Practices in Pediatric Cosmetic Dermatologic Procedures: A National Survey.

BACKGROUND: Adult populations have traditionally been the primary recipients of cosmetic treatments, but a growing trend shows an increase in such procedures among pediatric patients. OBJECTIVE: The objective of the authors' study was to investigate types of procedures currently being performed by pediatric and cosmetic dermatologists and factors that may influence their choice of treatments in a pediatric population. METHODS: The authors conducted an anonymous online survey targeting healthcare practitioners who frequently use lasers for pediatric cutaneous conditions. The survey collected information on participants' primary scope of practice, pediatric cosmetic procedures they performed, counseling topics, and procedural details. RESULTS: Of 85 survey respondents, 73 (86.00%) completed all questions. Most respondents identified as pediatric dermatologists (77.65%), followed by general dermatologists (18.82%), cosmetic dermatologists (8.24%), and dermatologic/Mohs surgeons (1.18%). Top pediatric cosmetic conditions treated included hypertrophic/traumatic scars (95.29%), acne (89.41%), axillary and facial hyperhidrosis (77.65%), hypertrichosis/hirsutism (67.06%), and pigmented lesion removal (64.71%). Commonly performed procedures were vascular lasers (77.65%), laser hair removal (50.59%), and pigmented lasers (28.24%), among others. Respondents prioritized understanding risks/benefits, clinically indicated treatment, and the natural course of the condition. CONCLUSION: As the first multisociety, national survey, these results offer valuable insight into the current landscape of pediatric cosmetic treatments from the perspective of dermatologists.

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.

Evaluating Common Ingredients Contained in Dietary Acne Supplements: An Evidence-Based Review.

Objective: Acne vulgaris is a common skin condition treated with various medications targeting different aspects of its pathogenesis. Though increasing in popularity, the United States Food and Drug Administration (FDA) does not evaluate the safety or efficacy of dietary supplements marketed for the treatment of acne, calling into question the veracity of their labels. This review aimed to assess the safety and effectiveness of ingredients in popular acne supplements. Methods: A comprehensive review was conducted on 13 popular supplements marketed for acne, found through a Google search. Their ingredients, prices, ratings, and existing literature on efficacy and safety were analyzed. A literature review was performed regarding the most common ingredients contained in these supplements. Results: The most common ingredients in acne supplements were probiotics, diindolylmethane (DIM), vitamin A, vitamin B complex, and zinc. Despite the increasing popularity of dietary supplements, including those for skin health and acne, the absence of FDA regulation and evidence-based data raises concerns about their safety and efficacy. The safety of acne supplement ingredients raises significant worries, with reported cases of thrombotic events and adverse effects, even during pregnancy. The lack of standardized labeling and clear dosing information further complicates the understanding and potential risks of these supplements. Additionally, there is a potential for interactions with other medications, yet this information is often not provided on the product labels. Limitations: A Google search was used to identify popular acne supplements. Search engine algorithms determine the ranking and presentation of results based on various factors, such as popularity, keywords, as well as user preferences and location, thus posing a potential sampling bias. Conclusion: It is crucial to exercise caution and prioritize evidence-based information when counseling patients regarding the use of acne supplements.

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.

Degradation Therapy with Collagenase and Deoxycholate.

Deoxycholate (deoxycholic acid) and collagenase are naturally occurring substances whose ability to degrade adipose tissue and collagen respectively has given rise to a variety of therapeutic applications. This article will discuss the indications for the use of deoxycholic acid, primarily its well-established role in the non-surgical reduction of submental fat, with a focus on patient assessment, procedural technique, risks, pitfalls, and key clinical tips. It will also review the indications for collagenase as a degradation therapy, its mechanism of action, and benefits in the management of wound healing, scarring, and adipose tissue modification.

Introduction and overview of radiofrequency treatments in aesthetic dermatology.

In this introductory article to this special supplement in radiofrequency (RF), we aim to summarize the scientific foundation of RF therapy and its role in aesthetic dermatology. Monopolar, bipolar, and multipolar RF systems are described in detail, along with the different delivery methods such as stamping, dynamic or continuous movement, fractional, fractionated (FR) needling, and non-contact devices as well as the minimally invasive platforms that use subdermal probes. The characteristics of different tissues and the technical parameters that influence the effect of RF therapy, such as the penetration of energy, are summarized. This article expands on the various treatment applications for these devices and the mechanism of action behind skin and adipose tissue remodeling, and also discussed are safety concerns, treatment endpoints, and specific considerations when using RF therapy to provide effective treatment outcomes with reduced patient downtime.

A Randomized Trial to Assess Effectiveness and Safety of a Hyaluronic Acid Filler for Chin Augmentation and Correction of Chin Retrusion.

BACKGROUND: The chin is important for facial appearance, affecting overall balance and harmony of the face. The purpose of this study was to evaluate effectiveness of the hyaluronic acid filler Restylane Defyne for chin augmentation and correction of chin retrusion versus a no-treatment control. METHODS: Male and female subjects, aged 22 years or older, with mild to moderate chin retrusion, were randomized 3:1 to the hyaluronic acid filler Restylane Defyne ( n = 107) or no treatment ( n = 33). Assessments included live, blinded evaluations on a validated chin retrusion scale (Galderma Chin Retrusion Scale), aesthetic improvement (Global Aesthetic Improvement Scale), subject-reported FACE-Q Satisfaction with Chin, and safety follow-up. RESULTS: Galderma Chin Retrusion Scale responder rate (≥1 grade improvement) was higher for the hyaluronic acid filler Restylane Defyne (81 percent) than for control (6 percent) ( p < 0.001) at week 12, and remained higher at week 48 (74 percent versus 11 percent; p < 0.001). Aesthetic improvement rates were high throughout the study as reported by investigators (≥96 percent) and subjects (≥85 percent). Subject satisfaction was higher in the hyaluronic acid filler Restylane Defyne group than in the control group at week 12 ( p < 0.001). In the individual FACE-Q scale items, 87 to 98 percent of subjects were satisfied at week 12. Treatment-related adverse events were mild to moderate. CONCLUSIONS: The hyaluronic acid filler Restylane Defyne was safe and effective for augmentation of the chin region to improve the chin profile and associated with high aesthetic improvement and subject satisfaction. Effectiveness was sustained throughout 48 weeks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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.

A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring.

Background: The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. Methods: This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale. Results: A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C-43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1- and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of -3.2 cm3 (STD ±1.2 cm3) per side for the cheek applicator and -4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction. Conclusions: This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.

1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations.

BACKGROUND: The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength. OBJECTIVE: To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system. MATERIALS AND METHODS: Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system. RESULTS: For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled. CONCLUSION: The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.

The effect of a dual-wavelength 532 nm and 1064 nm picosecond-domain laser with a fractionated holographic optic on photoaging and patient age perception: A pilot study.

INTRODUCTION: This study evaluated the efficacy of a dual-wavelength 532 nm/1064 nm Nd:YAG picosecond-domain laser with a holographic lens array in treating facial photoaging. METHODS: Thirteen subjects were enrolled with 10 completing the study. Receiving three-month treatments, subjects underwent full-face spot treatment of facial lentigines with the 532-nm non-fractionated handpiece, followed by two sequential facial passes of the 1064-nm and the 532-nm fractionated handpieces. Improvement was measured by treating physician evaluation of pigmentation and rhytids as well as blinded reviewer evaluation of pre- and post-treatment image sets taken 12 weeks after the final treatment. Participants completed treatment surveys to assess satisfaction. RESULTS: Physician grading on a 5-point scale revealed an average improvement of 1.6 in pigmentation (p = 0.0042) and 0.9 in rhytids (p = 0.0196). Blinded physicians appropriately selected baseline images in 44 of 50 (88%) image sets (10 subjects; five reviewers). On an 11-point scale for overall facial photoaging (0 = no change, 1 = 10% improvement, 2 = 20% improvement, etc.) treating physicians scored mean improvement as 3.3 ± 1.83 (95% CI 1.99 to 4.61; range 1-6), while blinded reviewers scored mean improvement as 2.32 ± 2.62 (range % -4 to 8, 95% CI 1.57 to 3.07). The greatest majority (80%) of participants reported satisfaction with the treatment. Adverse events were mild; however, one patient developed hyperpigmentation, consistent with melasma that was successfully treated with topical agents. CONCLUSION: This is the first study to show that picosecond-domain 532 nm/1064 nm laser treatments with combination non-fractionated and fractionated handpieces are well-tolerated, safe, and effective for the treatment of photodamage.

Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations.

BACKGROUND: Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users. METHODS: An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use. RESULTS: The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient. CONCLUSIONS: This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181.

A Randomized, Comparator-Controlled Study of HARC for Cheek Augmentation and Correction of Midface Contour Deficiencies.

BACKGROUND: HARC is a soft and flexible hyaluronic acid filler containing lidocaine, manufactured using XpresHAn® technology, restoring natural-looking volume and soft contours. OBJECTIVES: To evaluate safety and effectiveness of HARC for cheek augmentation and correction of midface contour deficiencies compared to a control product HAJV (hereafter referred to as Control). Primary objective was to demonstrate non-inferiority of HARC compared to the Control, by blinded evaluation of change from baseline in midface fullness 12 weeks after last injection, using a 4 grade midface volume scale (MMVS). MATERIALS AND METHODS: Subjects over the age of 21 with loss of fullness in the midface area (MMVS score 2, 3, or 4) were randomized 2:1 to treatment with HARC(n=142) or Control (n=68). Optional touch-up was allowed after 4 weeks. Study assessments included MMVS, aesthetic improvement, subject satisfaction, and safety. Subjects were followed for 48 weeks. RESULTS: Overall, most subjects were female (89%) and mean age was 53 years (range 24-80). Total mean volume injected was 4.3 mL for HARC and 4.9 mL for Control. Primary objective was met; mean change from baseline in MMVS score at week 12: -1.4 (HARC), -1.3 (Control), 95% CI: -0.22, 0.06. HARC effectiveness was supported by a high degree of aesthetic improvement and subject satisfaction throughout 48 weeks. Related adverse events were generally mild and transient. CONCLUSIONS:  HARC was well tolerated and non-inferior to Control for correction of midface fullness at 12 weeks after last injection. Aesthetic improvement and subject satisfaction were high and lasted through week 48.  J Drugs Dermatol. 2021;20(9):949-956. doi:10.36849/JDD.6191.

What Women Want: Women's Perspectives on Male Cosmetic Procedures.

BACKGROUND: The rate of growth for male cosmetic treatments has slowed in the past 5 years. There is limited data on why men may not seek cosmetic treatments. OBJECTIVE: To evaluate women's perspectives on male cosmetic treatments. METHODS: Heterosexual female patients (single (n = 64); in a relationship/married (IR/M) (n = 136)) completed an online survey. RESULTS: 87.5% of single and 36.03% of IR/M women reported that men are bothered by signs of aging (p < .0001). However, both single and IR/M women reported that men are interested in (single: 77.78%, IR/M: 65.44%) and will benefit (single: 93.55%, IR/M: 67.31%) from cosmetic procedures. Both groups of women (single: 93.75%, IR/M: 83.82%, p < .0530) indicated, however, that men are reluctant to seek cosmetic treatments. Societal stigma/perception of masculinity was the number one cited reason (single: 87.1.75%, IR/M: 73.02%, p < .0264). However, 87.5% of single and 94.86% of IR/M women (p = .0659) reported that male cosmetic treatments will not affect their perceptions of masculinity. Furthermore, 95% of women (single: 95.31%, IR/M: 95.59%, p = .9292) reported that they will support their partners from pursuing cosmetic treatments. CONCLUSION: Women strongly believe that men can benefit from cosmetic treatments, do not believe cosmetic treatments affect masculinity, and are overwhelmingly supportive of male cosmetic treatments.

Radiofrequency Microneedling: A Comprehensive and Critical Review.

BACKGROUND: Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear. OBJECTIVE: To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in. MATERIALS AND METHODS: A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded. RESULTS: Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia. CONCLUSION: Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.

Efficacy and Tolerability of a Procedure Enhancement System with TriHex Technology®as a Pre- and Post-Radiofrequency Microneedling Regimen.

Postoperative recovery is an important consideration for patients planning dermal rejuvenation procedures. A topical procedure enhancement system (PES) containing a tripeptide and hexapeptide (TriHex Technology®; Alastin Skincare®, Carlsbad, CA) hastens recovery from facial rejuvenation procedures, such as laser resurfacing. We assessed the efficacy and tolerability of the PES compared to a standard-of-care antioxidant regimen for improving recovery following three monthly facial radiofrequency (RF) microneedling treatments. Assessments included grading pre- and posttreatment digital images by two blinded physicians and a subject satisfaction questionnaire. Digital images revealed significantly less post-RF erythema following the introduction of the PES in a crossover study. Similarly, the side treated with the PES in a split-face study demonstrated significantly less post-RF erythema than the antioxidant regimen. Participants expressed preference for the PES. Expected adverse effects included immediate, posttreatment erythema, edema, and burning/stinging. Other adverse effects included acneiform eruptions in patients treated with the antioxidant regimen (n = 2) and the PES regimen (n = 1) and mild dermatitis in another PES-treated patient. A topical PES containing a tripeptide and hexapeptide appears to be a safer and effective regimen for reducing posttreatment erythema and accelerates recovery following RF microneedling.