Dong Hye Suh

Intense focused ultrasound tightening in Asian skin: clinical and pathologic results.

BACKGROUND Laxity and wrinkles of the aging face are common cosmetic concerns. Intense focused ultrasound (IFUS), a novel treatment modality for skin laxity, produces thermal effects at various depths while sparing overlying epidermis. OBJECTIVE To evaluate the safety and efficacy of IFUS in facial skin tightening. METHODS AND MATERIALS Twenty‐two Korean patients with facial laxity were analyzed after a single IFUS treatment. Patient assessments were recorded, and two blinded, experienced clinicians who assessed improvement of nasolabial folds and jaw tightening evaluated photographs of patients and rated skin laxity. Skin biopsies were taken from 11 patients before and 2 months after treatment. RESULTS Objectively, nasolabial folds and jaw lines were improved in all patients. Subjectively, 77% of patients reported much improvement of nasolabial folds, and 73% of patients reported much improvement at the jaw line. Histologic evaluation of skin biopsy samples using hematoxylin and eosin and Victoria blue stains showed greater dermal collagen with thickening of the dermis and straightening of elastic fibers in the reticular dermis after treatment. CONCLUSION IFUS is a safe, effective, noninvasive procedure to tighten the facial skin of Asian patients. Improvement is associated with greater production of dermal collagen and straightening of dermal elastic fibers. The authors have indicated no significant interest with commercial supporters.

Outcomes of polydioxanone knotless thread lifting for facial rejuvenation.

BACKGROUND Thread lifting is a minimally invasive technique for facial rejuvenation. Various devices for thread lifting using polydioxanone (PDO) are popular in aesthetic clinics in Korea, but there have been a few studies regarding its use. OBJECTIVE To describe PDO thread and techniques adopted to counteract the descent and laxity of the face. METHODS A retrospective chart review was conducted over a 24-month period. A total of 31 thread lifting procedures were performed. On each side, 5 bidirectional cog threads were used in the procedure for the flabby skin of the nasolabial folds. And, the procedure was performed on the marionette line using 2 twin threads. RESULTS In most patients (87%), the results obtained were considered satisfactory. Consensus ratings by 2 physicians found that objective outcomes were divided among “excellent,” “good,” “fair,” and “poor.” Texture wise, the outcome ratings were 13 as excellent and 9 as good. Lifting wise, ratings were 11 as excellent and 6 as good. The incidence of complications was low and not serious. CONCLUSION Facial rejuvenation using PDO thread is a safe and effective procedure associated with only minor complications when performed on patients with modest face sagging, fine wrinkles, and marked facial pores.

Comparative histometric analysis of the effects of high-intensity focused ultrasound and radiofrequency on skin

Abstract Introduction: High-intensity focused ultrasound (HIFU) and radiofrequency (RF) are used for non-invasive skin tightening. Neocollagenesis and neoelastogenesis have been reported to have a mechanism of controlled thermal injury. Objective: To compare neocollagenesis and neoelastogenesis in each layer of the dermis after each session of HIFU and monopolar RF. Methods: We analyzed the area fraction of collagen and elastic fibers using the Massons Trichrome and Victoria blue special stains, respectively, before and after 2 months of treatments. Histometric analyses were performed in each layer of the dermis, including the papillary dermis, and upper, mid, and deep reticular dermis. Results: Monopolar RF led to neocollagenesis in the papillary dermis, and upper, mid, and deep reticular dermis, and neoelastogenesis in the papillary dermis, and upper and mid reticular dermis. HIFU led to neocollagenesis in the mid and deep reticular dermis and neoelastogenesis in the deep reticular dermis. Among these treatment methods, HIFU showed the highest level of neocollagenesis and neoelastogenesis in the deep reticular dermis. Conclusions: HIFU affects deep tissues and impacts focal regions. Monopolar RF also affects deep tissues, but impacts diffuse regions. We believe these data provide further insight into effective skin tightening.

Transient median and ulnar neuropathy associated with a microwave device for treating axillary hyperhidrosis.

An antineoplastic agent derived from Streptomyces, mitomycin C inhibits DNA synthesis by cross-linking strands of the DNA double-helix, preventing tissue proliferation. Historically, mitomycin C has proven successful in the fields of ophthalmology and tracheal surgery. Early case reports in the use of resection and adjuvant mitomycin C to treat keloids were equivocal, although the concentration of mitomycin C used in these early case reports was low (0.4 mg/mL). Gupta and Narang, in a 2010 review, successfully treated 26 pinna keloids by applying a higher concentration of mitomycin C (1 mg/mL) immediately postoperatively and 3 weeks after surgery. We have also found success with a higher concentration and staggered application of mitomycin C.

Non-invasive cryolipolysis to reduce subcutaneous fat in the arms.

Background: Cryolipolysis received U.S. Food and Drug Administration clearance for reducing fat from the flanks, abdomen, and thighs. The upper arms are an off-label indication for cryolipolysis, and outcome data on reducing fat from the arms using a cryolipolytic device has rarely been published. Objective: This pilot study evaluated cryolipolysis to reduce upper arm fat. Materials and methods: A flat vacuum applicator was used to treat seven subjects in a single-side study. The patients underwent one cycle of upper-arm cryolipolysis treatment, and the contralateral arm served as a control. Follow-up was conducted at 8 weeks. Equalization treatments were delivered subsequently to the opposite arm. Efficacy was evaluated by ultrasound imaging, physicians assessment, and patient satisfaction. Side effects and adverse events were monitored. Results: Ultrasound measurements showed a decrease in the fat layer at 83.3% of the 12 measured sites. The mean reduction in fat layer thickness was 15.3%, corresponding to 2.03 mm. A significant difference was detected between baseline and 8-week assessments (p = 0.001). Conclusion: One treatment using a flat vacuum cryolipolysis applicator was safe and effective to reduce arm fat.

An open-label, split-face trial evaluating efficacy and safty of photopneumatic therapy for the treatment of acne.

Background Acne vulgaris is the most common skin disease worldwide, with many available treatment modalities, including oral and topical medications and laser therapy. Recently, a novel device (Isolaz, Pleasanton, CA, USA) that combines vacuum pressure and a broadband light source (400 nm to 1,200 nm) was developed for the treatment of acne. Objective To determine the clinical efficacy and safety of photopneumatic therapy for the treatment of acne vulgaris of the face. Methods Twenty adults with mild to moderate facial acne vulgaris received 4 successive treatments on one side of the face with a combined photopneumatic device (intense pulsed light: fluence=5.8 J/cm2; negative pressure=iMP mode) at 2 week intervals. Acne lesions on the opposite side of the face were not treated. Lesion counts were performed at baseline, prior to each treatment session, and at 3 months after the final treatment session. Results Significant lesion improvements and reduced numbers of acne lesions were observed on the treated side of the faces. Most patients experienced global clinical improvement. No severe side effects occurred during the study, with only a few patients experiencing transient erythema, purpura and/or exacerbation of pre-existing acne. Conclusion Photopneumatic therapy is a safe and effective treatment for mild to moderate acne vulgaris.

A case of motor neuropathy after cryolipolysis of the arm

Cryolipolysis treatment is a non-invasive option for localized fat reduction without damaging the surrounding tissue. Clinical studies about cryolipolysis show various side effects, including temporary erythema, bruising, and transient numbness. But, no reports are available on motor nerve malfunction after cryolipolysis. A 24-year-old female received cryolipolysis treatment on abdomen, both arms. After 10 days, patient complained of weakness and inability to lift heavy objects. Symptoms continued for 6 months, and fully recovered without treatment. Thus, we report a case of motor neuropathy after cryolipolysis, which is a rare complication of cryolipolysis.

Monopolar Radiofrequency Treatment in Asian Skin: Do Multiple RF Treatments Over Time Have Beneficial Effects? An Observational Report with Long-Term Follow-Up in Eight Patients

Monopolar radiofrequency (MRF) is a valuable modality that can be used to effectively tighten and rejuvenate photo-aged skin with little downtime and has emerged as a standard for nonsurgical tissue tightening. The ThermaCool system (Thermage, Inc., Hayward, CA) is a noninvasive nonablative device that uses MRF energy to tighten the skin. Since its approval by the U.S. Food and Drug Administration in 2002 for rhytides, a number of articles have been published on MRF with data supporting its clinical efficacy. Although MRF is a commonly used modality in dermatologic settings, little is known of the beneficial effects that multiple RF treatments can give over time. To determine the long-term effects of multisession MRF, we reviewed the charts and clinical photographs of eight Asian patients who received MRF at regular intervals.

Monopolar radio-frequency treatment in Asian skin: a questionnaire-based study.

The ThermaCool ® system (Thermage ® , Inc., Hayward, CA, USA) is a non-invasive, non-ablative device that uses monopolar radio-frequency (MRF) energy to tighten the skin (1). Since its approval by the US Food and Drug Administration in 2002 for rhytides, there have been a number of publications on monopolar RF with data supporting its clinical effi cacy (2). However, little is known of Thermage in Asian skin. It is generally recognized that Asian and European skin age differently. With a greater elastic nature and solar protection, there is a delayed onset of wrinkles in Asians (3). Instead, the Asian face tends to age principally due to gravitational descent. The thicker dermis with a greater amount of collagen, heavier malar fat pad, and weaker skeletal support all contribute to considerable facial sagging compared to Caucasians (4). Owing to the differences in the intrinsic properties of the skin, MRF may not be equally effective in Asians and Caucasians. In this study, the general opinion of dermatologists practicing Thermage in Asians is described to better understand its indications, benefi ts and limitations in Asian skin.

Intense focused ultrasound for facial tightening: Histologic changes in 11 Patients

Abstract Introduction: Intense focused ultrasound (IFUS) is a novel modality for treating skin laxity that produces thermal effects at various depths while sparing the overlying tissue. This study assessed histologic changes and the safety and efficacy of intense focused ultrasound (DoubloTM, HIRONIC Co., Sungnam, Korea) for tightening of facial skin in Asian patients. Methods: Eleven patients with facial laxity were treated with IFUS and evaluated before and after treatment. Mean age was 46 years (range, 35–64 years). Two available hand-pieces with different focal depths (3 mm and 4.5 mm) were used with three to five passes 1–2 mm apart. Outcome assessment included photographic evaluation by two blinded investigators, skin biopsies before and two months after treatment, and patient satisfaction. Results: Subjective and objective analyses showed 63.6% and 72.7% improvement at the two-month evaluation, respectively. Histologic evaluation by hematoxylin and eosin (H&E) and Massons trichrome staining showed increased collagen fibers in the lower dermis and between fat layers. Discussion and conclusions: Intense focused ultrasound can be used as a non-invasive skin tightening technique in Asian patients. It induced collagen generation in the dermis and fat layers and was effective and safe in our study population.