Skin Tightening Research Articles

The role of dermatocosmetics in the management of rosacea

Rosacea is a chronic inflammatory disease that affects the facial skin. This pathology is characterized by hyperaemia, erythema, telangiectasia and other manifestations. It is also accompanied by a group of unpleasant symptoms, such as burning sensations, itching, and skin tightness. The pathogenesis of the disease has not been sufficiently studied. But it is generally accepted that it is based on abnormalities in the immune system. In addition, excessive Demodex colonization and exposure to ultraviolet radiation may play a role in the development of rosacea. The incidence rate of rosacea worldwide reaches 5%. It is emphasized that some ethnicities face a greater risk of this disease than others. It is a very difficult task to treat rosacea for a specialist. The therapeutic approach differs in different forms of the disease. There is a wide range of treatments available for papulopustular rosacea, including systemic and topical medications and even physiotherapy. However, the therapy of erythematous rosacea mainly centres around the use of dermatocosmetic care. For patients with rosacea, it is important to choose products that, first of all, can effectively reduce skin redness and discomfort and will be well tolerated. A dermo-cosmetic composition has to have an anti-inflammatory effect and the ability to repair damaged skin. This article presents our own experience of using such drug in the monotherapy of erythematous rosacea and in the complex treatment of papulopustular disease. A significant effect had been achieved at 3–4 weeks of complex therapy in patients with papulopustular rosacea. We present a clinical case report of a 46-year-old patient N. as an example of the effectiveness of therapy.

Esophageal motility in systemic sclerosis before and after autologous hematopoietic cell transplantation.

Systemic sclerosis (SSc) is associated with esophageal dysmotility. Autologous hematopoietic cell transplantation (HCT) results in improvement of skin tightness and lung function. Whether esophageal motility improves after HCT is unknown. Esophageal motility was studied using high-resolution esophageal manometry in 21 SSc patients before and at multiple time points after autologous HCT. Median posttransplant follow-up was 2years (range, 6months to 5years). Prior to HCT, all 21 patients had abnormal motility-10 (48%) had unmeasurable and 11 (52%) had measurable peristalsis. Manometric diagnosis in the former 10 patients was "absent contractility" and in the latter 11 patients "ineffective esophageal motility (IEM)." After HCT, among the 10 patients with absent contractility, 9 continued to have absent contractility and one demonstrated weak measurable peristalsis. Of the 11 patients with IEM, 5 experienced SSc relapse, and 2 out of these 5 patients developed absent contractility. Among the 6 non-relapsed patients, 4 continued to have IEM, and 2 developed normal motility. HCT appears to have no beneficial effect on motility in patients with unmeasurable peristalsis. In patients with measurable peristalsis, HCT appears to stabilize and in some normalize motility, unless relapse occurs. Key Points • In patients with systemic sclerosis, esophageal dysmotility is a significant contributor to morbidity and so far, there has been no data describing the effects of hematopoietic cell transplantation on esophageal motility. • Our work demonstrated that in patients with systemic sclerosis and unmeasurable esophageal peristalsis prehematopoietic cell transplantation, there was no measurable beneficial effect of transplantation on esophageal motility. • In patients with systemic sclerosis and measurable peristalsis prehematopoietic cell transplantation, esophageal motility stabilized, except in relapsed patients.

Safety and tolerability of onabotulinumtoxinA in the treatment of upper facial lines from global registration studies in 5298 participants: A meta-analysis

Since its discovery as a facial aesthetic treatment >30years ago, onabotulinumtoxinA has received worldwide approval for dynamic upper facial line treatment. Meta-analysis examining the safety of onabotulinumtoxinA for treatment of glabellar lines (GL), crow's feet lines (CFL), and forehead lines (FHL). Participants (N= 5298) with moderate to severe GL, CFL, or FHL at maximum contraction received onabotulinumtoxinA or placebo in 1 of 18 registration studies (14 double-blind, placebo-controlled [DBPC]; 1 double-blind; 3 open-label). Adverse events (AEs) were analyzed by descriptive statistics and fixed-effects meta-analysis. In the overall double-blind placebo-controlled (DBPC) population, AEs were reported in 1443 (42.1%) and 486 (35.8%) participants in the onabotulinumtoxinA (n=3431) and placebo (n=1359) groups, respectively. Serious AEs were reported in 54 (1.6%) and 17 (1.3%) participants; 1 (spontaneous abortion) was considered possibly treatment related by the investigator. Using fixed-effects statistical meta-analysis, AEs of interest that were found to be statistically higher for onabotulinumtoxinA than placebo in the DBPC population were eyelid ptosis, eyelid sensory disorder, skin tightness, brow ptosis, eyelid edema, and facial pain (P≤.05). Retrospective, ad hoc analysis. This meta-analysis confirms the onabotulinumtoxinA safety profile for GL, CFL, and FHL treatment, with no new onabotulinumtoxinA-associated AEs.

Efficacy and safety of a home-use multi-energy-based device for skin tightening: a preclinical study

Efficacy and safety of a home-use multi-energy-based device for skin tightening: a preclinical study

42901 High-intensity, Parallel Ultrasound Tightening of Facial Skin: Clinical and Pathologic Results

42901 High-intensity, Parallel Ultrasound Tightening of Facial Skin: Clinical and Pathologic Results

New technologies for noninvasive aesthetic treatments

In recent years, the demand for noninvasive aesthetic treatments has increased significantly. New systems and technological innovations open new possibilities for practitioners and patients in the field of body contouring, noninvasive face lifting, skin tightening and rejuvenation, as well as effective therapies for urinary incontinence or erectile dysfunction. Currently, the most well-known innovations include technologies such as high-intensity focused electromagnetic field (HIFEM™) and radiofrequency (RF), which, after more than 30years of research, could be combined in the RF-SYNCHRODE™ (BTL Medizintechnik GmbH, Prague, Czech republic) without any health risks for the patient. This allows the reduction of adipose tissue and the building of muscle in asingle treatment. The newer HIFES™ technology was developed specifically for the treatment of the facial area and facial muscles. It is used with synchronized radiofrequency for noninvasive, painless face lifting and skin tightening, and is also suitable for botulinum toxin patients. Visible, noticeable, and long-lasting treatment results are achieved without significant side effects after only 4-6sessions. These noninvasive, FDA(Food and Drug Administration)- and CE-certified systems are used in everyday practice and clinical routine in dermatology, gynecology, urology, and physiotherapy and represent areal alternative to invasive aesthetic plastic surgery.

Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons.

Obesity is a growing global health concern, leading to various health issues, including diabetes. Semaglutide-based medications, such as Ozempic, Wegovy, and Rybelsus, have emerged as potential treatments. These medications, belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class, mimic the action of GLP-1, regulating appetite and promoting weight loss. Clinical trials have shown their effectiveness in reducing body weight and improving metabolic parameters. Ozempic, though Food and Drug Administration-approved for diabetes, is also used off-label for weight loss alone. Rapid weight and fat loss with Ozempic can lead to the characteristic "Ozempic face," where facial volume and fat are depleted, resulting in wrinkles and sagging skin. Providers prescribing Ozempic seldom counsel patients about the potential impact on the face. As a result, the plastic surgery community faces a challenge in managing facial changes associated with rapid weight loss. Dermal fillers, skin tightening techniques, and surgical interventions are useful for both restoration of facial volume and to manage excess skin. Discontinuation of Ozempic should be considered prior to general anesthesia due to gastrointestinal side effects including delayed gastric emptying. As the popularity of Ozempic grows, facial plastic surgeons must be aware of both the impact on facial appearance and perioperative considerations.

Lost in Translation.

"Scleroderma," the rheumatologist said after examining my stiff swollen arms and legs. "Unfortunately, given your biomarkers, it's likely to get worse before it gets better, but you never know." She gave a quick rundown of what I might expect-rapidly progressive skin and joint tightening, GI symptoms, high likelihood of multi-organ involvement…. "Let's hope for the best." She paused, then asked if I had any questions.

High intensity focussed ultrasound for skin tightening

High intensity microfocussed ultrasound (HIFU) is currently used for skin tightening and recently also for fat reduction. The HIFU uses bundled ultrasound waves that are focussed by a type of concave mirror to bundle thermal energy. The indications for HIFU include, in particular, sagging skin that does not need a plastic surgical operation for tightening. In most cases only one or two treatment sessions are needed. More expensive HIFU treatment can be further optimized by maintenance therapy with radiofrequency (RF). The greatest disadvantage of HIFU is that the treatment is very painful.

Extensive sclerodermoid signs in a pediatric patient after treatment for malignancy

AbstractA 17‐year‐old female with a history of acute lymphoblastic leukemia underwent hematopoietic stem cell transplantation. Over the following months, the patient experienced skin tightening, thickened patches on the trunk and limbs, limited joint mobility and other dermatological manifestations. The diagnosis of chronic sclerodermoid GVHD was confirmed by a skin biopsy. The patient improved with emollients and oral cyclosporine. Sclerodermoid GVHD is rare in pediatrics and its diagnosis may be misinterpreted or delayed. Early recognition is crucial in this challenging condition.This article is protected by copyright. All rights reserved.

Fractional microneedle radiofrequency - mechanism of action and assessment of safety, effectiveness in the treatment, and possible side effects based on a review of scientific literature

Introduction and purpose: 
 For all skin types, micro-needle radiofrequency (FMR) can be a safe and effective aesthetic medicine procedure for the treatment of various dermatological and aesthetic conditions. The aim of the study is to present the mechanism of action and assess safety, treatment efficacy, and possible side effects on the basis of a review of the scientific literature. 
 Description of the state of knowledge: 
 FMR uses micro-needles to penetrate the skin to a depth of up to 4.5 mm and deliver radiofrequency current in a fractional manner, producing the controlled fractions of micro-injuries in the dermis, inducing neocollagenesis, neoelastinogenesis, and angiogenesis. FMR has a wide range of positive effects such as skin rejuvenation, skin tightening, facial and body scar remodeling, and hair growth through transdermal collagen induction. 
 Summary: 
 Increasingly, patients are looking for minimally invasive methods of skin tightening and fat remodeling. In response, Aesthetic Medicine has proposed a combination of two techniques, micro-needling and radiofrequency. As more and more studies are showing the effectiveness and efficiency of this procedure, also emphasizing its safety, minimal risk of serious side effects, and ease of use, micro-needle radiofrequency is being proposed as an attractive answer to people's desires for a less invasive method of skin rejuvenation. However, further research in this area is needed to optimize the parameters of the treatment to achieve the best results.

CPC11 Immune checkpoint inhibitor-associated eosinophilic fasciitis: a case report

Abstract A 67-year-old man presented with a 3-month history of skin tightness associated with shooting, burning pains and numbness on both his upper and lower limbs. The patient had a background of metastatic bladder cancer, treated with six cycles of gemcitabine and cisplatin therapy from September 2019 to January 2020. Following this, he also had radical radiotherapy to the bladder, and in August 2020, he started pembrolizumab therapy. Pembrolizumab was paused in February 2022 due to the development of immunotherapy-related myositis. On examination, the patient had visibly shiny and thickened skin bilaterally involving the upper and lower limbs. Symptoms significantly limited the patient’s mobility and daily activities. A skin biopsy showed marked reduction in elastin fibres and mild fibromuscular thickening around the blood vessels, suggestive of scleroderma. Following a joint rheumatology and dermatology multidisciplinary meeting, a diagnosis of eosinophilic fasciitis (EF) secondary to the checkpoint inhibitor pembrolizumab was made. This was further supported by lower limb magnetic resonance imaging, which demonstrated evidence of bilateral oedema of the soleus muscle tendinous junction. Eosinophilic fasciitis is characterized by inflammatory infiltration, thickening and fibrosis involving the fascia. Unlike scleroderma, patients, such as in our case, with EF do not have sclerodactyly, Raynaud phenomenon, telangiectasias or nailfold capillary changes. Clinical manifestations of EF involve sudden onset, and pain and erythema (usually bilaterally) of the affected extremities. Patients have also been known to develop joint contractures, morphoea-like lesions and inflammatory polyarthritis. The reported triggers and causative agents of EF include trauma, autoimmune disorders and drugs. Only 13 cases have been reported secondary to pembrolizumab therapy, and the median time of symptom onset is 12 months following the commencement of checkpoint inhibitor treatment. According to the literature, there may be an underlying diagnosis of a solid tumour, haematological disorder or autoimmune disease. High-dose prednisolone is the primary treatment of choice, followed by methotrexate. However, some patients have shown spontaneous recovery. Our patient has now started a treatment course of high-dose intravenous methylprednisolone and methotrexate. While the therapeutic outcome is too early to report, he has already noticed improvements in skin tightening of the lower limbs.

Three-dimensional analysis for measuring volumetric changes after a noninvasive treatment performed with a new system delivering microwave energy for unwanted abdominal fat reduction.

A growing demand for aesthetic treatments for localized abdominal unwanted fat has developed as a healthy lifestyle is not always able to improve abdomen appearance. The purpose of this retrospective nonrandomized observational study was to evaluate the efficacy and safety of a new device delivering microwaves energy for unwanted fat reduction, using three-dimensional (3D) imaging analysis. Twenty patients (both female and male) were treated in the abdominal area. Subjects received 4 treatments with the study device. Follow-up evaluations were conducted to estimate safety and efficacy. A Numerical Rating Scale (NRS) was used for pain assessment. Patient's 3D imaging analysis was performed at baseline and at 3 months follow-up. Finally, a satisfaction questionnaire was filled in by all the patients. All subjects completed the whole cycle of treatments and presented for the follow-up visits. Analysis of 3D imaging yielded a significantly reduction in circumference (cm) and volume (cm3 ), passing, respectively, from 85.2 ± 8.1 cm and 1950.6 ± 471.0 cm3 at baseline to 80.8 ± 8.2 cm and 1728.9 ± 490.9 cm3 (p < 0.001) at 3-months follow-up after the last treatment. According to the NRS results, the treatment was well tolerated. From the analysis of the satisfaction questionnaire the 90% of patients are interested in carrying out the same treatment in other body areas. With the use of three-dimensional imaging techniques, the efficacy of a new system delivering microwaves energy for the reduction of abdominal volume correlated to a subdermal fat reduction while preserving/improving skin tightening, was quantitatively and objectively demonstrated.

ORAL CARCINOMA IN A PATIENT WITH SYSTEMIC SCLEROSIS

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder characterized by fibrosis, vasculopathy, and inflammation. SSc's disease-related characteristics include skin tightness, puffy fingers, open ulcers, and multi-organ involvement. Studies have also identified a higher risk for the development of malignancy in SSc patients. A 56-year-old woman with SSc presented an asymptomatic white plaque of 20 × 25 mm in the right lower lip. Medical history revealed a previous diagnosis of breast cancer and current diagnosis of colorectal cancer. An incisional biopsy was performed, and histological examination showed architectural and cytological atypia of the full epithelial thickness, consistent with those of a severe, in situ dysplasia/carcinoma. The patient was referred to oncology services. Early localized stage diagnosis of in situ carcinoma of the oral cavity brings more favorable prognosis with better overall management, especially in individuals with SSc who presented systemic overlapping complications. Funding: CAPES. Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder characterized by fibrosis, vasculopathy, and inflammation. SSc's disease-related characteristics include skin tightness, puffy fingers, open ulcers, and multi-organ involvement. Studies have also identified a higher risk for the development of malignancy in SSc patients. A 56-year-old woman with SSc presented an asymptomatic white plaque of 20 × 25 mm in the right lower lip. Medical history revealed a previous diagnosis of breast cancer and current diagnosis of colorectal cancer. An incisional biopsy was performed, and histological examination showed architectural and cytological atypia of the full epithelial thickness, consistent with those of a severe, in situ dysplasia/carcinoma. The patient was referred to oncology services. Early localized stage diagnosis of in situ carcinoma of the oral cavity brings more favorable prognosis with better overall management, especially in individuals with SSc who presented systemic overlapping complications. Funding: CAPES.

Non-invasive skin tightening – An update

Non-invasive skin tightening – An update

Treatment and Prevention of Umbilical Sagging with Laser-assisted Liposuction: The New Happy Protocol.

Sagging of the periumbilical skin, also known as the "sad umbilicus," is one of the most common postoperative complications in liposuction. It is characterized by an increase in the width and decrease in the height of the umbilicus. Technological advances in power-assisted liposuction resulting in skin tightening have been central to improvements in the treatment of sagging skin. Laser-assisted liposuction is a procedure in which a laser fiber induces lipolysis and skin tightening. Laser treatment delivered using a 980-nm diode laser may result in up to 30% skin surface area contraction. The aim of this study was to describe a new technique called the "happy protocol" for the treatment and prevention of the sad umbilicus. The periumbilical region is treated using a 980-nm diode laser set to an output power of 20 W, with a total delivered energy of 5000 J. The developed technique may be applied to correct shape distortions or to create a natural-looking and aesthetically pleasant umbilicus during liposuction. A decrease in the width of the umbilicus followed by an increase in height are observed in the first postoperative days. Patients who were followed up for 7 months postoperatively showed positive aesthetic results. The final outcome was an oval-shaped umbilicus, with increased height and reduced sagging in the periumbilical region.

Other hyaluronic acid fillers and combination fillers

AbstractThe use of hyaluronic acid (HA) fillers has become increasingly popular in the cosmetic industry due to their efficacy and versatility. Common types of HA fillers include Restylane, Juvéderm, and Bolotero. Other various options available for HA fillers include the resilient HA fillers (RHA) collection, Revanesse versa, and Prevelle silk. The fillers can be used singularly or in combination to achieve a desired cosmetic outcome. The RHA collection line is the first FDA approved filler used to treat dynamic facial lines using a less rigid formula than earlier HA fillers and by uniquely adapting to facial movement, stretching, and repeated facial compression. Revanesse versa filler is designed to effectively address moderate to severe facial wrinkles, including nasolabial folds, with a focus on providing lasting results even after the HA filler has been absorbed. Other HA fillers such as Prevelle silk, Hydrelle, and Puragen contain 0.3% lidocaine for more tolerable treatment for moderate to severe facial lines. Examples of combination fillers include HA/botulinum toxin, HA/calcium hydroxyapatite (CaHA), and HA/poly‐ l‐lactic acid. To facilitate the administration of injections, HA fillers can also be mixed with agents such as lidocaine, lidocaine and epinephrine, normal saline, and sterile water to decrease viscosity. Furthermore, the use of CaHA in conjunction with microfocused ultrasound with visualization (MFU‐V) has shown to enhance skin tightness and neocollagenesis. Other applications of HA include utilization of its bacteriostatic effects to coat biomedical devices, as a material for bioink and tissue‐engineering, and to create novel formulations to further personalize cosmetic goals.

Increased anti-oxidative action compensates for collagen tissue degeneration in vitiligo dermis.

Vitiligo is a common depigmentation disorder characterized by the selective loss of melanocytes. In our daily clinic experience, we noticed that the skin tightness of hypopigmented lesions would be more evident in comparison to that of uninvolved perilesional skin in vitiligo patients. Therefore, we hypothesized that collagen homeostasis might be maintained in vitiligo lesions, irrespective of the substantial excessive oxidative stress that occurs in association with the disease. We found that the expression levels of collagen-related genes and anti-oxidative enzymes were upregulated in vitiligo-derived fibroblasts. Abundant collagenous fibers were observed in the papillary dermis of vitiligo lesions in comparison to uninvolved perilesional skin by electron microscopy. The production of matrix metalloproteinases that degraded collagen fibers was suppressed. The deposition of acrolein adduct protein, which is a product of oxidative stress, was significantly reduced in vitiligo dermis and fibroblasts. As part of the mechanism, we found upregulation of the NRF2 signaling pathway activity, which is an important defense system against oxidative stress. Taken together, we demonstrated that the anti-oxidative action and collagen production were upregulated and that the collagen degeneration was attenuated in vitiligo dermis. These new findings may provide important clues for the maintenance of antioxidant ability in vitiligo lesions.

Speed of clinical improvement in the real-world setting from patient-reported Psoriasis Symptoms and Signs Diary: Secondary outcomes from the Psoriasis Study of Health Outcomes through 12 weeks.

Rapid skin improvement is a key treatment goal of patients with moderate-to-severe psoriasis (PsO). To compare the speed of clinical improvement of approved biologics on the symptoms and signs of psoriasis assessed by patients using the validated Psoriasis Symptoms and Signs Diary (PSSD) through 12 weeks. Psoriasis Study of Health Outcomes (PSoHO) is an international, prospective, non-interventional study that compares the effectiveness of anti-interleukin (IL)-17A biologics versus other biologics, together with pairwise comparisons of ixekizumab versus five individual biologics in patients with PsO. Using the PSSD 7-day recall period, patients assessed the symptoms (itch, skin tightness, burning, stinging and pain) and signs (dryness, cracking, scaling, shedding/flaking, redness and bleeding) of their psoriasis (0-10). Symptom and sign summary scores (0-100) are derived from the average of individual scores. Percentage change in summary scores and proportion of patients with clinically meaningful improvements (CMI) in PSSD summary and individual scores are evaluated weekly. Longitudinal PSSD data are reported as observed with treatment comparisons analysed using mixed model for repeated measures (MMRM) and generalized linear mixed models (GLMM). Across cohorts and treatments, eligible patients (n = 1654) had comparable baseline PSSD scores. From Week 1, the anti-IL-17A cohort achieved significantly larger score improvements in PSSD summary scores and a higher proportion of patients showed CMIs compared to the other biologics cohort through 12 weeks. Lower PSSD scores were associated with a greater proportion of patients reporting their psoriasis as no longer impacting their quality-of-life (DLQI 0,1) and a high level of clinical response (PASI100). Results also indicate a relationship between an early CMI in PSSD score at Week 2 and PASI100 score at Week 12. Treatment with anti-IL-17A biologics, particularly ixekizumab, resulted in rapid and sustained patient-reported improvements in psoriasis symptoms and signs compared with other biologics in a real-world setting.

Treatment Protocol on Using Microfocused Ultrasound with Visualization for Skin Quality Improvement: The Korean Experience.

Facial skin quality profoundly influences an individual's perceived appearance and is an important aspect of facial rejuvenation. Facial pore enlargement is one of the most common concerns among Asian individuals that adversely impacts perceived skin surface evenness and affects overall skin quality. One of the major causes of enlarged pores is facial skin laxity. Microfocused ultrasound with visualization (MFU-V; Ultherapy; Merz North America, Inc., Raleigh, N.C.) is indicated for lifting and tightening of the face and neck, and improving the appearance of wrinkles on the décolletage. In addition, it is useful for addressing several aspects of facial rejuvenation, including facial pores, skin laxity, skin unevenness, etc., but there is limited literature on these applications. Thus, we present our proposed MFU-V treatment protocol for achieving a harmonious outcome for attractive skin, along with practical strategies for its application, illustrated in patients presenting with enlarged pores as their main concern. Drawing on our collective experience in using MFU-V for facial rejuvenation and the recently published skin quality framework that advocates addressing interrelated attributes of skin quality for optimal outcomes, we developed a treatment protocol for improving skin quality using MFU-V. This MFU-V treatment protocol reliably improves overall skin quality in patients presenting with enlarged pores, through MFU-V's effects on skin lifting and tightening, and consequent improvement in facial pores and skin texture. This treatment protocol can be readily used as part of a multimodal layering approach to yield successful outcomes in patients with various facial skin concerns.