A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

BACKGROUND: The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES: To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS: To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS: Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION: The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin.

INTRODUCTION: Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES: To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS: Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS: Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS: The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.

Buttocks' Skin Laxity Severity Scale.

BACKGROUND: Clinical scales are useful to assess skin laxity in different areas of the body. OBJECTIVE: To elaborate and validate a photonumeric scale to assess buttocks skin laxity. MATERIALS AND METHODS: The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. RESULTS: The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). CONCLUSION: Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Considerations on zero-degree cellulite.

Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.

L-Lift Technique Using Poly-l-Lactic Acid: A Pilot Study.

BACKGROUND: Minimally invasive procedures that prevent and delay the aging process can be an alternative to more invasive surgical procedures. OBJECTIVE: To assess the efficacy and safety of L-Lift technique to improve skin firmness, facial global aesthetics, and the patient and investigator satisfaction. METHODS: Prospective, open, single-center study. Thirty participants underwent 3 treatment sessions 1 month apart and were assessed 8, 16, and 24 weeks after first injections. Assessments included the Facial Laxity Rating Scale (FLRS), Global Aesthetic Improvement Scale (GAIS), objective measurement of skin elasticity, and the Skin Distension Test. RESULTS: At Week 24, 60% of the patients had at least 1-class improvement in the FLRS for the middle face and 33% for the lower face. At Week 24, investigators considered that 90.0% of the patients improved according to the GAIS and 90.0% of the subjects considered they have improved. Skin elasticity (at Week 8 and at Week 16) and Skin Distension Test (at Week 24) assessments indicated improvement in skin firmness. Both patients and investigators were satisfied with the treatment at the study end. CONCLUSION: The technique is safe and efficacious. It may be particularly suitable for patients presenting initial signs of facial skin laxity.