Midface 3D restoration with an innovative high G' filler.

BACKGROUND: In the evaluation of the facial aging, the midface certainly represents the part that undergoes the most modifications and in which the aging process is most evident. The filling and redefinition of this part are fundamental to modify the perception of the age of the face and create a global rejuvenation effect. In general, high G' fillers with a deep implant are used to treat the midface, taking advantage of the high lifting capacity and persistence of the implant in place. METHODS: We report our experience in the treatment of 20 patients with a hyaluronic acid (HA) filler based on an innovative crosslinking technology (XTR™-eXcellent Tridimensional Reticulation) for midface treatment. GAIS (Global Aesthetic Improvement Scale) at 1 month and 3 months after treatment was evaluated as primary endpoint. Patient satisfaction with the overall appearance, repeatability of treatment, and also an instrumental evaluation of the improvement were performed. RESULTS: Global Aesthetic Improvement Scale and patient satisfaction were very good 1 month and 3 months after treatment. The majority of patients said they would undergo treatment again. Clinical results were confirmed by instrumental evaluation. CONCLUSION: The treatment of midface with this innovative HA high G' filler is really effective in restoration of the volumes and in reshaping the curves of zygomatic area.

Open-Label, Post-Marketing Study to Evaluate the Performance and Safety of Calcium Hydroxylapatite With Integral Lidocaine to Correct Facial Volume Loss

Background: Calcium hydroxylapatite (CaHA, Radiesse®) with integral 0.3% lidocaine (CaHA(+)) has recently been approved for use in aesthetic medicine. This study assessed the performance of CaHA(+) in subjects undergoing treatment for facial volume loss and evaluated subject and physician satisfaction. Methods: In a prospective, open-label, post-marketing study, 25 women seeking treatment for age-related facial volume loss received CaHA(+) injections in 1­3 facial areas including the cheeks, marionette lines, prejowl sulcus, and jawline. Subjects returned for follow-up at 14 and 120 days, with the option of touch-up injections at day 14 if required to achieve optimal correction. Filler performance was assessed using the Merz Aesthetics Scales (MAS) and subject satisfaction using the Global Impression of Change Scale (GICS). Physician satisfaction was assessed in terms of CaHA(+)-related properties (eg, ease of injection, distribution, positioning) and aesthetic outcomes. Adverse events were recorded. Results: Mean MAS scores at baseline were ~2 corresponding to moderate facial volume loss/sagging in the treated area. At day 14, the mean score had improved to ≤1.4 for all treated areas, indicating mild volume loss. At day 120, mean scores had further improved to ≤1.1. At both follow-up visits, mean GICS scores were ≥2 indicating facial appearance was 'much improved' compared with baseline. All subjects reported willingness to repeat treatment and recommend it to family/friends. Physician ratings were high for ease of CaHA(+) injection, distribution, positioning, sculpturing outcome, and effect on skin tension. Compared to CaHA without lidocaine, the physician rated CaHA(+) as better or similar in performance. Adverse events were mostly mild and expected with CaHA and filler injections in general. Conclusion: The well-established efficacy and safety profile of CaHA appears unchanged by the addition of integral lidocaine. CaHA(+) was effective for volume enhancement in a number of facial areas and associated with high subject and physician satisfaction. J Drugs Dermatol. 2019;18(1):86-91.

Treatment of Lateral Periorbital Lines with Different Dilutions of IncobotulinumtoxinA.

BACKGROUND: IncobotulinumtoxinA is a botulinum neurotoxin type A that is free from complexing proteins and is used in various therapeutic indications and aesthetic medicine. It is approved for the treatment of glabellar frown lines in the United States. In Europe, it is also approved for the treatment of lateral periorbital lines (crow's feet) and for the combined treatment of upper facial lines, including glabellar frown lines, crow's feet, and horizontal forehead lines. METHODS: In the present study, incobotulinumtoxinA was injected at two different dilutions to treat female subjects aged 40 to 50 years who had moderate-to-severe lateral periorbital lines at maximum contraction according to a score of 2 or 3 points on the 5-point Merz Aesthetics Scales (MAS). For Group 1 (n=20), 50U of incobotulinumtoxinA were reconstituted with 1.60mL of 0.9% NaCI, and for Group 2 (n=20), a reconstitution volume of 0.55mL was used. RESULTS: Merz Aesthetics Scales scores were markedly improved by at least one point in both groups at one month and three months. The mean Merz Aesthetics Scales scores at one month were 0.4 and 0.6 points for Group 1 and Group 2, respectively, corresponding to a mean improvement of 2.0 and 1.8 points compared with baseline, respectively. CONCLUSION: No significant differences in efficacy and tolerability of incobotulinumtoxinA were seen between the two dilutions at any time point.

Calcium Hydroxylapatite for Augmentation of Face and Hands: A Retrospective Analysis in Italian Subjects.

To assess the use and safety of calcium hydroxylapatite for volume restoration of the face and hands in clinical practice, subjects from four Italian aesthetic clinics who had received calcium hydroxylapatite augmentation treatment between January 2012 and December 2013 were recruited. Records were retrospectively reviewed for demographic characteristics, number of treatments, area treated, injection depth and volume, method of administration, and adverse events. A total of 1,783 treatments were administered to 800 subjects (female: 93.5%; mean age: 49.6 years). Overall, 620 (77.5%) subjects were treated over two sessions for a particular indication, and 243 (30.3%) treated over three sessions. The most frequently treated areas were the zygomatic area (men: 30.2%; women: 30.6% of all treatments), malar area (24.5% and 24.3%), and marionette lines (18.9% and 11.6%). A cannula was used for most treatments (86.7%). Injection volume ranged from 0.4 mL to 1.5 mL. Injection-site swelling and bruising occurred with 18.2% and 11.3% of treatments, respectively. Most cases resolved within one week and two weeks, respectively. No serious/unexpected adverse events occurred. In clinical practice, calcium hydroxylapatite is a versatile, well-tolerated treatment for filling folds and volume restoration of the face and hands.

Non-sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: preliminary clinical report.

This study evaluates results, adverse side effects and downtime of the protocol 'ActiveFX' for photodamaged facial skin. A non-sequential fractional ultrapulsed CO2 laser with specific settings is used in addition to a new computer pattern generator (CPG). From September 2006 to March 2007, 55 patients underwent this new 'soft' single-session, single-pass and full-face ablative fractional treatment. The patients were evaluated at baseline and 1 and 3 months after the treatment using a five-point scale. Seven aspects of photodamaged skin were recorded: global score, fine lines, mottled pigmentation, sallow complexion, tactile roughness, coarse wrinkles and telangiectasias. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Eight patients received a double-pass treatment on the crow's feet regions and the improvement of the coarse wrinkles was analyzed with a quartile grading scale. Significant differences (p<0.05) between baseline and 1 and 3 months post-treatment were observed for all features except telangiectasias. Coarse wrinkles presented a good improvement only in the regions submitted to a double-pass. Minimal and isolated adverse side effects were noted and the downtime was very low. Non-sequential fractional ultrapulsed CO2 light treatment ('ActiveFX') can be considered an excellent alternative for photodamaged facial skin.

Intense pulsed light treatment of 1,000 consecutive patients with facial vascular marks.

BACKGROUND: Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. METHODS: Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1-9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. RESULTS: Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. CONCLUSION: The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.

Facial teleangectasias: our experience in treatment with IPL.

BACKGROUND AND OBJECTIVES: Facial teleangectasias can be a relevant cosmetic problem, which the patient usually hides with a thick layer of makeup. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. METHODS: Five hundred eighteen consecutive patients were treated with Photoderm VL (Lumenis Ltd.). The average age of patients of various skin types (Fitzpatrick I to IV) was 48.5 years. They were subjected to a mean of 1.69 treatments (range 1-9) followed up 48 hours, 72 hours, 1 week, 3 weeks, and 1 month after each treatment. All patients were followed up after 2 months from the last treatment and the percentage of clearance was assessed by comparing pre- and post-treatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The physicians evaluation was also recorded on the same form. RESULTS: Patients (87.64%) presented a clearance of 75%-100%. The results appear not correlated with lesions size, age, skin type but with operator experience. Minimal side adverse effects occurred in 20% of the patients. CONCLUSION: The IPL source, Photoderm VL, can be considered an alternative or a supplement to the existing laser devices for facial teleangectasias treatment.