Clinical Implication of the Regional Thickness of the Lower Facial Skin, Superficial Fat, and Superficial Musculoaponeurotic System on High-Intensity Focused Ultrasound Treatment.

BACKGROUND: Knowledge of the topographic thickness of the skin and soft tissues is necessary when performing a high-intensity focused ultrasound (HIFU) procedure. Thermal tissue injury to the superficial musculoaponeurotic system (SMAS) or deeper can injure the facial nerve and its branches. OBJECTIVE: To demonstrate the topographic thickness of the lower facial skin, superficial fat, and SMAS. MATERIALS AND METHODS: The ultrasound data of 200 healthy patients who underwent lower facial rejuvenation were retrospectively reviewed. RESULTS: The mean age was 41.1 ± 13.7 years (range, 19-76 years). The jowl had thinner skin, thicker superficial fat, and deeper superficial and deep margins of the SMAS than the preauricle or lower cheek. The thickness of the superficial fat decreased with age, especially on the preauricle, lower cheek, and jowl. Women had thicker superficial fat than men on the preauricle and lower cheek. The superficial and deep margins of the SMAS were located more superficially in old and male patients with a slim facial figure than in young and female patients with a chubby facial figure. CONCLUSION: The present findings provide anatomical information regarding the superficial fat and SMAS, which is useful in determining the focal penetration depth of HIFU treatment for lower face rejuvenation.

The efficacy and safety of microneedle monopolar radiofrequency for the treatment of periorbital wrinkles.

BACKGROUND: Treatment of periorbital wrinkles is a challenging task because of its anatomical significance and delicate nature. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of a microneedle monopolar radiofrequency (RF) device for treating periorbital wrinkles. METHODS AND MATERIALS: This retrospective study involved 21 patients who were treated for periorbital wrinkles using a RF device. The type of microneedle used, clinical photography, VISIA wrinkle score, and adverse events were collected from the medical chart. Two independent dermatologists assessed the photographs. RESULTS: There were 18 female and 3 male patients with a mean age of 50.24 years. The severity of wrinkle was improved according to photographic assessment and VISIA wrinkle score at 6-month post-treatment. When 21 sites treated with a long microneedle (LMN, 1.5 mm) and the other 21 sites treated with a short microneedle (SMN, 0.8 mm) were compared, significant improvement in the VISIA wrinkle score was observed only in those treated with the LMN. No serious adverse events, including scarring and postinflammatory hyperpigmentation, occurred. CONCLUSIONS: We demonstrated the efficacy and safety of the microneedle monopolar RF device in treating periorbital wrinkles. The LMN was superior to the SMN in reducing VISIA wrinkle score.

Baumann Skin Type in the Korean Male Population.

BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy / Apneia obstrutiva do sono em mulheres na pós-menopausa: estudo comparativo usando endoscopia do sono induzido por fármaco

Abstract Introduction: The key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. Objective: The objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively. Methods: A total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n = 41) and post-menopausal patients (n = 37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI. Results: Upon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6 kg/m2 vs. 23.5 kg/m2; p = 0.019) tended to have a higher AHI and a lower lowest SaO2, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p = 0.001) and retrolingual levels (1.14 vs. 0.61; p = 0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p ≤ 0.0001, and lateral diameter, p = 0.042) in the lower BMI group (BMI < 25) and more concentric retropalatal collapse (lateral diameter, p = 0.017 and tonsillar obstruction, p = 0.003) in higher BMI group (BMI ≥ 25) than BMI and age matched male patients. Conclusion: Post-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

Resumo Introdução: A chave para o sucesso do tratamento da síndrome da apneia obstrutiva do sono (SAOS) é adaptar individualmente esse tratamento. Assim, é muito importante determinar a gravidade da SAOS, seu padrão e a medida do colapso, por sexo, idade e IMC. Objetivo: O objetivo do estudo foi compreender as características da apneia obstrutiva do sono em mulheres na pós-menopausa, comparando estas características entre mulheres na pós-menopausa e pré-menopausa, e homens, utilizando endoscopia do sono induzido por fármacos (DISE). Esperamos que o nosso estudo ajude a comunidade médica a diagnosticar e tratar a SAOS de maneira mais eficaz. Método: Foram recrutados 273 pacientes (195 do sexo masculino e 78 do feminino) com diagnóstico de SAOS. As pacientes do sexo feminino foram divididas em pacientes na pré-menopausa (n = 41) e na pós-menopausa (n = 37). O grupo de pacientes do sexo feminino na pós-menopausa foi pareada com um grupo de pacientes do sexo masculino com idade e Índice de Massa Corporal (IMC) semelhantes. Os achados da DISE foram comparados entre as pacientes do sexo feminino na pré-menopausa e as pacientes do sexo feminino pós-menopausa e também entre pacientes do sexo feminino na pós-menopausa e pacientes do sexo masculino pareados por idade e IMC. Resultados: Ao exame de PSG, as pacientes na pós-menopausa (que tinham um IMC significativamente maior do que as pacientes na pré-menopausa; 25,6 vs. 23,5 kg/m2; p = 0,019) tenderam a ter um IAH superior e uma saturação arterial de oxigênio (SaO2) mínima menor, mas as diferenças não atingiram significância estatística. Na análise do DISE, pacientes do sexo feminino pós-menopausa apresentaram valores mais elevados em todos os locais de obstrução, com um valor significativamente maior de diâmetro lateral dos níveis retropalatal (1,49 vs. 0,90; p = 0,001) e retrolingual (1,14 vs. 0,61; p = 0,003) em comparação com pacientes do sexo feminino na pré-menopausa. As pacientes do sexo feminino na pós-menopausa apresentaram colapso significativamente mais retrolingual (anteroposterior, AP, p ≤ 0,0001 e diâmetro lateral, p = 0,042) no grupo de IMC menor (IMC < 25) e colapso retropalatal mais concêntrico (diâmetro lateral, p = 0,017 e obstrução tonsilar, p = 0,003) no grupo de maior IMC (IMC ≥ 25) do que pacientes do sexo masculino pareados por IMC e idade. Conclusão: Com base nos achados do DISE, as pacientes do sexo feminino na pós-menopausa apresentaram um padrão diferente de obstrução das vias respiratórias em comparação com pacientes do sexo feminino na pré-menopausa e com os pacientes do sexo masculino pareados por idade e IMC.

Targeting of sebaceous glands to treat acne by micro-insulated needles with radio frequency in a rabbit ear model.

BACKGROUND AND OBJECTIVES: Many studies have investigated the application of micro-insulated needles with radio frequency (RF) to treat acne in humans; however, the use of a micro-insulated needle RF applicator has not yet been studied in an animal model. The purpose of this study was to evaluate the effectiveness of a micro-insulated needle RF applicator in a rabbit ear acne (REA) model. STUDY DESIGN/MATERIALS AND METHODS: In this study, we investigated the effect of selectively destroying the sebaceous glands using a micro-insulated needle RF applicator on the formation of comedones induced by application of 50% oleic acid and intradermal injection of P. acnes in the orifices of the external auditory canals of rabbits. The effects of the micro-insulated needle RF applicator treatment were evaluated using regular digital photography in addition to 3D Primos imaging evaluation, Skin Visio Meter microscopic photography, and histologic analyses. RESULTS: Use of the micro-insulated needle RF applicator resulted in successful selective destruction of the sebaceous glands and attenuated TNF-alpha release in an REA model. The mechanisms by which micro-insulated needles with RF using 1 MHz exerts its effects may involve inhibition of comedone formation, triggering of the wound healing process, and destruction of the sebaceous glands and papules. CONCLUSION: The use of micro-insulated needles with RF applicators provides a safe and effective method for improving the appearance of symptoms in an REA model. The current in vivo study confirms that the micro-insulated needle RF applicator is selectively destroying the sebaceous glands. Lasers Surg. Med. 49:395-401, 2017. © 2016 Wiley Periodicals, Inc.

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy.

INTRODUCTION: The key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. OBJECTIVE: The objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively. METHODS: A total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n=41) and post-menopausal patients (n=37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI. RESULTS: Upon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6kg/m2 vs. 23.5kg/m2; p=0.019) tended to have a higher AHI and a lower lowest SaO2, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p=0.001) and retrolingual levels (1.14 vs. 0.61; p=0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p≤0.0001, and lateral diameter, p=0.042) in the lower BMI group (BMI<25) and more concentric retropalatal collapse (lateral diameter, p=0.017 and tonsillar obstruction, p=0.003) in higher BMI group (BMI≥25) than BMI and age matched male patients. CONCLUSION: Post-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients.

OBJECTIVES: Atrophic post-acne scarring remains a therapeutically challenging condition despite various currently available technologies. Fractional photothermolysis (FP) is a novel concept of cutaneous resurfacing which induces non-contiguous microscopic thermal injury. The aim of this study is to evaluate the safety and efficacy of FP in the treatment of acne scars in Asian patients. METHODS: A total of 27 Korean patients (Fitzpatrick skin types IV or V) with moderate to severe facial acne scars received three to five sessions of FP treatment (Fraxel Laser; Reliant Technologies, CA, USA), each spaced 3-4 weeks apart. Standardized digital photographs were obtained before each treatment and 3 months after the final treatment. In addition, the patients' perceived degrees of improvement were assessed 3 months after the final treatment using a five-point grading scale. RESULTS: FP led to marked improvement in the appearance of acne scars at 3 months post-treatment. Patients' self-assessed degrees of improvement were as follows: excellent improvement in eight patients (30%), significant improvement in 16 patients (59%), and moderate improvement in three patients (11%). Adverse events were limited to transient pain, erythema and edema. CONCLUSIONS: The 1550-nm erbium-doped FP is associated with significant patient-reported improvement in the appearance of acne scars, with minimal downtime.