Effects of Exosome-Containing Skin Booster and Microneedling Treatment on Facial Aging: A Retrospective Analysis of 40 Cases.

Practical application of the facial fat compartments and the line of ligaments concept in achieving the lifting effect in the lower face region in female patients.

A variety of techniques and energy-based technologies are currently utilized for the treatment of facial wrinkles. Fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light have both been reported to be safe and effective for the non-invasive treatment of wrinkles and overall facial rejuvenation. A multicenter, prospective clinical trial evaluated a protocol of treatment with a device incorporating bipolar radiofrequency and infrared light followed by treatment with a fractional bipolar radiofrequency device for facial wrinkle reduction and improvement in the overall appearance of aged facial skin. Fifty-six patients with mild to moderate facial wrinkles received three full-face treatments (forehead, nose, cheeks, periorbital, and perioral areas) at 4 to 6 week intervals and were evaluated at 12 and 24 weeks after the last treatment. Clinical photographs at baseline and follow-ups were assessed by both the investigators and patients using the Global Aesthetic Improvement scale. Treatment safety was evaluated. Study participants also completed a satisfaction and improvement questionnaire. Fitzpatrick Wrinkling and Elastosis Score was decreased significantly at three months (P < .01; paired t test) and at six months (P < .001; paired t test) after the final treatment. Investigators' assessments of overall improvement in facial appearance, demonstrated 88% improvement at 12 weeks and 82% at 24 weeks after the final treatment. Subject evaluations were similar, consistently reporting improvement in wrinkles and overall facial skin appearance throughout the study, and high a degree of satisfaction with their final results. Subjects tolerated the procedures well, with only transient mild to moderate erythema and edema occurring in most patients, and without complications. A combined protocol of bipolar radiofrequency and infrared light treatment followed by fractionated bipolar radiofrequency treatment results in safe, well tolerated, and effective improvement in overall skin tone and texture and reduction of facial wrinkles. 4 Therapeutic.

Facial melasma is a disfiguring pigmentation and occurs frequently with aging skin. Topical treatment alone was often suboptimal. A recent study showed that fractional picosecond laser has promising result in benign pigmentary lesions. This study aims to investigate the efficacy and safety of 1064 nm picosecond laser in treatment of facial melasma and skin rejuvenation in Asian skin. Patients of Asian descent seeking treatment for facial melasma and skin rejuvenation were screened and recruited. Each patient received up to nine laser treatments at 4-6 weeks intervals with a fractionated nonablative 1064 nm picosecond laser. Baseline and posttreatment modified Melasma Area Severity Index (mMASI) and Global Aesthetic Improvement Scale (IGAS) were assessed by blinded investigators based on the clinical photographs. Subject overall satisfaction was assessed by the questionnaires after treatment. All adverse events were documented. Twenty patients were recruited with a median age of 52.7 ± 8.2 years. Three subjects had Fitzpatrick skin type III and 17 had skin type IV. All subjects received nine laser sessions. Over 70% of patients were satisfied with the treatment outcomes. There was a statistically significant improvement in mMASI which reduced from 10.8 at baseline to 2.7 and 3.6 at 6 and 12 weeks post-treatment, respectively (both P < 0.01). For skin rejuvenation, 70% reported at least a moderate improvement at 6 weeks of post-treatment. No major side-effect was reported. Erythema was the most frequent transient response, while some reported edema (1.1%). Both resolved spontaneously. None reported hypo- or hyperpigmentation after treatment. The overall mean pain scare (VAS) was 1.92. Fractionated non-ablative 1064 nm picosecond laser was effective in treatment of melasma and skin rejuvenation. It was also safe and well tolerated. Importantly, there was no hypo or hyperpigmentation reported. Lasers Surg. Med. 00:00-00, 2021. © 2021 Wiley Periodicals LLC.

Nowadays patients want to get an immediate result from skin rejuvenation techniques without sign of injections and consequent limitations in social life. Therefore, the least traumatic, more effective, and longer lasting treatment approach for skin quality improvement should be favored. Assess skin quality outcomes by clinical examination and self-reporting in patients treated with two non-crosslinked hyaluronic acid (HA) products, injected by cannula. Investigate the skin thickness and the longevity of dermal fillers in soft tissues by ultrasound examination. Fifteen female patients (mean age 41 years) were selected for injection with two non-crosslinked HA products (one for each hemiface and hemi neck). Subdermal injections were performed bilaterally and the retrograde linear fanning technique with a 25G 50 mm cannula from three entry points was used. An ultrasound examination of the skin layers thickness was carried out before the procedure and every 6-7 days up to three weeks, when patients skin quality improvement was assessed by GAIS (Global Aesthetic Improvement Scale) and patients asked about their satisfaction level. On the right hemiface, the use of the non-crosslinked HA-product with lidocaine was not associated with pain in the sites of injection. On both face sides, the signs of bruising or edema were minor and not associated with downtime or social life limitation after the procedure. After three weeks, despite both injected products could not be detected by ultrasound technique, signs of skin stimulation and skin layers hydration were still observed: The dermis became thicker on both hemifaces while the epidermis became thinner but showed more pronounced radiance and densification effect on the right hemiface. Subdermal injections of non-crosslinked HA "skin boosters" could be a good option for minimal traumatic and effective 3-week lasting skin quality improvement.

Platelet-rich plasma (PRP) with skin booster is a popular treatment for improving skin quality and reducing the signs of aging. However, few studies have evaluated its clinical efficacy in patients with aging face. This study aimed to evaluate the clinical efficacy, adverse reactions, and follow-up results of targeted injection of PRP with skin booster in treating patients with aging face. The study included 80 patients treated with targeted injection of PRP with skin booster from July 2022 to February 2023. The doctors compared the changes of the patients’ facial skin indicators, quality of life, and satisfaction with their appearance before and after treatment, and analyzed the clinical efficacy, adverse reactions, and follow-up results of the patients after treatment. After one course of treatment, the patients’ facial skin indicators, quality of life, and satisfaction with their appearance improved significantly, with P < 0.05. The total clinical effective rate was 88.75%, and the incidence of adverse reactions was 6.25%. After half a year of follow-up, 48.75% of the patients were willing to receive further treatment, and their facial soft feel, natural expression, and self-feeling comfort had significantly improved. Targeted injection of PRP with skin booster is an effective and safe treatment for improving facial skin symptoms such as coarse pores and wrinkles in patients with aging face. The results of this study provide evidence for the clinical use of PRP with skin booster in aesthetic medicine.

Although energy devices and botulinum toxin A (BTX-A) can alleviate age-related laxity, ptosis and platysmal bands, they have limited efficacy on horizontal neck lines. The purpose of this study was to investigate the efficacy, safety and patient satisfaction of a combined treatment of non-crosslinked hyaluronic acid (HA) compound filling plus mesotherapy for the correction of horizontal neck lines, in comparison with BTX-A. This multicentre, randomized, evaluator-blinded, prospective study enrolled female patients with moderate-to-severe horizontal neck lines corrected with either two or three sessions of non-crosslinked HA compound filling plus mesotherapy or one session of BTX-A injection. Improvement of the neck lines grades, Global Aesthetic Improvement Scale (GAIS), patient satisfaction and adverse events (AEs) were evaluated and compared at 1, 3, 6 and 10 months after the final treatment. Twenty-five patients received HA filling plus mesotherapy and 23 received BTX-A injection. Compared with BTX-A, the HA compound filling plus mesotherapy significantly improved the horizontal neck line grades on all follow-up visits (P &amp;lt; 0.001). Patients with different baseline grades (2, 2.5 and 3) demonstrated similar outcomes. The GAIS and patients’ satisfaction ratings were significantly higher for the HA filling plus mesotherapy treatment group (P &amp;lt; 0.001). Significantly higher pain ratings, higher incidence and longer recovery of adverse events (erythema, oedema and ecchymosis) were noticed in the combined treatment group (P &amp;lt; 0.001). No serious adverse events occurred. Compared with BTX-A, combined treatment with HA compound filling plus mesotherapy significantly improved moderate-to-severe horizontal neck lines and achieved a high level of patient satisfaction.

Facial aging results from intrinsic and extrinsic factors causing soft tissue volume loss, skin laxity, and wrinkles; minimally invasive fillers combining calcium hydroxyapatite (CaHA) and hyaluronic acid (HA) may mitigate these changes. This pilot study explored the feasibility, safety, and preliminary efficacy of a hyper-diluted 1:1 CaHA-HA combination in nine patients (30–65 years) with mild-to-moderate facial volume loss and laxity. Injections were delivered to affected areas using blunt-tip cannulas and fine needles. Clinical outcomes were measured with the Merz Aesthetic Scale (MAS), Wrinkle Severity Rating Scale (WSRS), and Global Aesthetic Improvement Scale (GAIS), while adverse events and patient satisfaction were recorded. MAS showed notable improvements in upper cheek fullness, lower cheek fullness, and jawline contour (+0.94, +0.94, and +0.89, respectively), and WSRS nasolabial fold severity decreased from 3.28 ± 0.18 to 2.50 ± 0.00 (p &lt; 0.0001) with large effect sizes (Cohen’s d &gt; 5.0). All patients rated themselves “very improved” on GAIS; no adverse events were reported, and satisfaction was high. These preliminary findings suggest that hyper-diluted CaHA–HA may be a safe and promising minimally invasive approach for facial rejuvenation, although confirmation in larger, controlled studies with longer follow-up is required.

BackgroundAlthough energy devices and botulinum toxin A (BTX-A) can alleviate age-related laxity, ptosis, and platysmal bands, they have limited efficacy on horizontal neck lines.ObjectivesThe purpose of this study was to investigate the efficacy, safety, and subject satisfaction of a combined treatment of non–cross-linked hyaluronic acid (HA) compound filling plus mesotherapy for the correction of horizontal neck lines, in comparison with BTX-A.MethodsThis multicenter, randomized, evaluator-blinded, prospective study enrolled female patients with moderate-to-severe horizontal neck lines corrected with either 2 or 3 sessions of of non–cross-linked HA compound filling plus mesotherapy or 1 session of BTX-A injection. Improvement of the neck lines grades, Global Aesthetic Improvement Scale (GAIS), patient satisfaction, and adverse events (AEs) were evaluated and compared at 1, 3, 6, and 10 months after the final treatment.ResultsTwenty-five patients received HA filling plus mesotherapy and 23 received BTX-A injection. Compared with BTX-A, the HA compound filling plus mesotherapy significantly improved the horizontal neck lines grades on all follow-up visits (P = 0.000). Cases of different baseline grades (2, 2.5, and 3) demonstrated similar outcomes. The GAIS and patients’ satisfaction ratings were significantly higher for the HA filling plus mesotherapy treatment group (P = 0.000). Significantly higher pain ratings, higher incidence, and longer recovery of AEs (erythema, edema, and ecchymosis) were noticed in the combined treatment group (P < 0.001). No serious AEs occurred.ConclusionsCompared with BTX-A, combined treatment with HA compound filling plus mesotherapy significantly improved moderate-to-severe horizontal neck lines and achieved a high level of patient satisfaction.Level of Evidence: 4

Personalized treatment with a combination of aesthetic protocols targets the different root causes, contributing to the patient’s aesthetic concerns and optimizes outcomes. This report presents the outcomes of a new protocol combining PEGylated hyaluronic acid (HA) hydrogel, non-ablative laser, and non-crosslinked HA skin booster to rejuvenate the perioral area within a single treatment session. This was a retrospective analysis of medical data from subjects who had undergone treatment with the perioral rejuvenation protocol at Kalea Clinic in the Netherlands. All subjects had been treated with the 3-step protocol involving: (i) injection with PEGylated HA hydrogel 24 mg/ml to contour and shape the lips; (ii) full-face treatment with a non-ablative, fractional diode laser with a wavelength of 1470 nm to smooth and tighten the skin; and (iii) full-face mesotherapy treatment with injection of non-crosslinked HA (18 mg/mL) with 0.01% calcium hydroxyapatite, glycine, and L-proline to improve skin quality. Follow-up visits took place at 6 (Visit 1) and 12 weeks (Visit 2), at which point physicians and patients assessed lip fullness and skin wrinkling on separate validated rating scales. Additional subjective assessment of treatment results was performed by both physicians and patients using the 5-point Global Aesthetic Improvement Scale (GAIS). Physician and patient satisfaction with treatment results was also assessed. Data were analyzed retrospectively for 14 female subjects with a mean age of 39.1 years. At baseline, lip fullness was rated as moderate by 71% of physicians and 64% of patients. At visit 2, 71% of lips were rated as thick and 14% as full by both physicians and patients. The mean skin wrinkle score improved from 1.30 (visible wrinkles with clear indentation) at baseline to 0.79 (fine wrinkle, slight indentation) at Visit 2. Mean GAIS scores for both physicians and patients indicated appearance was ‘improved’ at Visit 1 (mean scores of 3.0 and 2.7, respectively) and ‘much improved’ at Visit 2 (mean scores of 2.4 and 2.3, respectively). All treatments in the protocol were well tolerated. Both physicians and patients were satisfied with the combination protocol, and all patients reported they would be ‘likely’ or ‘very likely’ to recommend it. The combination of three different treatment modalities (PEGylated HA hydrogel, non-ablative laser, and HA mesotherapy) in a single treatment session demonstrated effectiveness in rejuvenating lips and perioral area. The complementary treatments were tailored to the individual for a natural-looking effect.

Introduction. Facial rejuvenation is one of the main reasons for consultation in aesthetic medicine and dermatology. The first signs of aging are observed in the infraorbital region, such as skin laxity and fine rhytides. Currently, there is a wide variety of treatments to improve the skin in this area. A new procedure is presented using hybrid hyaluronic acid complexes for bioremodeling of the infraorbital skin. Objective. This prospective, non - comparative, uncontrolled study brings together a series of Mexican patients who were administered intradermal stabilized hyaluronic acid hybrid complexes in the infraorbital region to investigate the effectiveness and safety of their use in this area in a protocolized manner. Material and Methods.Three visits were made, and digital photographs were taken in each. The doctor evaluated the degree of fine infraorbital wrinkles with a Likert scale; the patient assessed the degree of pain during the procedure with the visual analog scale (VAS); and the doctor and the patient evaluated the degree of satisfaction after the process through a global aesthetic improvement scale (GAIS). Likewise, an independent specialist not treating the patients assessed the aesthetic clinical improvement with the Likert scale. Adverse events that occurred during the study were documented. Results. The infraorbital rhytides scale score improved from 5.37 at the initial visit to 2.81 at the end of treatment. The patient's GAIS rating with the treatment outcome at the final visit was 1.43, indicating very good satisfaction. Likewise, the GAIS classification of the treating physician at the end of treatment was very satisfactory at 1.62. Discussion. According to the ratings obtained from the treating physician (GAIS and Likert), the patient himself (GAIS), and the independent researcher (Likert), this study demonstrated aesthetic improvement in the infraorbital rhytides. No adverse events were reported with the treatment. Conclusions. Infraorbital rhytides can be treated with hybrid hyaluronic acid complexes because of their call bioremodeling function.

A poloxamer solution acting as a vehicle for the lipid base particulate system (cubosome dispersions) containing alpha lipoic acid (ALA) has achieved encouraging results in skin aging. Evaluate the efficacy of 5% Cubosomal ALA as an anti-aging formulation. This single-blinded, placebo-controlled, comparative study was conducted on 20 females. Patients were instructed to apply a gel formulation containing the active ingredient over the right half of their face and a placebo gel on the left half twice daily for 6 months. Global aesthetic improvement scale (GAIS) was utilized as a measure of clinical progress. The thicknesses of the epidermis and dermis were assessed before and after treatment using an ultrasound biomicroscope. The GAIS score assessment at 3 and 6 months showed a significantly greater improvement on the right sides in comparison with the left sides. At the end of the treatment period, the mean epidermal thickness significantly increased on the right side in comparison with the left side and the mean dermal thickness increased more on the right side in comparison with the left side; however, this difference was not significant. 5% Cubosomal ALA is an effective and safe modality for improving aging face.

Calcium hydroxyapatite (CaHA) fillers are widely used for soft-tissue augmentation due to their volumizing properties and biostimulatory effects. However, clinical evidence supporting the dual role of CaHA as both a volumizer and a skin booster remains limited. To evaluate the efficacy of CaHA filler (VoLassom) in midface volume restoration and assess its effects on skin barrier function, hydration, and elasticity over 24 weeks. Fifteen participants aged 19-70 years with moderate midface volume deficiency (Midface Volume Deficiency Scale [MFVDS] grade ≥ 3) received CaHA filler injections. Clinical assessments included MFVDS scoring, the Global Aesthetic Improvement Scale (GAIS), and patient satisfaction ratings at baseline and at weeks 2, 4, and 24. Instrumental evaluations of transepidermal water loss (TEWL), corneometer-based hydration, and cutometer-measured elasticity (R2, R5, and R7) were conducted at all timepoints. MFVDS scores significantly decreased from baseline to weeks 2, 4, and 24, demonstrating sustained volume restoration. GAIS scores remained high, with all participants rated as significantly improved (5.0) at weeks 2 and 4, though slightly reduced at week 24 (4.53 ± 0.52). Patient satisfaction remained consistently high. TEWL significantly decreased at weeks 4 and 24 (p < 0.01), indicating improved skin barrier function. Corneometer measurements showed significant hydration improvements at all timepoints (p < 0.05 and p < 0.001, respectively). Skin elasticity, measured by R2, R5, and R7, significantly increased at weeks 4 and 24 (p < 0.01), suggesting enhanced skin firmness. CaHA filler demonstrated effective and sustained volume restoration while significantly improving skin hydration, barrier function, and elasticity. These findings suggest that CaHA functions not only as a volumizer but also as a skin booster, offering a comprehensive approach to facial rejuvenation. Nevertheless, further studies with larger cohorts are warranted to validate these results.

Objective To evaluate the efficacy and safety of fractional laser combined with smooth mode laser for the treatment of facial photoaging. Methods Thirty subjects with facial photoaging treated in Department of Plastic Surgery of China-Japan Friendship Hospital were enrolled. All subjects received treatment with fractional Nd: YAG laser combined with smooth mode Er: YAG laser,once every 4 weeks for 3 sessions. Subjects were followed up before the first treatment(V1), 4 weeks after the second treatment (V2), 4 weeks after the third treatment(V3)and 12 weeks after the third treatment(V4).During each follow-up,Global Scores for Photoaging (GSP) were used to evaluate the photoaging degree on the whole face, Global Aesthetic Improvement Scale(GAIS) were applied to evaluate the improvement degree of facial photoaging, and the Visual Analogue Scale(VAS)was adopted to assess pain induced by treatment.After the last treatment,self-assessment on the degree of satisfaction with therapeutic effects was conducted. Results All 30 subjects completed the treatments and follow-up. GSP decreased with the increase of visiting time after treatment (r=-0.736,P<0.01). GAIS increased with the increase of visiting time after treatment (r=0.616, P<0.01).There were significant differences in the measurements of VISIA Skin Detector at V1,V2,V3 and V4(all P<0.01). There was a positive correlation between GAIS and VISIA measurements at V2,V3 and V4; the correlation coefficients were 0.453 (P=0.012), 0.552 (P=0.002) and 0.564 (P=0.001), respectively. The average VAS score of 30 subjects after treatment was 1.2±0.1. No side effect was observed. The self-satisfaction rate was 76.7% (23/30). Conclusion Fractional Nd: YAG laser combined with smooth mode Er: YAG laser can be applied to treat facial photoaging safely and effectively. Key words: Skin aging; Laser therapy; Treatment outcome

Results of the United States Food and Drug Administration Clinical Trial of the CustomFlex Artificial Iris

Facial aging is a multifactorial process characterized by structural changes to the dermis and ligaments, lipoatrophy in the fat pads and hypodermis, remodeling of the bony skeleton, change in muscle tonicity and tissue descent. The purpose of this study is to evaluate the efficacy of a hyaluronic acid-based treatment for the aging face that addresses all its causes in a caudal to cranial and medial to lateral direction: the centrifugal technique. Between March 2015 and January 2018, 187 patients were treated with a high G' hyaluronic acid in two sessions, one/two weeks apart, to improve signs of facial aging, starting from the lower centrofacial area and progressing laterally and cranially. Results were assessed using a Global Aesthetic Improvement Scale (GAIS) judging pre- and post-treatment (32weeks) pictures. The technique effectively treated the aging face. The investigator and all patients evaluated the results improved or very much improved and agreed that the results were very natural looking. Use of a systematic centrifugal technique to address the signs of facial aging resulted in significant and long-lasting improvement, as judged by the investigator and high patient acceptance and satisfaction.