The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types.

BACKGROUND: The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery. OBJECTIVE: To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III-V. METHODS: Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment. RESULTS: Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator-assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted. CONCLUSION: The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III-V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.

Histologic and Clinical Changes in Vulvovaginal Tissue After Treatment With a Transcutaneous Temperature-Controlled Radiofrequency Device.

BACKGROUND: Although transcutaneous temperature-controlled radiofrequency (TTCRF) may effectively treat vulvovaginal laxity (VVL), atrophic vaginitis (AV), orgasmic dysfunction (OD), and stress urinary incontinence (SUI), there is a lack of histopathologic evidence to validate its use. OBJECTIVE: Evaluate clinical and histological changes induced by vulvovaginal TTCRF. MATERIALS AND METHODS: This was a prospective, nonrandomized trial. Ten female subjects with mild-to-moderate VVL, with or without AV, OD, and/or SUI underwent 3 TTCRFs at 4-week intervals. Five subjects underwent pre- and post-treatment biopsies of the labia majora and vaginal canal for histology. Assessments were performed at baseline and Days 10, 30, 60, and 120. RESULTS: Investigator-rated VVL improved significantly from baseline to Day 10, with improvement maintained through Day 120 (p = .001 and .001, respectively). Sexual satisfaction improved significantly by Day 60 (p = .001). Improvement in AV reached significance at Day 120 (p = .048). Although OD and SUI improved steadily, the difference in improvement did not reach statistical significance. Histology revealed that post-treatment increases in collagen, elastin, vascularity, and small nerve fibers. CONCLUSION: Transcutaneous temperature-controlled RF resulted in significant improvements in AV, VVL, and sexual satisfaction with milder improvements in OD and SUI. Post-treatment histology demonstrated neocollagenesis, neoelastogenesis, neoangiogenesis, and the first reported finding of TTCRF-related neurogenesis.

A Single Center, Prospective, Randomized, Sham-Controlled, Double-Blinded, Split-Face Trial Using Microinjections of Transparent Hyaluronic Acid Gel for Cheek Rejuvenation.

BACKGROUND: "Skin boosting" with injections of hyaluronic acid has been demonstrated to improve aged skin. OBJECTIVE: The aim of this study was to determine the efficacy and safety of small-particle hyaluronic acid with lidocaine (SP-HAL) microaliquots for the correction of fine lines of the cheeks. MATERIALS AND METHODS: Twenty subjects with mild to moderate static mid to lower cheek rhytides were enrolled. The right or left cheek was randomized to receive 1 mL of SP-HAL using a microdroplet technique, with the contralateral cheek treated with sham injection of sterile normal saline. The degree of cheek wrinkling and elastosis based on the Fitzpatrick-Goldman Wrinkle and Elastosis Scale was assessed at baseline and 7, 14, 30, 90, and 180 days after treatment. Subjects rated their satisfaction at days 90 and 180. RESULTS: Fourteen patients completed the study. There were no statistically significant improvements in wrinkling or elastosis of the SP-HAL-treated cheek or control cheek at any time point. In addition, there were no significant differences in wrinkling, elastosis, or patient satisfaction between the treatment cheek and control cheek. CONCLUSION: One treatment of intradermal microdroplet injections of SP-HAL to the mid to lower cheek failed to show superiority over normal saline in improving clinical signs of skin wrinkling and elastosis.

Role of Nonsurgical Chin Augmentation in Full Face Rejuvenation: A Review and Our Experience.

BACKGROUND: The chin is a critical component to the perception of facial attractiveness. Dermal fillers offer a nonsurgical, temporary method of correcting mild to moderate chin retrusion and resorption. Thus far, discussion of this procedure has been largely limited to the plastic surgery and otolaryngology literature. OBJECTIVE: To review pertinent aspects of anatomy, patient evaluation, injection technique, concomitant therapies, and complications in chin augmentation using injectable fillers. METHODS: A brief review of the literature surrounding chin augmentation using injectable fillers, as well as the authors' experience in this area, is provided. RESULTS: Chin augmentation using injectable fillers can be performed effectively and safely with adequate background knowledge of the regional anatomy and appropriate patient selection. The authors discuss both injection techniques in the published literature and their own approach. Potential complications and concomitant therapies are also reviewed. CONCLUSION: As chin augmentation is increasingly recognized as an essential component to complete facial aesthetic rejuvenation, dermatologic surgeons should be familiar with how to safely and effectively perform augmentation with injectable fillers to achieve an optimal cosmetic outcome.

A split-body study evaluating the efficacy of a conformable surface cryolipolysis applicator for the treatment of male pseudogynecomastia.

BACKGROUND: Cryolipolysis is a non-invasive method of body shaping that has been used for male pseudogynecomastia. However, traditional vacuum suction cryolipolysis requires a minimum pinchable fat layer which may not always be present in this area. OBJECTIVE: To evaluate the efficacy and safety of a conformable surface cryolipolysis applicator for the reduction of male pseudogynecomastia. MATERIALS AND METHODS: Ten male subjects with pseudogynecomastia received two cycles of cryolipolysis to the breast 6 weeks apart. Ultrasound was used to measure the thickness of adipose tissue. RESULTS: Seven of 10 patients completed the study. Compared to baseline, the mean ± SD change in adipose tissue thickness was 8.12 ± 6.94 mm for the treated versus 1.03 ± 6.03 mm for the control breast at week 6 (p = 0.014), and 8.71 ± 7.04 mm for the treated vs. 2.66 ± 7.04 mm for the control breast at week 12 (P = 0.16). Four (4) of seven (57%) patients were at least slightly satisfied with the treated breast, and although subject satisfaction was higher in the treated breast, this did not reach significance (0.085). Adverse events were mild and transient. CONCLUSION: A conformable surface cryolipolysis applicator was effective in reducing the mean adipose tissue thickness in subjects with male pseudogynecomastia. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Prospective studies of the efficacy and safety of the picosecond 755, 1,064, and 532 nm lasers for the treatment of infraorbital dark circles.

BACKGROUND: Infraorbital dark circles result from a combination of factors. The fractionated picosecond 755 nm alexandrite laser and dual wavelength picosecond Nd:YAG laser have not been examined as a method of addressing infraorbital hyperpigmentation. OBJECTIVE: To determine the efficacy and safety of treatment of infraorbital dark circles using fractionated picosecond 755 nm and dual wavelength picosecond Nd:YAG laser. METHODS AND MATERIALS: These trials did not utilize a comparative design; rather, these were separate, prospective, open-label, evaluator-blinded trials utilizing two treatment regimens: (i) 19 adult subjects were treated in a single session with the dual wavelengths of 532 nm and 1,064 nm in consecutive passes using the fractionated lens; (ii) 10 adult subjects were treated using the picosecond 755 nm laser via the fractionated lens in three treatment sessions at 3 week intervals. Subjects in both studies were followed-up for blinded-investigator assessment of infraorbital hyperpigmentation, adverse events, and improvement compared to baseline. RESULTS: The dual wavelength picosecond Nd:YAG laser, blinded-investigator assessment did not demonstrate a significant improvement in infraorbital hyperpigmentation at day 60 (P = 0.16). The picosecond 755 nm alexandrite laser significantly improved infraorbital hyperpigmentation by day 42, with improvement maintained through day 132 (P = 0.07 and 0.00001, respectively). Adverse events were mild and temporary. CONCLUSION: A single treatment with the fractionated picosecond 1,064/532 nm lasers did not produce a significant improvement in infraorbital hyperpigmentation. A series of three treatments with the fractionated picosecond 755 nm laser resulted in significant improvement in hyperpigmentation. Lasers Surg. Med. 50:45-50, 2018. © 2017 Wiley Periodicals, Inc.

Skin tightening-does it really exist?

Skin tightening is one of the cornerstones of skin rejuvenation and is defined as the improvement of skin laxity and crepiness of the skin. There are several energy-based devices that can produce significant skin tightening without surgery, both on and off the face. The mechanisms of skin tightening involve collagen denaturation resulting in collagen shrinkage and tissue tightening, and the wound healing response that generates new collagen and elastin. These hypothesized mechanisms of skin contraction leading to clinical skin tightening have been derived from histological, immunohistochemical, and electron microscope analysis, as well as in vitro and in vivo experiments. This review is aimed at evaluating and analyzing the literature on the proposed mechanisms for skin tightening by minimally invasive energy-based technologies.

A Randomized, Investigator-Blinded Comparison of Two Topical Regimens in Fitzpatrick Skin Types III-VI With Moderate to Severe Facial Hyperpigmentation.

Purpose: Though hydroquinone (HQ) remains the gold standard for treatment of hyperpigmentation, concerns about its safety have prompted the development of HQ-free topical skin lightening systems. OBJECTIVE: To compare the efficacy and tolerability of a new HQ-free system and a popular HQ-based system for the improvement of facial hyperpigmentation and photoaging in darker skin types. METHODS: This investigator-blinded trial randomized 30 subjects of Fitzpatrick skin types III to VI with moderate to severe hyperpigmentation to a new 7-product HQ-free system or a 7-product HQ-based system for 12 weeks. At 4, 8, and 12 week follow-up visits, a blinded investigator assessed efficacy and tolerability using standardized scales. Subjects also performed a self-assessment at each visit. SUMMARY: Both the HQ-free and HQ-based systems produced significant improvements in Overall Hyperpigmentation that were sustained through week 12 (P=0.008, 0.0003). The HQ-based system demonstrated better improvement in overall hyperpigmentation at weeks 4, 8, 12 (P=0.01, 0.001, 0.003, respectively). Mottled Pigmentation Area Severity Index (MoPASI) scores improved with both systems (P=0.02, 0.01), with no statistically significant differences between the two treatment groups. Subject-rated hyperpigmentation was not different between groups. Subjects reported significantly more discomfort with the HQ-free system at week 8 (P=0.02); otherwise, measures of irritation were the same between groups. All irritation was described as mild to moderate. At week 12, 100% of subjects in the HQ-free group and 92.3% of subjects in the HQ-based group were satisfied with their outcome. CONCLUSION: Both a new HQ-free skincare system and a widely-available HQ-based system improved hyperpigmentation in Fitzpatrick skin types III to VI. Though the HQ-based system produced greater improvement in hyperpigmentation when compared to the HQ-free system, there was no difference in MoPASI scores between the treatment groups. Subjects were satisfied with both treatments and reported only mild to moderate irritation using either system.

J Drugs Dermatol. 2017;16(11):1127-1132.

A randomized, double-blind, placebo-controlled clinical trial evaluating the role of systemic antihistamine therapy for the reduction of adverse effects associated with topical 5-aminolevulinic acid photodynamic therapy.

BACKGROUND AND OBJECTIVE: Following photodynamic therapy with 5-aminolevulinic acid (ALA-PDT), patients experience inflammation that may be partially attributable to H1 histamine receptor activation. The objective of this study was to evaluate the impact of antihistamines upon adverse effects following ALA-PDT. STUDY DESIGN/MATERIALS AND METHODS: This was a randomized, placebo-controlled clinical trial conducted at a single study site. Twenty subjects with facial actinic keratoses were randomized to ALA-PDT plus cetirizine 10 mg (n = 10) versus placebo daily (n = 10) from 3 days pre-treatment to 3 days post-treatment for a total of 7 days. Signs of inflammation including erythema, edema, crusting, exudation, vesiculation, and erosion were evaluated on post-treatment days 1, 2, 3, 7, 30, 90, and 180. Actinic keratosis counts, investigator-rated Global Assessment Improvement Score (GAIS), healing, tolerability, and subject satisfaction were also assessed. RESULTS: Erythema, edema, crusting, exudation, vesiculation, and erosion were not different between treatment groups. Actinic keratoses were significantly reduced by day 30 in both the antihistamine and placebo groups (P = 0.01 and 0.0009, respectively), with results sustained to day 60 in the antihistamine group and day 180 for the placebo group. However, counts were not different between groups at any time point. Investigator-rated GAIS, subject satisfaction, healing, and tolerability were similar between treatment groups. CONCLUSION: This study suggests that while H1 antihistamines do not impair the efficacy of ALA-PDT, they also do not relieve post-treatment inflammation and discomfort. Lasers Surg. Med. 49:738-742, 2017. © 2017 Wiley Periodicals, Inc.

A randomized, single-blinded trial of a tripeptide/hexapeptide healing regimen following laser resurfacing of the face.

BACKGROUND: A topical healing system containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™) has been found to stimulate neoelastogenesis and neocollagenesis. OBJECTIVE: Evaluate the use of the tripeptide/hexapeptide topical system following fractionated CO2 laser resurfacing compared to a bland ointment and cream. PATIENTS/METHODS: In this single-blinded, randomized study, 15 female subjects aged 45-70 years underwent laser resurfacing of the face. Subjects were randomized to use of the tripeptide/hexapeptide system (n=10) or a bland dimethicone-based ointment and petrolatum-based cream (n=5) from 3 weeks pre- until 12 weeks postprocedure. A blinded investigator graded erythema, edema, crusting, exudation, and healing on postprocedure days 1, 3, 4, 7, 28, and 84. A photodamage/wrinkle scale was completed on days 28 and 84. Subjects performed symptomatology grading on days 1 through 14 and completed self-assessments at days 28 and 84. RESULTS: Data from 14 subjects were analyzed. Blinded-investigator-rated healing was better for the tripeptide/hexapeptide system, reaching statistical significance at day 7. The tripeptide/hexapeptide group demonstrated less erythema and exudation during the first postprocedure week, reaching significance at day 3. On days 1 through 14, subjects using the tripeptide/hexapeptide system reported less tenderness and burning/stinging, also reaching significance on day 3. At day 84, subjects using the tripeptide/hexapeptide system reported higher satisfaction and were more likely to recommend the treatment to others. CONCLUSION: Postresurfacing use of a tripeptide/hexapeptide system proved effective and well-tolerated. Subject satisfaction was greater among those using this system, which may indicate an improved patient experience following laser resurfacing.