Mariana Soirefmann

Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging.

BACKGROUND Cellulite is characterized by alterations in the relief of the skin surface. Magnetic resonance imaging (MRI) is recognized as a reliable technique for measuring adipose volume according to body site and for the visualization of the subcutaneous structures. OBJECTIVE To compare subcutaneous tissue in areas with and without cellulite on the buttocks of same subjects using a noninvasive technique. METHODS AND MATERIALS Thirty female patients with cellulite on the buttocks underwent MRI. An area with cellulite and another without cellulite on the contralateral buttock were selected. Two soft gelatin capsules of different sizes were used as skin markers to differentiate the areas with and without cellulite. RESULTS Fibrous septa were visualized in 96.7% of the area with cellulite depressions; most of them were ramified (73.3%) and presented a high‐intensity signal on T2 images (70%). All fibrous septa found in the examined areas were perpendicular to the skin surface. The average fibrous septa thickness was 2.18 ± 0.89 in the area with cellulite and 0.27 ± 0.64 in the area without cellulite. CONCLUSION Results of the MRI analysis showed that cellulite depressions on the buttocks were significantly associated with the presence of underlying fibrous septa.

Cosmeceuticals for Cellulite

Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue.

Field effect of two commercial preparations of botulinum toxin type A: A prospective, double-blind, randomized clinical trial

BACKGROUND The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.

Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds.

BACKGROUND Injection‐related side effects and complications are likely to occur during or after filler injections; they are mainly caused by the injection technique. OBJECTIVE To assess safety and efficacy of a metallic cannula to inject hyaluronic acid (HA) filler in the nasolabial folds and to compare the safety of this cannula with that of a standard needle. METHODS This was a prospective, randomized, phase II, double‐blinded study that included 25 participants with Grade 2 to 3 for bilateral nasolabial folds according to the Modified Fitzpatrick Wrinkle Scale (MFWS). The side of the injection was randomized (cannula or needle), and 0.5 mL of HA was injected into each nasolabial fold. RESULTS At day 3, mean MFWS score fell from 2.40 ± 0.40 to 1.46 ± 0.52 (p < .001) on the cannulainjected side and from 2.40 ± 0.40 to 1.48 ± 0.60 (p < .001) on the regular needle‐injected side. Participants reported fewer side effects on the side injected with the new tool on the day of the injections: pain (p = .03), edema (p < .001), redness (p = .01) and hematoma (p < .001) than on the needle side. CONCLUSION The new cannula is a safe and useful tool to inject HA fillers in the nasolabial folds, producing less pain, edema, hematoma, and redness than regular needles.

Recommendations for Performing and Evaluating the Results of the Minor Test According to a Sweating Intensity Visual Scale

&NA; The authors have indicated no significant interest with commercial supporters.

Superficial Dermabrasion Versus Topical Tretinoin on Early Striae Distensae: A Randomized, Pilot Study

BACKGROUND Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. OBJECTIVES To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. MATERIALS AND METHODS Prospective, single‐center, randomized, open‐label study. Thirty‐two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. RESULTS Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. CONCLUSION Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients.

Increasing the Field Effects of Similar Doses of Clostridium botulinum Type A Toxin–Hemagglutinin Complex in the Treatment of Compensatory Hyperhidrosis

H yperhidrosis (HH) is characterized by excessive sweating, usually exceeding thermoregulatory needs. Medical and surgical treatments can be used, depending on the type, location, and severity of the HH. Thoracic sympathectomy is indicated for selected cases of severe palmar HH, but the procedure may result in troublesome compensatory HH (CHH). Injections of botulinum toxin type A can temporarily interrupt sweating, and this new therapeutic option has emerged as a treatment for many forms of focal HH, including CHH. Because the diameter of the field effects (FEs) resulting from the injection of botulinum toxin type A is about 2 cm, a number of injections are needed to treat different forms of HH. Herein, we describe a series of 3 women with CHH of the trunk occurring after thoracic sympathectomy. All 3 patients were treated with 5 U of Clostridium botulinum type A toxin–hemagglutinin complex (hereinafter “Dysport”; Ipsen Limited, Slough, England) at different dilutions and injected at different depths.

Fields of muscular and anhidrotic effects of 2 botulinum toxin-A commercial preparations: a prospective, double-blind, randomized, multicenter study.

BACKGROUND Longevity of effects and dose equivalence of different botulinum toxin type A (BoNT-A) preparations need to be better clarified because BoNT-A units are manufacturer-specific. These points are of particular importance for new brands emerging in the market. OBJECTIVE To assess the field of muscular and anhidrotic effects of 2 commercial preparations of BoNT-A (incobotulinumtoxinA: Xeomin [XEO]; abobotulinumtoxinA: Dysport [DYS]) administered to the upper third of the face. METHODS Patients were randomized for the side of the forehead (left or right) in which the products were administered. All were treated receiving BoNT-A injections in 10 points (5 on each side) at a dose equivalence of 1.0:2.5 U (XEO:DYS). Clinical assessments and Minor test were performed at baseline and Days 28, 84, 112, and 140. Electromyography was performed at baseline and Days 28 and 140, and ultrasound was performed only at baseline. RESULTS Eighty patients were enrolled in 2 research centers. Xeomin and DYS presented similar results regarding fields of muscular effects. However, a larger field of anhidrotic effects was found for DYS. There was a positive correlation between the muscle thickness and electromyography results. CONCLUSION The results of this study suggest that a lower dose equivalence between DYS and XEO could be established.

Reduction of Cellulite with Subcision

Subcision® is a simple surgical technique used for the treatment of cutaneous depressions. It was originally described by Orentreich and Orentreich for the treatment of cutaneous scars and wrinkles in 1995.1 (level of evidence *C) Subsequently, Subcision® was reported for the treatment of cellulite and liposuction sequella by Hexsel and Mazzuco in two series of cases with 462 (*C) and 2323 (*C) patients.3 Subcision® has also been reported for the treatment of atrophic depressed scars4 (*C), acne scars5 (*C), stretch marks6 (*B), and auricular deformities in rabbits7 (*C).

Fields of anhidrotic effects of abobotulinumtoxinA in patients with compensatory hyperhidrosis.

BACKGROUND Botulinum toxin type A can be used to treat compensatory hyperhidrosis (CHH), which presents areas of different intensity of sweating. More information about the anhidrotic effects is needed. OBJECTIVE To evaluate the fields of anhidrotic effects (FAEs) resulting from different doses (5 and 10 U), dilution, and depths of injection of abobotulinumtoxinA in patients with CHH. METHODS This was a prospective, single-center, pilot study. Ten patients suffering from CHH received 20 different injections of abobotulinumtoxinA on their backs. Midline received higher doses because of more intense sweating. The diameters of the FAEs were measured at 7, 30, and 180 days after the procedure. RESULTS Diameters of the FAEs were significantly larger at Day 30 (p < .0001) and did not significantly differ when compared with different injection depths and volumes. Points injected with 10 U exhibited significantly larger vertical diameters at 7, 30, and 180 days (p values .05, <.0001, and .043, respectively) than those injected with 5 U, but no statistical significance was observed for the horizontal diameters. CONCLUSION Areas of more intense sweating need higher doses to present similar diameters of the FAEs. Depth and volume of injections do not play a remarkable role on the FAEs diameters in patients suffering from CHH.