Aesthetic Dermatology Research Articles

Cosmetic Procedure Screening Questionnaire (COPS): creation and validation of the Polish language version.

IntroductionBody dysmorphic disorder (BDD) is a disabling mental disorder characterized by excessive preoccupation with appearance. Trying to fix imagined defects many individuals with BDD search for aesthetic dermatology treatments. Due to omitting preliminary evaluation for BDD in subjects undergoing cosmetic procedures and lack of proper diagnostic tools among this group of individuals, the results of such interventions may face their disapproval and disappointment.AimTo translate and validate the Polish version of a Cosmetic Procedure Screening Questionnaire (COPS), which can be used in a cosmetic procedure setting to screen patients suspected to be suffering from BDD.Material and methodsBoth forward and backward translations of the original English version of the questionnaire to Polish were performed in accordance with international standards. The validation was conducted on 33 individuals undergoing aesthetic procedures, who completed the questionnaire twice with 3–6 days’ interval. Moreover, the subjects were also asked to fill the Polish versions of BIQLI (Body Image Quality of Life Inventory) and HADS (Hospital Anxiety and Depression Scale) for convergent validity procedure.ResultsThe Polish version of COPS demonstrated good internal consistency (Cronbach α coefficient value of 0.76) and reproducibility (Intraclass Correlation Coefficient, ICC, of 0.79). COPS correlated strongly with BIQLI (r = –0.66, p < 0.01) as well as with HADS, in both depression and anxiety subscales (r = 0.68, p < 0.01 and r = 0.66, p < 0.01, respectively).ConclusionsThe Polish version of the COPS questionnaire showed sufficient internal consistency and reliability. It can be used for BDD screening among the Polish speaking subjects undergoing aesthetic dermatology procedures.

Postępowanie przy powikłaniach po zabiegach z użyciem kwasu hialuronowego. Rekomendacje Sekcji Dermatologii Estetycznej Polskiego Towarzystwa Dermatologicznego

Postępowanie przy powikłaniach po zabiegach z użyciem kwasu hialuronowego. Rekomendacje Sekcji Dermatologii Estetycznej Polskiego Towarzystwa Dermatologicznego

Consensus Recommendations for 4th Generation Non-Microneedling Monopolar Radiofrequency for Skin Tightening: A Delphi Consensus Panel

IMPORTANCE: The demand for non-invasive methods for facial and body rejuvenation has experienced exponential growth over the last two decades. While multiple treatment systems exist, device specific guidelines to help guide clinicians to achieve the best outcomes are lacking. OBJECTIVE: To develop expert consensus on the use of 4th generation non-microneedling monopolar radiofrequency. Design: In a modified Delphi process, a panel of 8 international experts in aesthetic dermatology participated in 3 rounds of consensus building commencing in April 2019. Initially, 32 consensus statements were developed addressing patient selection, patient outcomes, treatment settings, and practical use of non-microneedling monopolar radiofrequency. By the 3rd round, these had been reduced and refined to a total of 19 statements. The consensus process was completed in June 2019 and the data were analyzed in July 2019. RESULTS: In 3 Delphi rounds, the 8 panelists achieved consensus on 19 recommendations on the use of 4th generation non-microneedling monopolar radiofrequency and developed additional explanatory guidance to support 12 of the consensus statements including those related to patient selection, procedural technique, and anticipated treatment outcomes. CONCLUSIONS AND RELEVANCE: Although guidelines will never replace individual clinical judgment, as the demand for noninvasive tissue tightening increases, so too does the need for positive, reproducible outcomes. Careful patient selection, pre-treatment counseling, treatment planning, and good technique, are all critical for success. These consensus statements should assist clinicians in each of these areas.

Radiofrequency therapy in esthetic dermatology: A review of clinical evidences

Chronological skin aging causes the modification of genetic material through enzymes and proteins changes. The process reduces cellular proliferation, along with loss of tissue elasticity, reduced ability to regulate aqueous exchanges, and inefficient tissue replication. Appearance is negatively affected by cumulative changes in coloration, texture, and elasticity over time. The increase in the population's average life expectancy boosts the search for cosmetic therapies that can delay aging, mostly for the noninvasive modalities. Among the various options, radiofrequency therapy is a technique that can help reduce the effects of skin aging. Therefore, this study aims to review clinical evidence provided by scientific literature on the benefits of using radiofrequency therapy in reducing skin aging effects. A review of the literature concerning skin aging, characteristics of radiofrequency therapy, and radiofrequency therapy in the treatment of skin laxity and mechanism of action was conducted using PubMed. The included studies have suggested that the mechanism of radiofrequency action is heating the dermis while preserving the epidermis. This heating causes immediate collagen denaturation, which is followed by the formation of new collagen, naturally providing skin tightening and greater elasticity. Even when used as single therapeutic modality, radiofrequency seems to meet the expectations in reducing the effects of skin aging.

Stem cells in aesthetic dermatology: bioethical and professional obligations.

Recently, stem cells in aesthetics have attracted increased attention, especially as they have become a popular trend that is being mass-marketed to consumers on the Internet and social media. Unfortunately, studies have shown this marketing to be misleading as it portrays many purported benefits of stem cells that have yet to be proven in the limited studies that are available. It is important for clinicians to understand the evidence and marketing behind any new trends, especially in the fast-paced world of aesthetics, where treatments often outpace current medical understanding. As clinicians, we have bioethical and professional obligations to educate ourselves on current trends, ensure adequate patient safety, and advocate for continued consumer education.

Commentary on Simultaneous Lateral Tarsal Strip and Medial Spindle Procedures for Cicatricial Ectropion.

Surgical and Aesthetic Dermatology, Mohs & Reconstructive Surgery, Sacramento, California The author has indicated no significant interest with commercial supporters.

Integral Facial Management of the Aesthetic Patient: The Skin Age Management Protocol

Aesthetic dermatology offers many minimally invasive therapies that can help our patients age gracefully and discreetly. Because it is hard to systematize these treatments to make patients aware of the options they have for the area of the face they want to improve, at Clínica Dermatológica Internacional, we have developed the Skin Age Management (SAM) protocol. In this article, we describe this protocol designed to help doctors and patients to better understand and plan available treatments, underlining the advisability of combining techniques with the goal of achieving discreet changes to obtain what we consider to be optimum results, based on our experience at our center.

Application of chemical peeling in discosmetic dermatoses and facial rejuvenation

Chemical peeling is one of the three most common skin resurfacing techniques. Alpha-hydroxy acid, salicylic acid, trichloroacetic acid and Jessner′s solution are common chemical peeling agents, and their action depths range from the stratum corneum to the reticular layer of the dermis. Chemical peeling has been widely applied to aesthetic dermatology, and this review mainly summarizes common chemical peeling agents and application of chemical peeling in discosmetic dermatoses, such as acne and melasma, and facial rejuvenation. Key words: Chemexfoliation; Acne vulgaris; Chloasma; Facial rejuvenation

Microparticles based on natural and synthetic polymers for cosmetic applications.

Most peeling products (exfoliators) available on the market, used in cosmetic and aesthetic dermatology applications, contain synthetic microbeads as abrasive agents. After being released into the natural environment, these non-biodegradable microparticles have an adverse impact on it, especially on aquatic ecosystems. Cosmetics consisting of solid plastic particles will be prohibited in the European Union from 2020. Therefore, there is a great need to develop effective abrasive substances for cosmetic industry. An alternative to synthetic beads may be beads based on biopolymers. Spherical microparticles of sodium alginate and mixture of sodium alginate and starch were obtained using encapsulator BÜCHI B-395 Pro. The obtained microparticles were added to the developed peeling formulation. Subsequently, the evaluation of skin condition after application of peelings with alginate, alginate-starch and synthetic microparticles was made, including topography, skin's barrier quality, hydration, colour, and the level of sebum. The peeling containing sodium alginate and sodium alginate with starch beads does not irritate the skin - redness of skin, itching and dryness did not appear. Microparticles of sodium alginate and sodium alginate with starch act on the skin as effectively as commercial synthetic particles, therefore they may be successfully used as abrasive ingredients in the developed recipe.

Abordaje facial global del paciente estético: protocolo Skin Age Management

Aesthetic dermatology includes many minimally invasive therapies that can help our patients age gracefully and discreetly. Because it is hard to systematize these treatments to make patients aware of the options they have for the area of the face they want to improve, at Clínica Dermatológica Internacional, we have developed the Skin Age Management (SAM) protocol. In this article, we describe the protocol, which is aimed at helping doctors and patients to better understand and plan available treatments, underlining the advisability of combining techniques with the goal of achieving discreet changes to obtain what we consider to be optimum results, based on our experience at our center.

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

Objective: Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. Methods: The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. Results: A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I–VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. Conclusions: The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).

High Frequency Ultrasound in Aesthetic Dermatology. Novel Research For the Use of 18 MHz ShearWave Elastographyfor Pre and Post Therapy Assessment. Pre Clinical Trials of Collagen Fillers within the Dermal and Subdermal Layers of the Skin

Ultrasound elastography (USE) is an imaging technology sensitive to tissue stiffness and in recent years’ technology has enabled methods to add quantitive measurements of tissue stiffness. The study included female volunteers referred to a local aesthetic centre for use of hyaluronic fillers in the periorbital region. Patients included in the study would be over the age of 35 years with no previous history of scarring, allergy, atopy, trauma or subcutaneous skin disorders. All participants were subject to ultrasound evaluation by means of 18 MhZ linear probe Hitachi Aloka Arietta S70 to assess the skin in the periorbital region bilaterally. A small pilot study was performed to assess feasibility of shearwave elastography during treatment process. Results: The Histogram Width Tissue Characterization (HWTC) between 35 and 50 year age group shows significant difference between the epidermal and subcutaneous fat tissue characterization. The epidermis layer of 50 year old female has less gray scale levels with reduced HWTC rate. Conclusion: Further research is encouraged to include large sample populations. Following collagen filler treatment or other aesthetic methods, follow up sonography and elastography methods may prove to provide a measurable outcome in treatment. There is limited knowledge regarding elastography, shear wave elastography and strain elastography, which provides a large field of novel research to be delved upon in future. It is expected in future technology for tissue elasticity imaging there will be sophisticated improvements such as three dimensional and quantitative elasticity images based on tissue elasticity modulus.

High Frequency Ultrasound in Aesthetic Dermatology Novel Research for the Use of 18 MHz Shearwave Elastography for Pre and Post Therapy Assessment: A Pilot Study

Ultrasound elastography (USE) is an imaging technology sensitive to tissue stiffness and in recent years’ technology has enabled methods to add quantitative measurements of tissue stiffness. Most dermatologists and cosmetologists are not aware of the many useful properties of ultrasound in the clinical setting. Dermatologists interest for improved diagnostic techniques lies within the renewed medical interest in medical aesthetics application. Ultrasound can also be utilized to assess the skin’s response to treatments such as laser, mesotherapy or photodynamic therapy. Previous studies in the field of aesthetic dermatology were limited to indentometry and cutometry. Indentometry is highly subjective with low levels of accuracy and reproducibility reported from previous study findings. Cutometry is used for elasticity measures, but is not representative of the entire region of interest. Latest SWE technology provides an objective, noninvasive, whole body skin assessment. 18-22 MHz frequency probes have been shown to produce a lower signal to noise ratio, but previous studies to this extent is limited and requires further research output. Objective, non-invasive methods are there for required in practice to quantify physiological changes in the skin. Through these methods, diagnostic proficiency can be increased. The severity and progress of aging can be quantified to assess treatment outcomes.

High frequency ultrasound in aesthetic dermatology. Novel research for the use of 18 MHz shearwave elastography for pre and post therapy assessment. Pre clinical trials of collagen fillers within the dermal and subdermal layers of the skin

High frequency ultrasound in aesthetic dermatology. Novel research for the use of 18 MHz shearwave elastography for pre and post therapy assessment. Pre clinical trials of collagen fillers within the dermal and subdermal layers of the skin

Clinical Evaluation of a Novel Blended Mode Diode Laser for Hair Removal

Introduction: Photoepilation by lasers is a popular procedure in aesthetic dermatology for removing unwanted body and facial hair. The use of the most appropriate laser wavelength is crucial as it affects treatment depth and melanin absorption. The three commonly used hair removal lasers are of specific wavelengths: 755 nm, 810 nm, and 1064 nm, each preferred certain types of skin and hair characteristics. The current evaluation reports the safety and efficacy of unique blended modes 755/810 nm and 810/1064 nm diode lasers for hair removal. Methods: Hair removal results from 50 patients treated with the 755/810 nm handpiece and 50 patients treated with the 810/1064 nm handpiece were gathered from a few clinics. 3 treatments on various body areas were conducted 6 weeks apart and patients were followed up with 6 months after the last treatment. Results were evaluated by baseline, follow-up photographs, and hair counts. Results: Treatment area photos demonstrated hair reduction in the treated body and facial areas. Average hair count reduction at 6 months follow-up was 84% for the 755/810 nm handpiece and 81% for the 810/1064 nm handpiece. No significant or unexpected adverse events were detected in any of the patients. Conclusions: The novel blended mode hair removal diode lasers are proven to be safe and effective for hair removal in facial and body areas for patients of various skin types and hair characteristics.

Complications of laser and light-based devices therapy in patients with skin of color.

Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.

Vieillissement cutané – Vieillissement facial global : orientation thérapeutique

Correction of cutaneous and facial ageing is the key reason for consultations in aesthetic dermatology. This demand on the part of patients, which has become a social phenomenon, has increased thanks to the remarkable progress made in nonsurgical and less invasive therapies such as lasers, botulinum toxin and fillers. But in order to optimise their use and to provide a personalised touch, since each face ages differently, an overall facial analysis, both static and dynamic, is essential. Indeed, ageing is obviously not restricted to skin but also concerns underlying tissue such as muscle, fat tissue and supporting bone. In this article, we provide a clinical and physiopathological analysis of the ageing of skin and of the various types of ageing, whether chronological, hormonal or environmental, and we examine the major role played by UV radiation, as well as tobacco smoke and, in certain cases, pollution. The description of cutaneous ageing covers not only the face, in which photoaging is the predominant factor, but also ageing of skin throughout the rest of the body. Next we describe the general modes of facial ageing for the subcutaneous structures, first those of the skin muscles, which compensate for their atrophy by means of permanent hypercontraction that result in dynamic wrinkles, then those of fat tissue in which ptosis can occur, coupled in some cases with atrophy and loss of the fullness and harmonious facial curves of youth, and those of supporting bone structures and preferential areas of resorption, which are also where the most pronounced ageing of soft tissue is discernible. The upper third, middle and lower third of the face do not age in the same way and the relevant methods of correction thus differ. Finally, we briefly discuss the therapeutic choices available, taking into account the generally extremely reasonable expectations of patients, who tend to seek moderate and natural rejuvenation in keeping with their personality, as well as the elimination of negative expressions associated with ageing, and who want neither a rigid face nor aesthetic cloning.

Whole- and partial-body cryotherapy in aesthetic dermatology: Evaluating a trendy treatment.

This manuscript addresses the use of whole- and partial-body cryotherapy in aesthetic dermatology. Over the past several years, these have become trendy treatments that have been marketed for many purported benefits in overall skin appearance and skin health. With increased access through cryotherapy facilities and medical spas, whole- and partial-body cryotherapy have grown in popularity. Unfortunately, many of the advertised claims have little, if any, scientific evidence behind them. Here, we summarize the data available in the literature. As trends evolve, clinicians should continue to be knowledgeable about them and their evidence in order to properly counsel patients appropriately.

Aesthetic Dermatologic Surgery Training in Canadian Residency Programs.

The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs. An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training. Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience. The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.

Travel as a teaching and learning tool

Throughout history, physicians have traveled extensively to acquire new knowledge or to learn the latest therapeutic techniques from colleagues and academicians. This “wanderlust” persists in many who want to understand the world around them and learn from others, physicians or nonphysicians. Before the era of instantaneous online telecommunication, dermatologists would enhance their education by traveling abroad to learn from world-renowned experts in Europe and elsewhere and return with a treasure trove of knowledge and new skills. With the Internet, webinars, and teledermatology, the attraction for travel has diminished, mainly due to our ever-increasing demanding world of obligations; however, face-to-face interaction with colleagues of a different culture and educational background still has an inexorable educational value. To facilitate such endeavors, many insightful educators have taken the opportunity to establish several international societies and academies, where on-site educational activities can take place. Currently, a few of the more active and popular dermatologic organizations that are conducting meetings around the world are the International League of Dermatologic Societies; International Society of Dermatology; North American Clinical Dermatologic Society; International Society of Dermatologic Surgery; International Academy of Cosmetic Dermatology; and European Society of Cosmetic and Aesthetic Dermatology, all of which exemplify “travel as a teaching tool.”