Facial Lines Research Articles

IncobotulinumtoxinA in the Treatment of Upper Facial Lines: Results From Two Randomized, Double-Blind, Placebo-Controlled, Phase III Studies.

Two randomized, double-blind, placebo-controlled, Phase III studies of incobotulinumtoxinA for treating upper facial lines (UFL; combination of glabellar frown lines [GFL], horizontal forehead lines [HFL] and lateral canthal lines [LCL]) were conducted in the US (ULTRA I: NCT04594213) and Germany (ULTRA II: NCT04622254). To evaluate safety and efficacy of simultaneous intramuscular injections for UFL. Longer-term safety and efficacy were assessed in open-label extension periods (OLEX). Healthy participants (≥18 years) with moderate-to-severe GFL, HFL and symmetrical LCL at maximum contraction on the five-point Merz Aesthetics Scales (MAS) were randomized 2:1:1 to receive up to 64 Units of incobotulinumtoxinA in the main period (MP) for each trial. Treatment groups were: UFL, GFL & HFL (ULTRA I), LCL (ULTRA II) and placebo. Primary efficacy endpoints were the proportions of GFL, HFL and LCL responders, defined as a MAS score for the respective area of 0 (no) or 1 (mild) and ≥2-grade improvement from baseline to Day 30, as assessed by both investigator and participant. Overall, 362 and 368 participants received treatment in ULTRA I and ULTRA II, respectively. In both studies, incobotulinumtoxinA treatment was significantly more effective than placebo with respect to the primary endpoint (p < 0.0001) and key secondary endpoints (p < 0.0001). OLEX results were consistent with those seen in the MP. No new safety findings were identified. In ULTRA I and ULTRA II, safety and efficacy of incobotulinumtoxinA for the simultaneous treatment of moderate-to-severe UFL were demonstrated, with significant improvements across all primary and secondary endpoints versus placebo.

Depictions of Aging in a Self-Portrait by David Bailly (1584-1657).

I present a case involving a portrait of David Bailly, containing 2 images portraying changes over a period of ∼40 years, and I compare the facial features that illustrate the aging process. He was 67 years old when he painted "Self-Portraits With Vanitas Symbols" (1651). By juxtaposing past representations with present reality, the painting suggests that the young artist is contemplating his future aging. The young man, appearing so vividly within the painting's immediate reality, actually symbolizes a bygone era Compared with the young portrait, the older portrait exhibits a slightly drooped eyebrow tail, indicative of brow ptosis. In the young portrait, the lid margin is aligned with the upper border of the iris, whereas in the older portrait, it is aligned with the upper border of the pupil. The margin reflex distance 1 decreases with age. In addition, the older portrait shows baggy lower eyelids. The nasojugal groove is more pronounced, and the nasolabial fold is deeper. The beard and mustache are more extensive, and silver strands are interspersed among the black hairs. Presenting 2 images from a 40-year interval, the older portrait exhibits more pronounced signs of facial aging than the younger portrait. Portraits from that era, whether painted by western or eastern artists, demonstrate that the painters had an understanding of facial skin lines and the aging process. The process of creating portraits provides insights into historical contexts and remains significant in contemporary settings, particularly concerning perceptions and identity.

Quantification of facial symmetry in orthognathic surgery: A novel approach integrating 3D contour maps and hyper-dimensional computing

This study aimed to enhance the evaluation of facial symmetry crucial for planning and assessing outcomes of orthognathic surgery (OGS). An innovative approach combining three-dimensional (3D) facial contour lines with hyperdimensional (HD) computing was developed for this purpose. Data were collected using 3D cone beam computed tomography (CBCT) at Chang Gung Memorial Hospital from 2016 to 2021. A comprehensive dataset was compiled, including images from 150 normal individuals and 2500 patients, totaling 5150 preoperative and postoperative facial images. A machine learning model was trained to analyze these images, and 3D contour data were used to create a facial symmetry quantification system with HD computing. Additionally, 3D CBCT data from 200 patients before and after OGS were retrospectively reviewed for clinical application. The developed facial symmetry algorithm demonstrated an overall accuracy of 84.1 %. Postoperative facial symmetry scores improved significantly, with a mean score increase of 53 %, from 2.40 to 3.63. The study culminated in the creation of a web-based system that leverages HD computing and 3D contour mapping to automate facial symmetry assessment. This system offers a user-friendly interface for rapid and accurate evaluations, facilitating better communication between clinicians and patients.

Radiofrequency Improves Facial Fine Lines by Thermal Effect: Damage or Just Stimulation?

Radiofrequency (RF) has been widely used for rejuvenation treatments, but without knowledge of the effective temperature of the target tissues or guidance on treatment parameters, it often leads to adverse reactions and pain. The aim of this study was to demonstrate that thermal stimulation can produce facial rejuvenation effects and to determine the optimal bipolar RF treatment parameters for treating facial fine lines. A bipolar RF device combined with CORE Technology was used in this study. Exvivo studies were conducted on both miniature swine and human skin, utilizing thermographic thermometry and histological analysis. Invivo swine studies were conducted using histological analysis and electron microscopy. A clinical trial was conducted, and the results were evaluated using the Alexiades Comprehensive Grading Scale (ACGS) and Global Aesthetic Improvement Scale (GAIS) scales. The bipolar RF technology can produce a significant effect by thermally stimulating collagen within just 2 weeks without causing thermal damage. A clinical trial involving 46 patients showed a noticeable rejuvenating effect of the bipolar RF device, especially on fine wrinkles. This study confirmed that thermal stimulation, rather than thermal damage, is sufficient to achieve rejuvenation effects. The study also found a range of bipolar RF treatment parameters that are both safe and effective for facial fine lines.

Utility of Keystone Flap in Armory of Dermatosurgeons

Abstract Purpose and Background: To create awareness among dermatosurgeons about the versality of keystone flaps in re-surfacing post-excisional small, medium and large skin defects. Aims and Objectives: Single-staged tension free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome. Material and Methods: This retrospective study was conducted, between October 2021 – January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA n=13, Omega cum Sydney melanoma unit modification n=3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (n=3) and benign hairy nevus (n=2) on cheek, basal cell carcinoma forehead (n=1), electric burns on deltoid (n=2), giant neurofibroma back (n=1), tattoo forearm (n=3), chronic non-specific granuloma thumb (n=2) and pilonidal sinus disease (n=2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months. Results: None had wound dehiscence or loss of flap. Conclusion: Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.

Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression.

Nasolabial fold (NLF) depression can affect the facial appearance of patients to some extent and increase their psychological burdens. In recent years, autologous fat grafting (AFG) combined with botulinum toxin A (BTX-A) injection (AFG + BTX-A injection) has been gradually applied in the treatment of patients with NLF depression. Although studies have been conducted on the efficacy and safety of AFG + BTX-A injection in treating NLF depression, the experimental design, observational indicators, and sample enrollment criteria vary remarkably, making it difficult to draw convincing and consistent conclusions. Thus, further relevant research is warranted. To assess the esthetic improvement, efficacy, and safety of AFG + BTX-A injections in patients with NLF depression. This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021. These patients were categorized into control (n = 30) and observation (n = 30) groups. The observation group received AFG + BTX-A injection, whereas the control group underwent AFG only. All patients were evaluated using the wrinkle severity rating scale (WSRS) and global aesthetic improvement scale. The compactness of facial contours, skin evaluation indexes, adverse reactions, and satisfaction of the two groups were evaluated 3 months postoperatively. The WSRS scores of the observation group at 1, 3, and 6 months postoperatively were lower than those of the control group (P < 0.05). Three months postoperatively, facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group (P < 0.05). The compactness of facial contours was better in the observation group than in the control group (P < 0.05). In addition, no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness, facial asymmetry, facial bruising, and facial concavity inequality (P > 0.05). AFG + BTX-A injection is a highly safe, cost-effective, effective, and long-lasting treatment for NLF depression with high esthetic value, which should be promoted in the future.

Comparative study between the efficacy of prabotulinum toxin-A versus onabotulinum toxin-A for the treatment of upper facial expression lines.

Botulinum Toxin (BoNTA) is the most used nonsurgical aesthetic procedure to treat facial expression lines. This study compared the efficacy of Prabotulinum toxin-A, a novel BoNTA that originates from Clostridium botulinum Hall-A, with onabotulinum toxin-A in treating facial expression lines using the Facial Wrinkle Scale (FWS) and FACE-Q questionnaires. This was an experimental, comparative, longitudinal, open-label, and prospective study. Patients aged between 25 and 40 years with upper-third facial expression lines were included. Follow-ups were made at three, seven, 30, and 120 days. A total of 26 patients were included: 20 female, and six males, with a mean age of 28.26 years. An average of 31.00 IU and 31.38 IU were administered to the onabotulinum and prabotulinum groups, respectively. The prabotulinum group demonstrated superiority in FWS and Face-Q scores between the first and third days (p ≤ 0.001, p < 0.001, respectively), which continued on day 7. By day 30, there were no differences in the scores of the two questionnaires. Prabotulinum toxin-A is a safe and effective treatment for upper-third facial wrinkles. On day three and seven, the results suggest that prabotulinum toxin-A has a quicker onset of action than onabotulinum toxin-A. On days 30 and 120, both groups showed similar FWS and Face-Q scores.

Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women.

IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women. A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day0) and days30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit. Participants ranged in age from 30 to 60years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day180. At day240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95%CI 18.8-58.1%), and for crow's feet lines in 26.9% (95%CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure. The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.

Effectiveness of Injectable Platelet-Rich Fibrin Therapy in Alopecia and Facial Rejuvenation: A Systematic Review.

Platelet-rich fibrin (PRF) has gained attention in regenerative medicine for its potential to enhance tissue repair and regeneration. Its application in dermatology, particularly for treating alopecia and facilitating facial rejuvenation, is of significant interest but requires systematic evaluation. This review aims to systematically assess the effectiveness of injectable PRF therapy in treating alopecia and facial rejuvenation procedures. We searched PubMed, Scopus, and Web of Science for studies published up to 2023 that involved injectable PRF for alopecia and facial rejuvenation. Eligible studies included prospective cohorts, original studies, case series, and retrospective studies that reported clinical outcomes. Key outcomes were improved hair growth for alopecia and skin texture, elasticity, and appearance for facial rejuvenation. Seven studies met the inclusion criteria, encompassing 130 patients. For alopecia, three studies reported a noticeable improvement in hair density and growth. For facial rejuvenation, four studies demonstrated moderate to significant improvements in skin texture and elasticity and a reduction in facial wrinkles and lines, confirmed by both subjective assessments and objective measurements such as VISIA® skin analysis. Injectable PRF therapy shows promise in treating androgenetic alopecia and enhancing facial esthetics, indicating its potential as an effective treatment option in regenerative dermatology. However, further research involving larger sample sizes, control groups, and longer follow-ups is required to validate these findings and establish standardized treatment protocols.

The clinical efficacy and tolerability of a novel triple acid exfoliating blend for reducing signs of photoaging in sensitive skin.

Chemical exfoliation of the skin is a frequently utilized treatment in dermatology to improve the appearance and health of photoaged skin. Photodamaged skin is especially prone to dryness and irritation. Over-exfoliation with at-home products are partially to blame for the "epidemic" of sensitive skin affecting over half the population. Combining AHA, BHA, and PHA together creates a complementary blend that has the potential to target numerous age-related changes in the skin including the appearance of pores and smoothing skin texture, while firming skin and increasing its collagen and moisture content. The following study tested the clinical efficacy of a triple acid blend designed specifically for sensitive skin and measured improvements in signs of photodamage and hydration levels in the skin over time. Thirty females aged 35-60 with mild to moderate facial lines, wrinkles, sun damage, uneven skin tone/texture, dark spots, or pores were enrolled. Subjects were instructed to use the test article, DWB-EN, on a clean face at night 3 times weekly with 48 h between applications for 4 weeks. Statistically significant improvements were noted in all parameters of photoaging clinical assessments (wrinkles, pores, overall appearance, luminosity, visible texture, skin tone evenness, hyperpigmentation) at the end of the 4-week study period. There were no instances of skin irritation throughout the duration of this study despite half of the women having sensitive skin. Overall, this study demonstrated the clinical efficacy and tolerability of DWB-EN for treating photoaging in subjects with all skin types.

Le Fort fractures: a review

Rene Le Fort proposed 3 classifications to determine the type of facial fracture based on the main facial lines with the least resistance, these being the places where facial fractures are most located. These fractures occur mainly because of high-velocity impact mechanisms. Le Fort fractures are difficult to manage and at the same time challenging, although it is not a common pathology, it is potentially lethal, and its initial approach and resuscitation are critical in the first hours. As in any other trauma, an initial evaluation must be carried out exhaustively and following the ABC, which mainly includes evaluation of the airway, breathing and circulation. Once a facial fracture is suspected, its extension and location must be determined through images such as x-ray or computed tomography. CT being the gold standard. Once the patient is stabilized, reconstructive surgery will be the indicated approach in most cases, with the main objective being the restoration of occlusion, direct exposure and manual reduction of the fractures, reconstruction of the medial and lateral bone buttresses, restoring the projection of the face and restore the width of the maxillary arch, nose and orbit. In general, some of the most frequently described postoperative complications are hemorrhage, infection, foreign body reaction, malunion, among others; however, these will vary depending on their classification.

Why do marionette lines appear? Exploring the anatomical perspectives and role of thread-based interventions.

The pathogenesis of marionette lines involves a complex interplay of anatomical, physiological, and age-related factors leading to the development of wrinkles around the oral commissures. This exploration delves into the distinct anatomical predispositions observed among different ethnicities, emphasizing the role of compact modiolus structures and muscle compositions. Notably, individuals of East Asian descent exhibit inherent facial structures that predispose them to pronounced sagging around the oral commissures during aging. The emergence of distinct facial lines, such as the commissural line and the melolabial fold, contributes to the formation of marionette lines. This specific wrinkle pattern, resembling a marionette puppet's mouth contours, is influenced by various factors like bone resorption, gravitational forces, fat compartment variations, muscle compression, ligament tethering, and skin aging. Treatment strategies for marionette lines encompass diverse interventions, including filler injections, botulinum neurotoxin, surgeries targeting fat reduction, thread lifting, and volumizing fillers. These approaches aim to address the underlying causes and mitigate the appearance of marionette lines. Botulinum neurotoxin injections, for instance, weaken specific facial muscles, reducing downward strain and aiding in tissue retraction. Anatomical considerations during procedures are crucial to avoid nerve or vascular damage. Delicate manipulation and precise entry points are essential to prevent inadvertent injuries, particularly concerning blood vessels like the facial artery and nerves like the mental nerve. Technical guidelines for procedures targeting marionette lines involve specific techniques like cogged thread reverse methods and volumizing thread placements. Attention to entry points, tissue engagement, and the direction of threads is crucial for effective treatment outcomes, minimizing complications, and ensuring patient safety.

Evaluation of people's satisfaction with botulinum toxin injection for facial rejuvenation based on age.

Botulinum toxin type A injections are widely used for facial rejuvenation; however, research on people's satisfaction based on age is limited. This study assessed patient satisfaction with botulinum toxin injections for forehead, glabella, and periorbital wrinkles in Birjand, Iran. The current study examined 150 people aged 18 to 70 who requested botulinum toxin type A injection in the forehead, glabellar, and periorbital area in 2022, who visited the plastic surgery clinic and the authors' offices in Birjand City. To check patients' satisfaction, Facial Lines Treatment Satisfaction (FTS) Questionnaire was used. One month after botulinum toxin type A injection, this questionnaire was completed by the clients. Also, the brand type of botulinum toxin, age, gender of the clients, frequency of visits, and complications were collected in the relevant checklist. The average age of participants was 38.8 ± 8.29 years with 73.3% being female. Masport botulinum toxin (MasoonDarou Pharmaceutical Company, I.R. Iran) was the most frequently used botulinum toxin brand at 66.7%. The average satisfaction score with the result of botulinum toxin injection in the forehead/glabella and periorbital area, in the age group under 30 years and 30-40 years, was significantly higher than in the age group over 50 years. The same indicators in the age group under 30 years old were significantly higher than in the 30-40 age group (p < 0.05). Furthermore, brand selection and the number of visits (first-time vs. second-time clients) demonstrated varied outcomes in satisfaction. There was a total of 62.7% side effects postinjection, with varying degrees of severity.

The Patient Journey in Facial Aesthetics: Findings from a European Consensus Meeting on Improving the Quality of Life for Patients Receiving Botulinum Toxin Injections.

Successful treatment of facial lines with botulinum toxin is largely dependent on patient satisfaction; thus, a structured treatment journey that uses patient-reported outcomes (PROs) is helpful for maximizing botulinum toxin results. To develop a patient-centric approach for botulinum toxin injections in facial aesthetics, a group of clinicians met to provide opinions on an optimal treatment journey that uses PROs to quantify treatment benefits on patient quality of life. A multidisciplinary panel of 9 clinicians with expertise in facial aesthetic procedures convened for an advisory board that was preceded by and followed up with a structured, multistep consensus discussion. Based on current literature, the panel's expertise, structured questions, and group discussion, panelists assessed, reconciled, and agreed upon on a patient journey for botulinum toxin treatment in facial aesthetics. Panelists agreed that an optimal patient journey includes screening, assessment, treatment, posttreatment, and follow-up visits. A compact, easy-to-complete, and digital PRO questionnaire should be provided before the visit. During screening, thorough assessments are integral for a successful patient journey because they provide an opportunity to understand treatment goals, address patient concerns, discuss risks and benefits, obtain medication lists/medical history, and take pretreatment photographs. Treatment strategies should include discussing and educating on the approach/choice of botulinum toxin and ensuring patients are comfortable. Posttreatment, clinicians should request intense muscle movements to enhance product uptake and be available to address patient concerns. Finally, during follow-up, PRO questionnaires can be provided to gauge patient satisfaction with treatment, and pretreatment photographs can be provided to allow patients to track their progression. Follow-ups should be scheduled with new patients or those reporting low satisfaction. Establishing a relationship, being aware of the patient's goals, and developing an individualized care plan allows for a structured, patient-centered treatment journey that promotes positive aesthetic outcomes.

Consensus Recommendations for Treatment of the Upper Face With LetibotulinumtoxinA.

One of the authors (K-H. Y.) convened a panel of seven aesthetic experts from South Korea and Australia to create guidelines for treating facial lines of the upper face with letibotulinumtoxinA. The panel members provided recommendations for injection sites, dosage, and injection techniques for using letibotulinumtoxinA and also considered relevant anatomy, patient assessment and selection, and individual variations to evaluate clinical strategies for minimizing complications. The panelists provided recommendations for treating forehead horizontal lines, glabellar frown lines, and lateral canthal lines. The guidelines developed by the panel will support clinical practitioners of all skill levels in providing safe and effective aesthetic treatments of the forehead, glabellar complex, and lateral canthal lines with letibotulinumtoxinA.

Significantly Enhanced Improvement in Dryness, Roughness, Fine Lines and Radiance Following Daily Use of a Novel Multi-Weight Hyaluronic Acid Plus Antioxidant Complex-Based Lotion Compared to a Single-Weight HA Plus Ceramide-Based Lotion

Introduction: Hyaluronic acid (HA) has become a commonly used ingredient in many topical moisturizing products due to its strong humectant properties and essential role in skin hydration; however, limitations of delivery of HA to only the surface of skin has hindered leveraging the full capacity of HA biology necessary for skin rejuvenation. Here we describe the head-to-head clinical comparison of a novel multi-weight HA plus antioxidant complex-based lotion with SPF 30 and a single-weight plus ceramide-based lotion with SPF 30 for clinical efficacy on dryness, roughness, fine facial lines, and radiance following daily use. Methods: A double-blind comparative study was conducted on 70 female subjects (n=35, multi-weight HA plus antioxidant complex-based lotion with SPF 30; n=35, single-weight plus ceramide-based lotion with SPF 30) ages 25 to 65 years with mild to moderate facial dryness and visible fine lines and wrinkles, including subjects with Fitzpatrick Skin Types I-VI, with 20% having Fitzpatrick Skin Types V-VI. Clinical grading of the face including dryness, roughness, and fine lines were assessed at baseline, 30 minutes, 2 weeks, 4 weeks, and 8 weeks after once daily application in the morning. Visible, cross-polarized (X-Pol), parallel-polarized (P-Pol) and UV fluorescence clinical images were acquired for each time point. X-Pol and P-Pol images were used to quantify skin radiance. Results: Daily use of the multi-weight HA plus antioxidant complex-based lotion with SPF 30 demonstrated significant improvements in all clinical grading assessments of dryness, fine lines, and wrinkles as early as Week 2 compared to baseline. Improvements in visible dryness (Week 2), roughness (Week 2), and fine lines (Week 8) were greater for the multi-weight HA plus antioxidant complex-based lotion with SPF 30 compared to the single-weight HA plus ceramide-based lotion with SPF 30, with overall statistical significance across all three parameters assessed favoring the multi-weight HA plus antioxidant complex-based lotion with SPF 30. For radiance, daily use of the multi-weight HA plus antioxidant complex-based lotion with SPF 30 demonstrated significant increase in radiance at Week 4 compared with baseline, while the single-weight HA plus ceramide-based lotion did not show any improvement in skin radiance compared with baseline. Conclusions: The marked improvements in dryness, roughness, fine lines, and radiance following daily utilization of the multi-weight HA plus antioxidant complex-based lotion with SPF 30 may be attributed to the inherent properties of HA. These improvements may be further attributed to the ability of multi-weight HAs to moisturize the skin surface and penetrate the upper surface layers of the skin, combined with the added benefits of key antioxidants, including glycine saponin and glycyrrhetinic acid, which have been previously shown to induce endogenous HA synthesis and inhibit endogenous hyaluronidase activity in vitro, respectively.

A survey on the cosmetic use of injectable polynucleotide: The pattern of practice among Korean Dermatologists.

Skin boosters denote injectables that promote global improvement of the skin which includes skin texture, elasticity, hydration, and overall appearance. Polynucleotide (PN) products have become popular, but there is surprisingly little guidance on their use. We aimed to maximize the safety and efficacy of injectable PN by providing information on their pattern of practice among board-certified dermatologists. A total of 235 Korean board-certified dermatologists familiar with skin boosters participated in a survey which questioned the participant's years of practice, selection of skin boosters in one's clinic, and range of lasers and light sources as well as skin care devices that are available. For those who use PN, one was asked to check all its aesthetic indications, mode of delivery, injection depth, treatment interval as well as options for combined therapy. Seventy-one percent of the survey participants had at least 5 years of professional experience as a board-certified dermatologist, and among the different skin boosters, 88% replied that they practiced PN injection. The top six indications for PN were fine lines on the cheek followed by infraorbital fine lines, periorbital fine lines, uneven skin texture, dry skin, and fine lines on the forehead. Many opted for a 33G needle and the serial puncture technique targeting the dermis. A total of three sessions of PN injection spaced 4 weeks apart is most often recommended. 79 percent of PN users blended PN injection with lasers and light therapy with the most popular being radiofrequency (non-invasive, needle RF) and high-intensity focused ultrasound (HIFU). PN is a skin booster which is widely practiced among Korean dermatologists. According to our survey, the best indication of PN is facial fine lines, and as such PN injection is often repeated and combined with a variety of non-surgical rejuvenation procedures. We hope our data help dermatologists better understand and utilize PN injection.

Antioxidant and anti-aging potential of collagen peptide conjugated with ionic liquid

Lactobionic acid-arginine (LAA) ionic liquid was prepared using an ion-exchange method. The LAA ionic liquid and five kinds of different molecular weights of collagen can self-assemble into spherical 5D LAA-Collagen peptides in solution. The 5D LAA-Collagen peptide has a small particle size, good stability, and biocompatibility, and can transdermally deliver collagen with different molecular weights to the epidermis and dermis through the skin. The activity and expression of IL-1β, MMP-1, and TNF-α decreased after adding 5D LAA-Collagen peptide. 5D LAA-Collagen peptide can inhibit MAPKs phosphorylation, activate the PI3K/AKT signaling pathway, increase the protein expression of Nrf2, and inhibit the high protein expression of Keapl to play an anti-aging role in multiple ways. The 5D LAA-Collagen peptide has a good antioxidant ability, can delay cell aging and death, and can reduce the length and number of facial wrinkles, fine facial lines, and texture to achieve an anti-wrinkle effect. Therefore, 5D LAA-Collagen peptide has potential applications in the field of cosmetics.

Botox Treatment: A Comprehensive Review

An exotoxin called botulinum toxin, or Botox, is isolated from Clostridium botulinum. It prevents the cholinergic nerve end plates from releasing acetylcholine, which causes the innervated muscles or glands to become inactive. Botox has proven to be effective for improving facial cosmetics, but new research has shown that it can also be used to treat a variety of surgical and medical disorders that aren't cosmetic. This article examines the available data regarding Botox use for non-cosmetic head and neck problems too. Because of its quick, distinct and long-lasting outcomes for the reduction of facial fine lines and wrinkles and cosmetic rejuvenation, injectable treatments like botulinum toxin are gaining popularity. Excessive sweating or hyperhidrosis can also be treated with Botox. Botox treatment can reduce the frequency of migraines, with chronic migraines requiring treatment in every three months. Additionally, Botox can help in reducing urinary incontinence caused by an overactive bladder. However, the usage of pure botulinum toxin dosages employed by certified healthcare professionals are strictly to be done under the stringent medical guidelines. When handled properly, botulinum toxins utilized in medicine are non- hazardous.

Metoposcopy redux

Phrenology is the pseudoscience in which practitioners claim that they can discern one's character and personality traits by studying the structure of the skull. Long before “head bumps” were viewed as determinants of character, skin lines were analyzed to provide similar information and to divine one's future. Palmistry, also called chiromancy, is the interpretation of the lines of the palms and is one of the oldest forms of divination. A similar pseudoscience, metoposcopy, suggests that facial lines and marks, mainly forehead lines, can reveal one's personality and foretell events in one's future. Metoposcopy was first practiced by the ancient Chinese and was popularized during the Renaissance by Girolamo Cardano and later by Richard Saunders. Metoposcopy is a largely forgotten form of skin-based pseudoscience that is no longer practiced today, unlike palmistry.