow-up visit, 3 months after the fourth treatment. Subjects also rated clinical improvement of their neck and chest, along with overall appearance. Blinded evaluators used baseline and follow-up photographs to quantify improvements of rhytids and hyperpigmentation of the neck and chest using a 6-point improvement scale. RESULTS: Of the original cohort, 20 subjects completed all four treatments and 3-month follow-ups. The mean rhytid scores improved by 0.7 ± 1.0 for both neck and chest. Meanwhile, texture scores improved by 1.2 ± 0.4 for the neck and 1.4 ± 0.7 for the chest, with pigment scores improving by 0.5 ± 0.6 for the neck and 0.67 ± 0.7 for the chest. Statistical analysis using paired t-tests, performed on all pre- and posttreatment scores, revealed significant differences (p < 0.05) in wrinkle severity, skin texture, and pigmentation of the neck and chest posttreatment. The degree of improvement was consistent for both the neck and chest areas. Blinded evaluators graded clinical improvements in rhytids and pigmentation at 0.6 ± 1.0 and 0.8 ± 1.2 respectively, corresponding to mild improvement of both neck and chest. CONCLUSIONS: A series of treatments with the nonablative low-energy fractional 1440 and 1927-nm diode laser appears to be safe and effective for improving rhytids, skin texture, and hyperpigmentation of the neck and chest.

Prospective study to assess the efficacy and safety of a noninvasive electro-muscular stimulation for improvement of muscle strength and muscle toning of the extremities.

OBJECTIVE: We sought to evaluate the safety and efficacy of an electrical muscle stimulation (EMS) device in the improvement of muscle strength and toning of the upper extremities. This device, which is FDA-cleared as a two-channel muscle stimulator, provides up to eight electrodes with waveforms inducing muscle stimulation. Although a prior study demonstrated it is safe and effective for use in the abdomen, this system, which has electrodes specifically designed for the extremities, has not previously been evaluated in the upper extremities. METHODS: Forty-five subjects enrolled in the study to assess improvement in arm (i.e., bicep and tricep muscle) strength, and appearance following a protocol of treatments with this bioelectric muscle activation (BMA) device. All subjects received four 30-min EMS treatment sessions in Arm mode-twice weekly for 2 weeks and at least 48 h apart. Follow up visits were also scheduled 30- and 90-days after treatment. Strength was measured with a dynamometer device at baseline, at the final treatment session, and at the posttreatment 30- and 90-day assessment. Subject satisfaction was assessed gauging overall comfort of the treatment and satisfaction including willingness to recommend to others. The changes in strength between initial treatment and final treatment, as well as 30 and 90-day assessment were evaluated. Clinical photography at these visits was also assessed for each patient. Patients were instructed to not modify their normal exercise routine while participating in this study. RESULTS: All 45 subjects completed the treatment protocol. Most patients showed an improvement in muscle strength from the initial to final treatment (i.e., the fourth treatment). Specifically, the maximum bicep strength increased by a mean of 7.5 lbs (22.83%, p = 0.006), while the average increased by a mean of 8.2 lbs (25.76%, p = 0.001) during this period. Similarly, the maximum tricep strength from initial to final treatment increased by a mean of 10.0 lbs (23.16%, p = 0.000), while the average increased by a mean of 9.6 lbs (27.12%, p = 0.000). Thirty days after the last treatment, the maximum bicep strength increased by a mean of 13.3 lbs (34.13%, p = 0.001) while the average increased by a mean of 13.6 lbs (37.05%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 30 days postfinal treatment increased by a mean of 10.9 lbs (24.37%, p = 0.000), while the average increased by a mean of 10.5 lbs (29.37%, p = 0.000). Finally, 90 days after the last treatment, the maximum bicep strength increased by a mean of 19.4 lbs (48.4%, p = 0.000), while the average increased by a mean of 17.4 lbs (46.53%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 90 days postfinal treatment increased by a mean of 10.8 lbs (27.12%, p = 0.000), while the average increased by a mean of 10.0 lbs (30.94%, p = 0.001). CONCLUSION: This device was well tolerated and resulted in increased strength measurements in the upper extremities, as assessed by a dynamometer, which were sustained at 30 and 90 days.

Commonly used hair oils in the Black community: a narrative review in their use to treat androgenetic alopecia.

Alopecia, the loss of hair on the scalp and/or body, experienced by millions of people worldwide, can be a very debilitating condition. Specifically, androgenetic alopecia (AGA), commonly known as male or female pattern baldness, is the most common form of hair loss. In the African diaspora, oils have traditionally been used to promote hair growth and recently, the application of hair oils to the scalp for the treatment of alopecia has become increasingly popular. With the recent surge of hair oil usage in the Black community, more research is needed to determine the efficacy of hair oils, as most studies have primarily used mice subjects. This article reviews the existing literature to better understand the use of hair oils in the treatment of androgenetic alopecia. Specifically, we investigate the popular carrier oils, castor oil, and pumpkin oil as well as the essential oils, lavender, peppermint, rosemary, and tea tree oil.

Muscle Stimulation for Aesthetic Body Shaping: A Comprehensive and Critical Review.

BACKGROUND: Aesthetic muscle stimulation (AMS) using high-intensity electromagnetic field (HIFEM) targets skeletal muscle neurons, causing muscle hypertrophy and loss of adipose tissue, thereby cultivating a sculpted physique. Many studies have evaluated AMS for noninvasive body contouring; however, the efficacy, safety, and long-term data remain unclear. OBJECTIVE: To critically evaluate the current literature on the use of electromagnetic muscle stimulation for body contouring and provide a consensus on patient selection and long-term efficacy of AMS. MATERIALS AND METHODS: PubMed and Embase were searched using the terms: "HIFEM," "Electromagnetic therapy," and "muscle" or "Electrical stimulation muscle treatments" and "aesthetics." Studies involving the use of muscle stimulation for nonaesthetic/dermatologic, in vitro studies or studies involving animals were excluded. RESULTS: Twenty studies in total were included [9 moderate-quality, 8 low-quality, and 3 very low‒quality studies] based on the Grading of Recommendations, Assessment, Development, and Evaluation scale, representing 521 patients. Body sites evaluated included the abdomen (378 patients), buttock (156 patients), arms (22 patients), and calves (15 patients). CONCLUSION: Electromagnetic muscle stimulation represents an effective therapeutic intervention for abdominal contouring that yields increased muscle thickness, and reduced abdominal fat thickness, for up to 1 year after treatment. Larger, controlled studies are needed to determine the efficacy of electromagnetic muscle stimulation alone for contouring of buttocks, thighs, arms, and calves.

Treatment of facial and non-facial lentigines with a 730 nm picosecond titanium: Sapphire laser is safe and effective.

OBJECTIVE: A 730 nm picosecond-domain laser was developed to improve the clearance of pigmented lesion and reduce adverse events. This study assessed the safety and efficacy of this system for the clearance of lentigines and explores how the short picosecond pulses interact with tissue via histology. STUDY DESIGN AND METHODS: Twenty subjects with Fitzpatrick skin types II-IV were enrolled in this prospective, IRB-approved study. Four treatments were administered using a 730 nm picosecond-domain laser. Pre- and posttreatment photos were assessed by blinded reviewers at 4- and 12-week follow-up visits, using a 5-point clearance scale. Subject satisfaction was measured using a 5-point scale. Investigator Global Improvement Score (IGIS) was performed at the 4- and 12-week follow-up visits, using an 11-point clearance scale. Subject pain level was measured using an 11-point scale (no pain [0], extreme pain [10]). Histology of 730 and 532 nm picosecond pulses was compared with 755 and 532 nm nanosecond pulses. RESULTS: Sixteen subjects with a total of 118 discontinuous treatment areas, each comprised of 1-20 lesions, completed all study visits. Thirty body regions were studied, including arms (6), hands (16), scalp (1), forehead (2), face (3), and back (2). Spot sizes ranging from 2 to 5 mm diameters were used with fluences ranging from 0.8 to 4.0 J/cm2 . Mean pain score was 3.6 of 10 for all four treatments. Ninety-nine percent of randomly paired 4-week posttreatment images and 100% of 12-week posttreatment images were correctly identified from their respective baseline images by three blinded reviewers. Mean IGIS demonstrated scores of 6.7 and 7.0 at 4- and 12-week follow-up visits, respectively. At the 4- and 12-week follow-up visits, 76% and 73% of subjects, respectively, were satisfied to highly satisfied. The mean clearance score for all 118 treatment areas was 3 of 4 in follow-up visits. At 12-week follow-up, 36% of 118 treatment areas had a clearance score of 4, and 38% had a clearance score of 3. Post treatment, there was typical erythema, edema, dryness, crusting, and itching but negligible purpura, no pinpoint bleeding, blistering or scarring, and no significant hyperpigmentation or hypopigmentation. Histology showed diffuse, focal epidermal vacuolization ~5-10 µm in diameter and mild extravasation of erythrocytes with 730 nm picosecond pulses, while diffuse epidermal vacuolization was observed with coalescence of vacuoles (~20-100 µm), junctional clefting and mild extravasation of erythrocytes with 755 nm nanosecond pulses. Picosecond pulses of the wavelength of 532 nm produced diffuse, focal epidermal vacuolization and larger dermal vacuoles to depths of 500 µm, while 532 nm nanosecond pulses produced diffuse epidermal vacuolization with coalescence of vacuoles and marked dermal hemorrhage. CONCLUSION: This study demonstrated the potential of a new 730 nm picosecond-domain laser for the clearance of lentigines. The results showed good clearance with no adverse events and good subject satisfaction in patients with skin type II-III. Additional studies need to be conducted on darker skin types. The histopathologic findings demonstrate that the picosecond 730 nm laser produces excellent selectivity for pigment with minimal disruption of the dermal-epidermal junction and may therefore reduce healing times and the risk of adverse events.

The role of home monitoring in interstage management of infants following the Norwood procedure.

Although outcomes for infants with complex single ventricle heart defects have steadily improved in recent decades, there is still a significant risk for mortality and morbidity during the interstage period between stage 1 Norwood hospitalization discharge and stage 2 palliation. Home monitoring programs, which involve parental surveillance of daily weight and oxygen saturations during the interstage period, have been shown to significantly improve survival rates. This article describes the potential risk factors or causes of interstage mortality and reviews the role of home monitoring in early detection and potential prevention of adverse outcomes.