Sabrina G. Fabi

Retrospective Evaluation of Micro-focused Ultrasound for Lifting and Tightening the Face and Neck

BACKGROUND Microfocused ultrasound (MFU) is an effective means for tightening and lifting lax facial and neck skin. OBJECTIVE To evaluate the safety and efficacy of MFU with visualization (MFU‐V) for noninvasive treatment of facial and neck skin laxity 180 days after treatment and determine what lifestyle factors affect treatment outcomes. MATERIALS AND METHODS Healthy women (N = 48) previously treated with MFU‐V on the face and upper neck were enrolled. Depending on when MFU‐V treatment occurred, subjects completed 90‐ or 180‐day follow‐up visits or both. Digital images of each subject were obtained before treatment and at follow‐up visits. RESULTS Data were obtained at 90 (N = 16) and 180 days (N = 45), and physician Global Aesthetic Improvement Scale (GAIS) scores demonstrated that 81.3% and 77.7% patients achieved improvement, respectively. At 90 and 180 days, subject GAIS scores showed 75% and 77.8% of subjects perceived improvement, respectively. At 180 days, blinded reviewer assessments indicated that 67% of subjects showed improvement in appearance. There was no association between improvement and age, Fitzpatrick skin type, alcohol intake, or major illness. One minor adverse event was reported. DISCUSSION Although the data obtained at 90 days must be interpreted cautiously because of the smaller number of patients, subjects achieved significant lifting and tightening of facial and neck skin up to 180 days after one MFU treatment.

Combination of intense pulsed light, Sculptra, and Ultherapy for treatment of the aging face

Facial aging is a gradual process that involves a complex interaction of multiple factors including cutaneous photodamage and laxity, subcutaneous tissue volume loss, and bony resorption. These features have all been show to significantly improve with intense pulsed light (IPL), microfocused ultrasound (MFUS, Ultherapy), and poly‐L‐lactic acid (PLLA).

Treatment of melasma with the 1,927-nm fractional thulium fiber laser: A retrospective analysis of 20 cases with long-term follow-up†‡

Melasma is a common acquired symmetrical hyperpigmentation that is often recurrent and refractory.

Monopolar radiofrequency for skin tightening: our experience and a review of the literature.

BACKGROUND Effective nonablative skin tightening has become a reality. There are many devices that are now available. OBJECTIVE To create a concise reference material for existing and new practitioners who wish to be updated about the available technologies. MATERIALS AND METHODS The authors reviewed the literature from the points of view of efficacy and safety and availability. RESULTS The increasing number of nonablative systems all seem to be effective and safe when used in the recommended manner. CONCLUSION Radiofrequency energy can be applied to human facial, neck, and body skin to create tightening without surgical incisions and recovery time.

Photodynamic Therapy: A Clinical Consensus Guide.

BACKGROUND The American Society of Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Advances in photodynamic therapy (PDT) have been many and PDT use has been established in a variety of skin conditions. OBJECTIVE The ASDS board of directors proposed a committee of experts in the field to develop consensus documents on different treatments. An expert panel reviewed the literature on PDT and discussed the findings. The consensus was reached with evidence-based recommendations on different clinical applications for PDT. PATIENTS AND METHODS This consensus document includes discussions regarding PDT, including different photosensitizers and various light source activators, historical perspective, mechanism of action, various therapeutic indications and expected outcomes, pre- and post-care, and management of adverse outcomes. RESULTS Photodynamic therapy is highly effective for pre-cancerous lesions, superficial nonmelanoma skin cancers, inflammatory acne vulgaris and other conditions. New protocols including laser mediated PDT significantly improve results for several indications. CONCLUSION The ASDS consensus document on PDT will be helpful for educating members on safe and effective PDT for a variety of indications.

Comparison of Intense Pulsed Light with 1,927-nm Fractionated Thulium Fiber Laser for the Rejuvenation of the Chest

BACKGROUND Rejuvenation of the aging chest is important to prevent noticeable disparities between the treated skin of the face and that of the untreated chest. OBJECTIVE To compare a high‐density thulium fiber laser (TFL)‐based protocol for the rejuvenation of the aging chest with intense pulsed light (IPL). METHODS AND MATERIALS We conducted a retrospective chart review comparing patients treated with IPL and those treated with TFL in combination with a quality‐switched alexandrite laser and long pulsed dye laser. Blinded photographic assessment of overall improvement, rhytides, skin texture, dyspigmentation, and telangiectasia was performed. Patient satisfaction was assessed in a standardized follow‐up survey. Cost and practicality were compared. RESULTS At a mean follow‐up of 45.8 days for IPL and 78.3 days for TFL, the two protocols had comparable clinical efficacy in achieving rejuvenation of the chest. Differences existed in terms of cost and practicality. CONCLUSION TFL can be used at high density and in simultaneous combination with other targeted laser modalities to achieve rejuvenation of the aging chest. IPL achieves similar clinical efficacy. The choice between treatment modalities depends on physician and patient preferences.

Complications in the Cosmetic Dermatology Patient: A Review and Our Experience (Part 1).

BACKGROUND Over recent decades, the options available to patients for cosmetic rejuvenation have expanded dramatically. The range of options commonly available to patients now includes neuromodulators, fillers, sclerotherapy, chemical peels, liposculpture, lasers, and lights and other energy devices and continues to grow. As with all therapeutic interventions, these cosmetic dermatologic procedures are not without risk. Timely recognition of complications and intervention are paramount for optimal patient outcomes. OBJECTIVE Part 1 of this review will focus on the common complications of injectable cosmetic procedures, such as neuromodulators, fillers, and sclerotherapy. The second part will discuss the complications of chemical peels, lasers, light and energy devices, and fat removal procedures. MATERIALS AND METHODS A MEDLINE search was performed on cosmetic dermatology complications from 1989 to 2015, and results are summarized. Practical considerations of these complications are also provided. RESULTS Reports of complications after neuromodulator, injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate, sclerotherapy, fat transfer, liposuction, cryolipolysis, chemical peels, lasers, and light sources, such as Q-switched laser, intense pulsed light, nonablative and ablative resurfacing lasers, were found. CONCLUSION Review of the literature revealed multiple management options for potential complications of the multitude of cosmetic dermatology procedures now available to patients.

Neurotoxins: Current Concepts in Cosmetic Use on the Face and Neck--Lower Face.

Summary: Botulinum toxin A was Food and Drug Administration approved in 2002 for the temporary correction of glabellar frown lines. Since that time, a variety of neuromodulators have established a convincing profile for both safety and efficacy in the treatment hyperdynamic rhytides of the upper face. With increasing clinical experience and expertise, these applications have been expanded to include targeted treatment of muscles in both the mid and lower face. This article details common techniques using botulinum toxin to treat orbicularis oris, depressor anguli oris, mentalis, and masseter muscles for the temporary correction of unwanted lower face hyperdynamic rhytides and facial contouring. Although we detail our suggested quantity of units per injection site based on onabotulinumtoxinA, all neuromodulators can be used in all of these suggested treatment areas with adjustment of the quantity of units based on the efficacy of the specific neuromodulator. A more compete discussion on the relative efficacy of all neuromodulators is beyond the scope of this article.

A prospective multicenter pilot study of the safety and efficacy of microfocused ultrasound with visualization for improving lines and wrinkles of the décolleté.

BACKGROUND A previous pilot study demonstrated microfocused ultrasound with visualization (MFU-V) to lift and tighten the décolleté produced significant and durable aesthetic improvements. OBJECTIVE To further evaluate the safety and effectiveness of MFU-V for improving lines and wrinkles of the décolleté in a larger patient population. MATERIALS AND METHODS Healthy women with moderate-to-severe décolleté skin lines and wrinkles were enrolled. After obtaining digital images, MFU-V was administered using 3 transducers emitting ultrasound at frequencies of 4 MHz and a focal depth of 4.5 mm, 7 MHz/3.0 mm, and 10 MHz/1.5 mm. During the procedure, 280 lines of discrete thermal coagulative points 25 mm long and 2 to 3 mm apart were applied to the treatment area. Additional imaging for masked assessments and live assessments were completed at 90 and 180 days. RESULTS Among the evaluable subjects, 77 (66.4%) demonstrated aesthetic improvement at 180 days based on blinded assessments. Approximately, 75% and 65% of treated subjects demonstrated some degree of improvement at 90 and 180 days, respectively, and most were satisfied with treatment outcomes. Adverse events were generally mild. CONCLUSION A single MFU-V treatment provided significant aesthetic improvement for moderate-to-severe décolleté lines and wrinkles for at least the 180-day duration of the study.

Clinical Efficacy and Safety Evaluation of a Monopolar Radiofrequency Device with a New Vibration Handpiece for the Treatment of Facial Skin Laxity: A 10‐Month Experience with 64 Patients

BACKGROUND Although ablative laser technology and surgical treatment are considered to be the criterion standard for the rejuvenation of aging skin, the demand for procedures with less down time and risk, such as nonablative laser and radiofrequency (RF) treatments, has increased over the last several decades. OBJECTIVES To investigate the efficacy and safety of the newest generation of monopolar RF (mRF) devices by evaluating our patients after treatment. METHODS AND MATERIALS Sixty‐four patients with mild to moderate facial skin laxity were treated using the new mRF with vibration handpiece. Patients were surveyed between 1–10 months after treatment to determine degree of improvement, satisfaction, and presence of side effects. RESULTS With the new system, 80% (n = 51) reported at least mild correction of skin laxity, 55% (n = 35) noticed skin texture improvement, average pain level was 6.06 (0–10 scale), 9% (n = 6) found the procedure too painful, and 43% (n = 28) would have the procedure again. CONCLUSION The new mRF system was safely tolerated and efficacious for most patients for facial treatment sites.