Ji Yeon Hong

A potential relationship between skin hydration and stamp-type microneedle intradermal hyaluronic acid injection in middle-aged male face

There is an increasing interest in skin rejuvenation using hyaluronic acid (HA) fillers beyond the improvement of deep wrinkles and volume deficiencies, which have been primary research foci in the past. We conducted a pilot study using a sample of six middle‐aged male subjects. Using an automatic intradermal injector with 0.020 mL of material contained in each injection point with a total of 100 points, 2 mL of non‐cross‐HA filler was injected into the entire face at every treatment session. We administered injections of HA for a total of three sessions per subject at 2‐week intervals and evaluated the results using a corneometer, TEWL, cutometer, measures of patient satisfaction, and the global aesthetic improvement scale (GAIS). Corneometer values increased steadily at each measurement, while the average value of TEWL increased in comparison with baseline after each application of the procedure. However, values returned to readings similar to those at 4 weeks after complete termination of the procedures. Cutometer values differed between the baseline and after procedures. All patients were assessed as “very much improved” or “much improved” according to GAIS, and all were pleased with the outcomes of treatment in terms of the enhancement of moisture, elasticity, and brightness.

Chronic, intractable nodules after filler injection successfully treated with a bipolar radiofrequency device

Nodules are frequently observed after soft tissue augmentation. Chronic and intractable nodules that persist for months despite such procedures may become increasingly fibrotic, and thus require excision due to the possibility of foreign body granuloma. A 48-year-old female presented with multiple skin-colored nodularities on her forehead. She had received hyaluronic acid (HA) filler injections for forehead volume augmentation one year prior. The patient was treated using a minimally invasive intradermal needle RF device twice at 1-week intervals. The treatment resulted in significant improvement of the forehead contour. We suggest bipolar RF as an effective and safe treatment method for implant nodules.

Efficacy and safety of non-invasive body tightening with high-intensity focused ultrasound (HIFU)

Noninvasive skin‐tightening devices have become increasingly popular in response to increasing demand for improvements in skin laxity and tightening with minimal risk and recovery time.

Skin necrosis after filler-associated vascular compromise: successful treatment with topical epidermal growth factor

Dear Editors, Vascular compromise that leads to skin necrosis is one of the most concerning complications of filler injection. It is usually caused by direct vascular injury, perivascular compression by excessive filler volume or intravascular obstruction because of the filler material itself. Filler-induced necrotic wounds are difficult to treat and are likely to leave a permanent scar. Affected patients might experience depression as a result of the opposite outcome of what was expected after cosmetic soft tissue augmentation. In this study, we report the effects of topical epidermal growth factor (EGF) solution on wound healing in a case of filler-induced facial skin necrosis. A 42-year-old female presented with a diffuse dusky red painful patch on the right nasolabial fold, cheek and nasal dorsum (Figure 1). She had received a hyaluronic acid (HA) filler injection in both nasolabial folds the day before presentation. Hyaluronidase was injected immediately into the lesional site to resolve and disperse the HA filler materials. Sublingual nitroglycerin and low-dose aspirin were also prescribed to increase lesional blood flow and to prevent further clot formation, respectively. A wet dressing was applied twice daily until no newly developed pustules were observed at day 5. Then, we applied topical recombinant human epithelial growth factor solution (EASYEF 0.005%, Daewoong Pharmaceutical Co., Ltd., Seoul, Korea) to the occlusive wet dressing applied to the necrotic ulcer once daily for 2 weeks. The wound showed gradual reepithelisation and was completely resolved after 4 weeks, leaving no residual scarring (Figure 2). EGF has been administered to enhance the healing process in various kinds of wounds. EGF is known to promote

Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment

BACKGROUND Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. OBJECTIVE The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. METHODS The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. RESULTS The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. CONCLUSION Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

Protective effects of fermented honeybush (Cyclopia intermedia) extract (HU-018) against skin aging: a randomized, double-blinded, placebo-controlled study

ABSTRACT Background: Oxidative stress and photodamage resulting from ultraviolet radiation exposure play key roles in skin aging. Fermented Cyclopia intermedia, which is used to brew honeybush tea, exerts antioxidant and anti-wrinkle effects by inhibiting reactive oxygen species production and downregulating matrix metalloproteinase activity. Objectives: This randomized, double-blinded, placebo-controlled study aimed to evaluate the efficacy and safety of fermented honeybush (Cyclopia intermedia) extract (HU-018) for skin rejuvenation. Methods: 120 Korean subjects with crow’s feet wrinkles were randomized to receive either low-dose extract (400 mg/day), high-dose extract (800 mg/day), or placebo (negative control, only dextran) for 12 weeks. Wrinkles were evaluated using JANUS® and PRIMO pico®. Skin elasticity, hydration and transepidermal water loss were measured. Results: Global skin wrinkle grade was significantly improved in both low-dose and high-dose groups compared to placebo group, as well as for skin hydration and elasticity. Both the low- and high-dose groups showed significantly decreased TEWL compared to the placebo group. There were no adverse effects during the entire study period. Conclusion: Our data indicate that HU-018 is effective for improving skin wrinkles, elasticity, and hydration. Therefore, daily supplementation with fermented honeybush could be helpful for protecting against skin aging.

A review of hydrolifting: A new modality for skin rejuvenation

ABSTRACT Background: Hydrolifting is a newly developed modality of skin rejuvenation, which enhances overall facial volume augmentation and recovers skin thickness through multi-pass HA injection. Although it is commonly performed, only a few articles have reported on the rejuvenating effects of hydrolifting. Moreover, clear protocols and possible mechanisms of the procedure have not been elucidated. Objective: To define a novel technique for injecting HA and to clarify how to choose an appropriate HA filler based on the procedural purpose. Methods: This article is based on a review of the medical literature and the authors’ clinical experience in investigating and treating skin wrinkles with the hydrolifting method. Results: In hydrolifting, HA filler serves as a hydration source, dermal volumizer, and stimulator of dermal collagen and antioxidants. Hydrolifting is frequently indicated in minor wrinkles, minor volume depletion and rough skin texture. Conclusion: The hydrolifting method is a newly introduced antiaging treatment modality. It effectively covers the blind spots of conventional HA injection, such as infraorbital, perioral and hand dorsal wrinkles. However, further investigations are needed to reach a consensus on the basic concepts of treatment, choice of appropriate fillers and optimal technique in hydrolifting.

Efficacy and safety of a novel, soluble microneedle patch for the improvement of facial wrinkle

Various kinds of functional cosmetics are on the market, although there are a variety of opinions concerning the actual effect. Transdermal microneedle patch has been introduced as a newly developed device for drug delivery through the skin.

Brimonidine tartrate gel plus topical steroid for the prevention of laser therapy-related postinflammatory hyperpigmentation

Brimonidine gel, originally approved for the treatment of facial rosacea, causes direct vasoconstriction and possesses extensive utilization in dermatologic fields. A Q‐switched (QS) neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser is generally used to treat solar lentigo (SL), often leaving unwanted postinflammatory hyperpigmentation (PIH), especially in dark‐skinned individuals. A 58‐year‐old man with Fitzpatrick skin type IV presented to remove solar lentigines from his face. Prior to and after laser treatment, topical brimonidine gel and steroid cream were applied. In this study, we investigated whether topical application of the α‐adrenergic receptor agonist brimonidine could reduce PIH after QS laser treatment of lentigine in a dark‐skinned patient.

Impending skin necrosis after dermal filler injection: A “golden time” for first‐aid intervention

Vascular compromise with impending skin necrosis is one of the most serious potential complications. Early recognition of vascular occlusion and swift and aggressive treatment are required to avoid any irreversible changes. However, initial symptoms of a vascular event are often dismissed as simple post‐procedural discomfort. If more than 3 days pass after filler injection, crust formation is initiated over the erythematous base along with a rim of fibrous tissue. Due to the replacement of normal tissues by fibrous material, the healing process may result in scar formation in spite of debridement and aggressive dressing changes. Scars often cause contracture and subsequent cosmetic disfigurement, which results in a traumatic burden to the patient. By sharing our experience of the patients with filler induced skin necrosis, we suggest that treatment should be initiated no later than 3 days after the procedure.