Multicenter study of noninvasive radiofrequency for periorbital tissue tightening

Efficacy and safety of a noninvasive, home-based radiofrequency device for facial rejuvenation: An open-label, intraindividual controlled trial

BACKGROUND

Wrinkle formation is the most visible characteristic of facial aging. Radiofrequency (RF) technology is currently utilized to reduce facial wrinkles and contribute to skin rejuvenation.

OBJECTIVE

To analyze the efficacy and safety of a noninvasive, home-based RF device applied for facial rejuvenation in Chinese people.

METHODS

A single-center, open-label, intraindividual controlled trial was performed on subjects who received an 8-week treatment of the RF device. A total of 22 female individuals aged 25-60 years with Fitzpatrick skin type III-IV were enrolled. Efficacy of treatment was subjectively evaluated using the Fitzpatrick Wrinkle Classification Scale (FWCS) assessed by physician or overall satisfaction of subject with a 10-point VAS, and objectively using the skin ultrasound examination as well as the 3D skin analysis system. Adverse event was recorded at each visit.

RESULTS

In comparison with the baseline, evaluator-assessed FWCS scores showed significant improvement at 4 weeks (p < 0.005) and 8 weeks (p < 0.005) after treatment. All subjects reported different degrees of improvement in facial wrinkles after 8 weeks of treatment. The results of skin ultrasound examination revealed significant increase of the dermal thickness at week 8 (p < 0.05) as compared to the baseline. In addition, a significant decrease in the proportion and density of perioral wrinkles evaluated by the 3D skin analysis system was observed from baseline to week 4. The treatment was well-tolerated, and no serious adverse event was observed.

CONCLUSION

This noninvasive, home-based RF device was effective in improving skin texture and elasticity with a safe and well-tolerated treating procedure.

Remodeling of facial soft tissue induced by simultaneous application of HIFES and synchronized radiofrequency provides nonsurgical lift of facial soft tissues

BACKGROUND

The application of radiofrequency (RF) and HIFES on the body provides improvement in skeletal muscle tissue, reduction in fatty tissue, reorganization of connective tissue, and skin texture improvement. However, overall facial appearance relies on both skin and underlying structures, specifically muscles and connective tissue which have to be treated as one unit to achieve proper care while preserving fatty layers that define youth facial appearance.

AIMS

The aim of this study is to find whether the effect of novel RF + HIFES is safe and can induce the lifting of soft tissue and overall improvement in facial appearance.

METHODS

In this study, 21 subjects were enrolled. The therapy was administered in four 20-min treatments on the forehead and cheeks. Photographs were evaluated by a Global Aesthetic Improvement Score (GAIS) and linear measurements of facial tissue lifting at 1- and 3-month follow-ups. Volumetric changes in the cheek area were investigated as well. The patients' satisfaction, safety, and comfort were documented throughout the study.

RESULTS

The data indicated improvement in overall facial appearance, and 23% of average lifting was found in brows (p = 3.14 × 10-12 ) and cheeks (p = 6.00 × 10-15 ). The assessment of digital photographs showed an improvement in 100% of patients at 3-month follow-up. The treatments were safe, accompanied by high therapy comfort and subject satisfaction of 98%.

CONCLUSIONS

The treatment by simultaneous RF and HIFES technology produces significant changes to the overall facial appearance, characterized by the lifting of facial tissues.

Interventional and device treatment of the periocular area

Growth in the research, innovation, and development of laser and energy-based technologies over the past few decades has led to dramatic increases in treatment options for dermatologic and cosmetic concerns of the periorbital area. We highlight recent treatment options using laser and energy-based devices for the clearance of periocular pigmented lesions, including solar lentigines and nevus of Ota; vascular lesions, including port-wine birthmarks, infantile hemangiomas, superficial telangiectasias, and reticular veins; laser ablation of benign tumors, such as xanthelasma; cosmetic rejuvenation; treatment of infraorbital dark circles and festoons; laser removal of eyebrow and eyeliner tattoos; and device-based treatment of chronic dry eyes.

Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients

OBJECTIVE

To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting.

METHODS

The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars.

RESULTS

A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management.

CONCLUSION

FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.

Subjective evaluation of monopolar radiofrequency treatment by patients in aesthetic rejuvenation

OBJECTIVE

To assess the subjective experiences of patients following monopolar radiofrequency (RF) treatment for facial rejuvenation and anti-aging purposes.

METHODS

A study involving 50 female patients (aged 30-70 years, Fitzpatrick skin type III and IV) who received a single session of RF treatment. Exclusion criteria comprised active infections, skin diseases, pregnancy, or history of recent anti-aging treatments. Thirty-four patients completed a 10-question questionnaire after 3 months of treatment.

RESULTS

Among the respondents, 82% expressed satisfaction with the RF treatment, reporting significant improvements primarily in the mid and lower face, and eyelids. Mainly, patients noted improvements in skin laxity (52.9%), skin texture (17.6%), and skin tone (11.7%). Notably, 73.5% noticed changes within 1-2 months post-treatment, with the peak effect observed at 1-2 months. Mild complications (swelling and erythema) were reported, usually resolving within a week. The mean pain score was 1.94 (±0.66), indicating mild to moderate discomfort.

DISCUSSION

Monopolar RF devices, apply high-frequency electric currents generating heat, stimulating collagen production for skin tightening. This study's unique focus on detailed subjective patient experiences provides insights valuable in clinical settings, aiding clinicians in managing patient expectations and achieving optimal results. The satisfaction rates align with previous findings, emphasizing RF treatment's efficacy in addressing facial laxity, especially in the mid and lower face. Positive feedback extended beyond skin tightening, encompassing skin texture and tone improvements. While the study's observation period was 3 months post-treatment, longer-term studies are warranted for comprehensive assessments.

CONCLUSION

The study underscores the efficacy of monopolar RF device, as a non-invasive and effective anti-aging treatment. The findings contribute to diversifying the RF market, potentially aiding clinicians in optimizing patient care. Considering the growing complexity of patient demands and treatment responses, this study serves as a valuable reference for clinicians engaging in RF treatments.

The Safety of Contraction of Subcutaneous Tissue Following Liposuction Procedures

This paper examines the practice of using a helium plasma radiofrequency (RF) device for contracting subcutaneous soft tissue following liposuction in all body areas. A review of the data from 6 industry-sponsor-initiated retrospective studies was performed, wherein 483 real-world patients underwent liposuction followed by contraction of the subcutaneous soft tissue with the helium plasma RF system. These data were evaluated to determine if any new or increased risks were introduced compared to the risks of liposuction alone. The totality of the real-world data demonstrates there are no new or increased risks for helium plasma RF procedures following liposuction compared to liposuction alone. These data support the safety of helium plasma RF for subcutaneous soft-tissue contraction following liposuction. There are currently no alternative therapies specifically cleared by the FDA that can claim use following liposuction for the purpose of contracting the subcutaneous soft tissue.

Level of Evidence 3

Laser Impacts on Skin Rejuvenation: The Use of a Synergistic Emission of CO2 and 1540 nm Wavelengths

Background and Objectives: For nearly 15 years, carbon dioxide (CO2) laser has been the gold standard in skin rejuvenation. Aim: The purpose of this study was to assess the efficacy of a new laser device which combines CO2 and 1540 nm wavelengths in wrinkles reduction, using a recently developed scanning unit named the µScan DOT scanner. Materials and Methods: A total of 20 female patients underwent from two to four laser treatment sessions performed once every 45-90 days. Wrinkles reduction was evaluated using the Fitzpatrick Wrinkle Classification System (FWCS). Evaluations of five-point Global Patient's Assessment (PGA) and an Oedema and Erythema index based on a four-point scale were carried out. A careful photographic evaluation was performed to observe the patients' aesthetic improvements. All the assessments were performed before and at 3 months follow up (3 MFU) after the last treatment session. Results: The mean FWCS score significantly (p < 0.01) decreased from 5.45 ± 2.21 at baseline to 3.3 ± 1.78 at 3 MFU after the last treatment session. In total, 8/20 (40%) subjects reported excellent improvement, 7/20 (35%) subjects showed good improvement, 5/20 (25%) subjects showed slight improvement, and 0/20 (0%) subjects showed no improvement. Concerning the Oedema index, 15/20 subjects experienced a mild one, 5/20 subjects experienced a moderate one, and none of 20 experienced a severe one, while for the Erythema index, 1/20 patients experienced mild, 18/20 patients experienced moderate, and only 1/20 patient experienced severe erythema. No severe adverse events were observed. Conclusions: This dual-wavelength laser technique may become a promising new option for safe, nonsurgical improvement for skin rejuvenation with an extremely low risk of scarring or hypopigmentation and shorter healing times.

Efficacy of a Diode Vaginal Laser in the Treatment of the Genitourinary Syndrome of Menopause

INTRODUCTION

Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) are the most frequent menopause-related clinical entities and are consistently included in the definition of pelvic floor disorders (PFDs). Nonhormonal therapies, such as lubricants and moisturizers, are indicated as first-line treatments, while the "gold standard'' is represented by topical estrogen products; however, in cancer survivors hormonal treatment is not indicated. For this reason, energy-based therapeutic approaches-for instance, through laser technologies-may be employed as alternative options in this kind of patient; however, there are no studies evaluating the efficacy of a pure diode vaginal laser in the treatment of GSM. As a consequence, with our study, we aimed to evaluate outpatient nonablative diode laser treatment in sexually active women, with contraindications, no response, or refusal of local estrogenic therapy.

METHODS

This prospective study included patients with GSM, aged ≥ 18 years old, with contraindications, or refusal of local estrogen therapies. Women were evaluated via the use of their Vaginal Health Index (VHI) scores, which consists of five measures: elasticity, fluid volume, pH, epithelial integrity, and moisture. Moreover, the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia, and dysuria) was measured using a 10 cm visual analog scale (VAS), where the left extreme of the scale (score = 0) indicated "absence of symptom" and the right indicated "symptom as bad as it could be" (score = 100). Sexual function was evaluated with the Female Sexual Function Index (FSFI-19) questionnaire. The treatment was performed using a Leonardo Dual diode laser (Biolitec Italia Srl, Milano, Italy). The laser treatment consisted of three sessions, one per month. One month after the third session, the VHI, symptom VAS, and FSFI-19 were re-evaluated. In addition, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected.

RESULTS

Our study enrolled a total of 26 consecutive patients. All patients were either in menopause or under treatment with gonadotropin-releasing hormone (GnRH). None of the patients reported adverse effects after laser treatment. In total, 19 (73.1%) patients referred improvements of their symptoms according to PGI-I scores. All domains of the FSFI-19 questionnaire, significantly improved after the diode laser treatment. The mean VHI score increased by 3.2 points, from 12.2 to 15.4 (p < 0.001). Additionally, we documented a significant improvement in symptoms affecting the VAS score, from 69.2 to 43.5 points (p < 0.001).

CONCLUSION

A diode vaginal laser is an effective and easily tolerated ambulatory procedure for vaginal functional restoration in the treatment of GSM and VVA.

Periorbital Skin Rejuvenation of Asian Skin Using Microneedle Fractional Radiofrequency

BACKGROUND

The periorbital area plays an important role cosmetically. Periorbital wrinkles are attributed to long-term, repeated use of orbicularis oris muscles and UV-induced dermal collagen degeneration. Fractional microneedle radiofrequency (RF) treats scars and laxity by creating vertical channels of injury in the dermis, triggering a scarless healing cascade and neocollagenesis.

OBJECTIVE

To evaluate the effect and safety of a novel fractional microneedle RF device on periorbital wrinkles based on several objective indicators.

METHODS

Eleven healthy Korean patients aged 30 to 75 years with periorbital wrinkles were included in this study. Wrinkle grades were evaluated using the Fitzpatrick wrinkle assessment scale (WAS). The melanin and erythema index, transepidermal water loss (TEWL), and three parameters for elasticity were recorded. Skin biopsies were obtained in patients who consented.

RESULTS

All patients exhibited wrinkle improvement in the lateral periorbital area, and two patients also showed efficacy in the lower eyelid area. There was a statistically significant decrease in WAS and a significant improvement in the melanin index of V4 and V5. TEWL also showed a considerable decline on V4 and V5, suggesting that the water content of the skin increased with repeated laser sessions. A peak increase in viscoelasticity and a decrease in retraction time following the first laser application were observed. In the histopathologic examination, the dermis had a denser collagen and elastin content.

CONCLUSION

Microneedle fractional RF resulted in statistically significant long-term clinical improvement of periorbital wrinkles and enhanced pigmentation and skin hydration.

Evaluation of eyebrow position and upper eyelid laxity after endolift laser treatment

The periorbital area is one of the most sensitive areas in the face, and many techniques are used to change the eyelid laxity and position of the eyebrows. Recently the use of noninvasive or minimally invasive techniques is developed so, the amount of surgical procedures has decreased. In the present study. We evaluate the effect of Endolift laser as a non-invasive method on upper eyelid laxity and eyebrow position. Nine patients underwent Endolift laser and evaluated for eyelid laxity and change in eyebrow position. Two blinded physicians assessed the cosmetic outcome of improvement in upper eyelid tightening via photography 6 months post-treatment. The physicians evaluated the patient's improvement degree using the photographs by two clinical factors: skin laxity and total cosmetic result. Also, eyebrow height from the center of the pupil (CPEBH), Central eyebrow height (CEBH), Lateral eyebrow height (LEBH), Medial eyebrow height (MEBH) were measured by ImagJ before and 6 months post Endolift laser treatment. Our results showed eyelid laxity and eyebrow height were significantly changed after treatment.

Safety and Efficacy of Renuvion Helium Plasma to Improve the Appearance of Loose Skin in the Neck and Submental Region

BACKGROUND

Minimally invasive procedures that deliver thermal energy to subcutaneous tissue offer a solution when deciding between excisional and noninvasive options to address face and neck aging-related changes. A minimally invasive helium plasma device, Renuvion, was first utilized for subdermal tissue heating to reduce skin laxity under an FDA general clearance for cutting, coagulation, and ablation of soft tissue.

OBJECTIVES

The purpose of this study was to demonstrate the safety and effectiveness of the helium plasma device for improving the appearance of loose skin in the neck and submental region.

METHODS

Patients undergoing the procedure with the helium plasma device in the neck and submentum were studied. They were seen for 6 months following the procedure. The primary effectiveness endpoint for improvement in lax skin in the treatment area was determined by 2 of 3 blinded photographic reviewers. The primary safety endpoint was the level of pain after treatment.

RESULTS

The primary effectiveness endpoint was met; 82.5% demonstrated improvement at Day 180. The primary safety endpoint was met; 96.9% of patients experienced no pain to moderate pain to Day 7. There were no serious adverse events reported related to the study device or procedure.

CONCLUSIONS

The data demonstrate benefit to patients by improvement of the appearance of lax skin in the neck and submental region. Outcomes resulted in US Food and Drug Administration 510(k) clearance in July 2022, expanding indications for the device to include subcutaneous dermatological and aesthetic procedures to improve the appearance of loose skin in the neck and submental region.

Evaluation of short-term face rejuvenation effects of non-ablative bipolar radiofrequency treatment performed by Med-RF© device

OBJECTIVE

Skin laxity and wrinkling are common signs of the aging process. This physiological condition of the skin is often accompanied by psychological and social concerns, especially for females, entailing considerable expenses for cosmetics and pharmaceuticals to cease or slow down its advancement. The objective of this study was to evaluate the short-term impact of a new non-ablative radiofrequency device available in the skin face cosmetic field.

METHODS

A randomized study was run on 62 healthy subjects with normal-age related-grade skin laxity, subdivided into two groups. Group 1 received one treatment with Modula RF device (Wavemed, San Cesareo RM, Italy) over the whole face surface. Group 2 received three monthly treatments.

RESULTS

Clinical improvements of the exposed areas were detected by measuring skin parameters, such as total water content, elasticity, and sebum levels at baseline and 1 h after the treatment. Data showed significant effects of Med-RF treatment on skin hydration (p < 0.001), skin elasticity (p < 0.0001), and sebum (p = 0.0009). Moreover, a negative linear correlation was obtained between women's age and hydration.

CONCLUSION

In conclusion, the results of this study suggest that radiofrequency significantly improves the subjective and objective judgment of patients and doctors, supported by the positive results obtained on the skin quality parameters evaluated. These results confirm that Med-RF technology represents an important tool to achieve face rejuvenation in the field of non-invasive procedures.

Microneedling-Associated Procedures to Enhance Facial Rejuvenation

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.

Clinical outcomes and patient satisfaction after S.I.H technology®: follow-up of 258 patients

BACKGROUND

Aging is a natural process. The association between the gradual loss of tissue integrity and the force of gravity determines a condition from which it is complex to go back. The approval by the American FDA of the monopolar radiofrequency (Thermage^®) dates back to 2002. Since then, innovation has made great strides up to the development of endodermal technology in recent years which allows subcutaneous probes to act with precision and under careful control on the treated areas.

METHODS

We retrospectively reported our experience in rejuvenation treatments of the face and of different areas of the body using the Subdermal Induced Heat (S.I.H.) technology^®, featuring a population of 258 patients who received 502 treatments between 2018 and 2022. Clinical outcomes and patient satisfaction were assessed, respectively by analyzing adverse events and complications at 7 days from treatment, and patient-reported outcome at 3, 6 and 12 months using a 5-point Likert Scale.

RESULTS

Only 25 complications were reported, of which 68% consisted in bruising, 24% in hematomas and 8% in edema. Most patient were reportedly satisfied with overall treatment, with 55% of them being "very satisfied" with the results at 6 months from initial procedure.

CONCLUSIONS

We highlight the manageability of the S.I.H. technology which has been proven to be safe and effective in achieving satisfying results for skin rejuvenation, with a reduced number of sessions required and good maintenance of the results obtained.

Radiofrequency and Radiofrequency Microneedling in Skin of Color: A Review of Usage, Safety, and Efficacy

BACKGROUND

Radiofrequency (RF) and radiofrequency microneedling (RFM) for rhytides, scarring, and skin rejuvenation are believed to have a lower risk of postprocedural dyspigmentation in darker skin types.

OBJECTIVE

To explore the safety and efficacy of RF and RFM in Fitzpatrick skin Types III to VI.

METHODS AND MATERIALS

A systematic review of PubMed/MEDLINE databases from 2000 to 2021 using combinations of the terms radiofrequency, microneedling, skin of color, and Fitzpatrick was performed. Exclusion criteria included non-Fitzpatrick skin Types III-VI patient population, nonprimary articles, nonskin radiofrequency, and nonhuman studies.

RESULTS

Thirty-five articles addressing the use of RF or RFM in skin of color were identified-22 for skin rejuvenation, 7 for acne scars, 4 for nonacne scars, 1 for hyperpigmentation, and 1 for acne treatment. Seven studies noted transient postinflammatory hyperpigmentation, 1 observed mild prolonged hyperpigmentation, and only 1 study reported permanent scarring.

CONCLUSION

Radiofrequency and RFM seem to have a low risk of scarring or hyperpigmentation in skin of color. This review demonstrates that these procedures have been successfully used primarily for rhytides, acne scarring, and skin rejuvenation. However, a large proportion of the studies lack strong quality evidence.

Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars

BACKGROUND AND OBJECTIVE

New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO₂ ) laser in the treatment of postburn hypertrophic scars.

PATIENTS AND METHODS

Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO₂ laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFβ₁ ) levels were measured for biochemical evaluation.

RESULTS

Both fractional CO₂ and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFβ₁ levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO_2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively).

CONCLUSION

Our results demonstrate the value of FMR as an effective alternative to fractional CO₂ in the treatment of hypertrophic scars, with a potentially favorable safety profile.

Adverse Events of Non-Invasive Body Contouring: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database

BACKGROUND

Multiple non-invasive modalities have become popular alternatives to surgical procedures for body contouring.

OBJECTIVE

To analyze adverse events (AEs) associated with non-invasive body contouring devices reported through the Manufacturer and User Facility Device Experience (MAUDE) database.

METHODS AND MATERIALS

The MAUDE database were queried for AEs associated with non-invasive body contouring devices between January 2011 and June 2021. An extensive list of keywords and brand and manufacturer names was used.

RESULTS

A total of 1,325 reports with 1,590 AEs were identified among 6 modalities. More than 70% were reported in the past 5 years. Cryolipolysis made up 38.3% reports, which mostly pertained to paradoxical hyperplasia and hernias. Radiofrequency had the most reports (41.9%). Like laser devices, most of their reports described burns. Focused ultrasound was commonly associated with unintentional fat loss and surface irregularities. Focused electromagnetic field resulted in only 7 reports.

CONCLUSION

The analysis of present study supports previous studies concerning common local symptoms caused by these devices, but it also reveals complications not reported in previous device studies. This study highlights the importance of proper technique and adherence to device guidelines. Practitioners should be knowledgeable of potential complications from each device to both prevent and manage them accordingly.

Objective assessment of facial laxity changes after monopolar radiofrequency treatment by using moiré topography

Radiofrequency (RF) has been widely used as a noninvasive technique for skin tightening and rejuvenation. Moiré is a type of interference pattern corresponding to the shape of the face. We aimed to objectively evaluate the effect of RF on facial skin laxity using moiré. Ten subjects participated and were treated with a monopolar RF on the face. Clinical photographs and moiré images were obtained at the baseline and after treatment. The periorbital angle from the upper third of the face, zygomatic length ratio (L1/L2), angle from the middle third, perioral perpendicular length, and angle from the lower third were analyzed. After one session of RF treatment, the mean zygomatic length ratio (L1/L2) from the middle third of the face significantly increased in the 4th week (by 49.68%, P = .047). The L1/L2 ratio increased to nearly one, which were not significant after 8 weeks. The mean perioral perpendicular length decreased to 282.25 ± 84.069 pixels (px) after 4 weeks, and to 281.38 ± 76.03 px after 24 weeks; these differences were statistically significant. The parameters of zygomatic length ratio and perioral perpendicular length extracted from illuminated moiré images can be useful for objectively assessing various facial tightening treatments in clinical settings.

Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: A systematic review

BACKGROUND

Radiofrequency technology has emerged as a treatment for aesthetic rejuvenation.

OBJECTIVE

To examine radiofrequency for facial and neck rejuvenation, clinical studies were assessed on effectiveness and safety of radiofrequency for acne, acne scars, and facial aging by subjective and objective measures.

METHODS

A systematic literature review was performed. Eligibility criteria included articles in English, primary literature, clinical or ex vivo studies, use of radiofrequency, and face or neck treatment. Ablative techniques, home-use devices, combined modalities, and studies unrelated to rejuvenation were excluded. All studies were appraised for quality and biases.

RESULTS

We identified 121 articles. Radiofrequency effectively treated acne by reducing sebum levels and lesion count and improving acne scars. Radiofrequency demonstrated a volumetric reduction in facial fat, and improved skin laxity, elasticity, and global skin aesthetic. Patient satisfaction was higher for those desiring modest rejuvenation. There were histological changes consistent with repair response, neocollagenesis, and neoelastinogenesis. Radiofrequency was safe apart from one patient who developed a neck fistula.

CONCLUSION

Most studies demonstrated radiofrequency treatment of acne, scars, or facial rhytids had positive subjective improvement ratings. Objective studies demonstrated reduction of acne, decreased scarring, lifting effect, improvement in elasticity and collagen, volumetric fat changes, and wrinkle reduction.

Optimizing skin tightening in aesthetics in men

The field of cosmetic dermatology has recently witnessed unbridled growth in the past several years. Part of this has been due to the increasing popularity of aesthetic treatments in men, who represent a growing patient population. Men tend to have higher levels of collagen density and greater skin thickness, but these begin to decrease earlier on. They can also more frequently have severe photodamage. Their clinical presentations can affect the selection of treatments. Physicians should be familiar with the subtle differences between treating men and women. Early studies and literature are beginning to shed more light on these important distinctions. We review the notable differences in facial aging, pathophysiology, and patient selection and discuss available treatment options with these factors in mind.

Focused radiofrequency and ultrasound for face and neck rejuvenation: A retrospective evaluation of 158 patients

BACKGROUND

Radiofrequency is a commonly used method to non-invasively tighten the skin that can be safely applied to any skin type.

AIMS

The aim of our study was to evaluate the safety and efficacy of the focused radiofrequency and ultrasound hybrid device for face and neck rejuvenation, in terms of improvement of facial wrinkles and jaw sagging.

METHODS

A total of 158 patients had undergone four weekly sessions of focused radiofrequency and ultrasound to face and neck area. Photodocumentation was obtained before first visit and two weeks after last visit. An independent, blinded dermatologist evaluated the severity of wrinkles and sagging of seven different anatomical regions on a validated scale of 0-4 (0: no lines/sagging, 1: mild, 2: moderate, 3: severe, 4: very severe) before and after the procedure. Patients rated their satisfaction with the result of the treatment on a scale of 1-5 (1: dissatisfied, 2: poorly satisfied 3: satisfied, 4: very satisfied, 5: perfectly satisfied).

RESULTS

For seven anatomical regions, statistically significant reduction was observed in mean wrinkle/sagging scores (p = < 0.001). Patients were satisfied with the effects of the procedure, with a mean satisfaction score of 4.61 ± 0.55.

CONCLUSIONS

Our findings demonstrate that combined focused radiofrequency and ultrasound is an effective and safe method for the rejuvenation of different sub-areas of the face and neck with high patient satisfaction scores.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33–63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

Nonsurgical Light and Energy-Based Devices: Utility in Eyelid and Periorbital Surgery

Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.

Prospective Clinical Trial of the Latest Generation of Noninvasive Monopolar Radiofrequency for the Treatment of Facial and Upper Neck Skin Laxity

BACKGROUND

Aging of the face and upper neck is a complex process characterized by loss of collagen and elastic fibers, resulting in clinical skin laxity. Noninvasive interventions such as monopolar capacitively coupled radiofrequency (MRF) have gained popularity, offering a safer and more convenient alternative to traditional surgical face lift. The latest MRF device features larger tips, vibration, cooling, and impedance matching.

OBJECTIVE

We performed the first open-label clinical trial, measuring the efficacy, safety, and patient satisfaction of this device for noninvasive lifting and tightening of the face and upper neck.

MATERIALS AND METHODS

Forty subjects 30 to 60 years of age with mild/moderate skin laxity of the face and upper neck were enrolled. After pretreatment with ketorolac 60 mg intramuscular injection, subjects underwent treatment with MRF. Follow-up evaluations were performed on Days 30, 60, and 180.

RESULTS

Our study demonstrated that the newest generation MRF produced statistically significant improvement in skin laxity 6 months post-treatment, especially in the jowls and melolabial folds. According to the Investigator Global Aesthetic Improvement Score, 73% of subjects had improvement at 6 months post-treatment. Subject satisfaction and improvement questionnaires supported these findings.

CONCLUSION

Our data coupled with the excellent adverse effect profile validates MRF as an attractive treatment modality for facial and upper neck skin laxity.

Radiofrequency Rejuvenation of the "Tweener" Patient: Under, Over, or Through the Skin

The demand for noninvasive facial rejuvenation continues to increase as younger, well-informed patients enter the aesthetic market. We refer to a subset of these patients as "tweeners," those who present with early signs of neck and facial aging, but who have not yet developed changes significant enough to warrant a traditional excisional surgery approach. Many of these patients are in search of a minimally invasive intervention, a bridge in between observation and surgery. The authors describe their experience with radiofrequency (RF) technology as an in-office tool to address the aging face in a select patient population. This review also attempts to comprehensively search the existing body of literature to describe the RF technologies and devices available for facial rejuvenation. The efficacy and safety profiles of the devices are discussed, and the devices are categorized by their method of RF delivery-over (contact), through (microneedle), and under (percutaneous) the skin.

The Use of Radiofrequency in Aesthetic Surgery

The use of radiofrequency for soft tissue tightening has increased over the past 10 years. Both minimally invasive and noninvasive devices are frequently in use. This article describes the different types of radiofrequency technology and the current evidence behind their safety and efficacy.

Microneedling Options for Skin Rejuvenation, Including Non-temperature-controlled Fractional Microneedle Radiofrequency Treatments

The use of microneedling with or without radiofrequency continues to expand in aesthetics. There are now many different devices available that have multiple indications, unique protocols, and low side effect profiles.

Monopolar radiofrequency treatment for facial laxity: Histometric analysis

BACKGROUND

A monopolar radiofrequency device can be used in facial tightening. The device targets the dermis and fibrous septae, and the treatment results in immediate collagen contraction and the induction of subsequent collagen remodeling.

AIMS

We aimed to evaluate the histometric change of the subjects treated with a monopolar radiofrequency device using a novel tip.

MATERIALS AND METHODS

Eleven subjects with skin types III and IV participated in the study. They received a single session of a monopolar radiofrequency on the face, and biopsies were performed before treatment, and 2 and 6 months after the treatment. Hematoxylin and eosin, Masson trichome, and Victoria blue stains were used. An image analysis was performed using the Image J software. The dermal density of collagen and elastic fiber, and the coherency of collagen fibers were assessed in the papillary, upper reticular, and lower reticular dermises, respectively.

RESULTS

The monopolar radiofrequency treatments led to improvements in collagen fiber density and coherency. In the Masson trichome staining, the collagen fiber densities were 0.736 ± 0.06 and 0.652 ± 0.063 before treatment and increased to 0.773 ± 0.044 (P = .018) and 0.686 ± 0.05 (P = .045) in the papillary and lower reticular dermises, respectively. The density of the elastic fibers in all parts of the dermis showed a tendency to increase after treatment, though not statistically significantly. The mean coherency was higher after than before treatment.

CONCLUSIONS

In this in vivo study, we found that the collagen and elastic fiber densities and architectural structures were improved after treatment.

The efficacy and safety of microneedle monopolar radiofrequency for the treatment of periorbital wrinkles

BACKGROUND

Treatment of periorbital wrinkles is a challenging task because of its anatomical significance and delicate nature.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of a microneedle monopolar radiofrequency (RF) device for treating periorbital wrinkles.

METHODS AND MATERIALS

This retrospective study involved 21 patients who were treated for periorbital wrinkles using a RF device. The type of microneedle used, clinical photography, VISIA wrinkle score, and adverse events were collected from the medical chart. Two independent dermatologists assessed the photographs.

RESULTS

There were 18 female and 3 male patients with a mean age of 50.24 years. The severity of wrinkle was improved according to photographic assessment and VISIA wrinkle score at 6-month post-treatment. When 21 sites treated with a long microneedle (LMN, 1.5 mm) and the other 21 sites treated with a short microneedle (SMN, 0.8 mm) were compared, significant improvement in the VISIA wrinkle score was observed only in those treated with the LMN. No serious adverse events, including scarring and postinflammatory hyperpigmentation, occurred.

CONCLUSIONS

We demonstrated the efficacy and safety of the microneedle monopolar RF device in treating periorbital wrinkles. The LMN was superior to the SMN in reducing VISIA wrinkle score.

Effects of device variables to radiofrequency (RF) applications

RF devices have frequency, power and duration setting options, it is important to make sure that the device meets the targeted values at the head output. This study was made to evaluate the RF device output value accuracy and the effects of different frequencies on the tissue heat levels. RF was applied to invitro tissues obtained from surgical operations, and invivo tissues during operations. Heat differences and depth were measured by laser/IR thermometer and thermal infrared camera. First, the output frequency and power values provided by the device were approved. Then, three three heads (monopolar, bipolar and tripolar) with three different frequencies (1,7, 20 MHz) were used. Depth of heat increase was evaluated in millimeters. The results showed that temperature increase varied between 10°C and 30°C at different depths using different frequencies. Heating of the skin with a radiofrequency device in a therapeutic dose is possible if the appropriate frequency and adequate power values are applied. Because the therapeutic temperature is close to the complication limit, the practitioner should be an expert using the device, well-knowledgeable about the regional skin structure and thickness, as well as be able to properly adjust the application doses in order to get therapeutic results.

Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition

Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.

The efficacy of micro-insulated needle radiofrequency system for the treatment of lower eyelid fat bulging

BACKGROUND AND OBJECTIVES

Conventional treatment options for eyelid fat bulging are generally limited to surgical approaches. However, many attempts have been made recently to manage this disfigurement using non-surgical interventions. The purpose of this study was to evaluate the efficacy and safety of a micro-insulated needle radiofrequency system for the treatment of lower eyelid fat bulging.

METHODS

This is a single center pre-post comparative study. Twenty-two subjects with lower eyelid fat bulging were treated twice using the needle radiofrequency system, at an interval of four weeks. Two types of partially insulated needles with different lengths were used in each session. A three-dimensional photogrammetry system was used to objectively measure changes in the extent of the fat bulge. The investigator's global assessment (IGA) of the severity of fat bulging was also evaluated.

RESULTS

The average extent of fat bulging was decreased significantly after twelve weeks, and was maintained until 24 weeks. The IGA score was significantly decreased after four weeks and further decreased after twelve weeks, and then maintained until 24 weeks. There were no side effects, except for lower eyelid swelling and bruising that lasted for about a week.

CONCLUSION

The micro-insulated needle radiofrequency system can be a beneficial and well-tolerated treatment for lower eyelid fat bulging.

Efficacy of noninvasive multisource radiofrequency treatment on periorbital rhytids using an imaging device

OBJECTIVE

To evaluate the efficacy of the multisource radiofrequency in periorbital wrinkles treatment using a VISIA imager.

METHODS

This is a prospective cohort study involving 30 sites in 15 patients.

INCLUSION CRITERIA

healthy subjects with periorbital wrinkles. Patients underwent five treatment sessions for each site using multisource radiofrequency. VISIA imager was used before and after each treatment, and in 12-week follow-up. The wrinkle scores were calculated and compared between baseline and 12-week follow-up. Changing in periorbital wrinkles were evaluated by blinded dermatologist using a scale of 0-3. After the study, patients rated their satisfaction using a scale of 0-3. The study protocol was approved by our institutional human research review committee, according to the ethics guideline of Helsinki (1975).

RESULTS

The effect of treatment on subjects on follow-up compared to baseline showed a highly significant difference with P-values <0.05. Only two patients had no improvement according to blind dermatologist assessment of photographs. Thirteen patients reported satisfaction scale between 1 and 3.

CONCLUSIONS

The multisource radiofrequency is safe and effective in reducing periorbital rhytids, and with the help of VISIA imager we can get more objective data to evaluate the efficacy of radiofrequency treatment on the periorbital areas. Lasers Surg. Med. 51:251-255, 2019. © 2018 Wiley Periodicals, Inc.

Quantitative evaluation of skin shrinkage associated with non-invasive skin tightening: a simple method for reproducible linear measurement using microtattoos

Non-invasive skin-tightening devices can induce thermal denaturation and skin shrinkage via externally applied radiofrequency emissions or high-frequency ultrasound. Therefore, the purpose of this study is to develop and test a method for measurement of skin reduction associated with application of such energy devices. Twenty-five healthy participants with mild to moderate skin laxity of the arms were enrolled. Pinpoint microtattoos were placed at each of the treatment sites to delineate two 6 × 12 cm rectangles per subject. A non-stretchable filament, tape and marking pen apparatus was used to measure the size of each rectangle before treatment and at follow-up visit by two blinded investigators. After randomization, one side received a single pass with a radiofrequency device (6.78 MHz), while the contralateral side received multiple passes. Participants underwent two treatment sessions to each side 2 weeks apart, and returned for follow-up 4 weeks after the second treatment. Length and area measurement were analyzed to assess precision and accuracy of measurements and to compare efficacy of treatment between pre- and post-treatment. Concordance correlation coefficients (CCC) demonstrated substantial inter-investigator reliability and precision in length measurements (CCC, 0.94 to 0.98 in pre-treatment; 0.95 to 0.98 in post-treatment). Measurements at the 6-week post-treatment follow-up demonstrated a statistically significant skin reduction in all six of the measured parameters. A simple skin measurement method requiring minimal instrumentation can quantitatively evaluate skin shrinkage associated with non-invasive skin-tightening devices.

Combined treatment of melasma involving low-fluence Q-switched Nd:YAG laser and fractional microneedling radiofrequency

Background: While low fluence Q-switched Nd:YAG laser (QSNY) demonstrates moderate efficacy in the melasma treatment for darker skin types, this single regimen still remains challenges. Fractional microneedling radiofrequency (FMR) is known to enhance dermal microenvironment, possibly offsetting pathogenic factors of melasma aggravation. Objectives: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and FRM with QSNY monotherapy in Asian melasma patients Methods: A retrospective study was undertaken for melasma patients to compare clinical data between 56 patients receiving combination regimen and 58 patients with QSNY only. For the 10 sessions at 1-week intervals, combination group was consecutively treated with QSNY and FRM, while QS toning group with QSNY alone. Two blinded dermatologists evaluated the efficacy based on modified Melasma Area and Severity Index (mMASI) and the physician's global assessment (PGA) at baseline and 3 months after the final treatment. Treatment-related side effects and disease course was recorded in detail. Results: Combination group demonstrated better efficacy compared with QS toning only group. Both median degrees of mMASI decrease (2.9 vs. 1.8) and proportions of PGA achieving better than 'good' grades (68% vs. 54%) showed superior efficacies of combination group. No significant difference was observed for treatment-related side effects between two groups, while the prevalence of mottle hypopigmentation and rebound hyperpigmentation was higher in QSNY only group. Conclusion: A novel dual mode of low-fluence QSNY and FRM represents a safe and effective treatment for melasma in Asian melasma patients.

Arm Contouring: Review and Current Concepts

Arm contour improvement is a desired goal of the massive weight loss and the aging population who want to maintain the arm aesthetics. Brachioplasty is a growing and safe procedure to improve the arm contour and different approaches and innovative treatment options have been described since the 1930s. This paper reviews the relevant literature in arm contouring including surgical and nonsurgical procedures used to aesthetically improve the arm. A comprehensive literature review was performed using the words "brachioplasty," "arm lift," "arm contouring," "arm liposuction," "noninvasive arm lift," "minimally invasive arm lift." Commonly used techniques, classification systems, and procedure outcomes are described. The review demonstrated that there are several methods to accomplish good arm contouring. There is no consensus about the best incision type and location, but the classification systems help guide treatment. Assessment of fat excess, skin excess, and location of the deformity (proximal, entire arm, arm and chest) help determine the best approach including liposuction only, skin resection only, a combination of liposuction and excision, or even the use of nonsurgical devices. Infection, hematoma, and unsatisfactory scars are the most commonly reported complications. Brachioplasty is a growing procedure and can be performed with low complication rates and good patient satisfaction. Classification systems stratify deformities to the ideal treatment but no studies have shown the superiority of any technique. Nonsurgical fat removal and skin tightening of the arms are promising procedures for selected patients and higher levels of evidence are needed to show clear indication for different technologies and devices.

Usefulness of Monopolar Thermal Radiofrequency Treatment for Periorbital Wrinkles

Background

Over the past 10 years, monopolar radiofrequency (MRF) technology has been widely used by dermatologists as a valuable modality to effectively tighten and rejuvenate photoaged skin. It also has the benefit of a short recovery time.

Objective

Using an objective parameter, this study aimed to assess the efficacy and safety of MRF, which is the basic modality of radiofrequency technologies, for treatment of periorbital wrinkles in Korean patients.

Methods

We enrolled 70 middle-aged female patients with periorbital wrinkles for this study. Each patient underwent triple sessions of MRF treatment in the periorbital region, separated by 2-week intervals. Clinical photographs were obtained, and the areas of wrinkles were measured using a Robo Skin Analyzer CS50 (Inforward Inc., Japan) at baseline and 4 weeks after the final treatment session.

Results

Significant reduction in the mean area of periorbital wrinkles was detected at 1-month follow-up (80.64±28.96 mm²) compared to baseline (95.08±31.93 mm²). The improvement ratio of the wrinkle area was 15.19%. Pain during procedure seemed to be tolerable without any local anesthesia for all patients. Transient mild erythema was the only side effect reported during the study.

Conclusion

In conclusion, MRF could still be an attractive modality for Korean patients with periorbital wrinkles if the treatment is conducted repeatedly with sufficient energy and proper intervals.

Novel device-based acne treatments: comparison of a 1450-nm diode laser and microneedling radiofrequency on mild-to-moderate acne vulgaris and seborrhoea in Korean patients through a 20-week prospective, randomized, split-face study

BACKGROUND

While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1450-nm diode laser (DL) and fractional microneedling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodelling effects.

OBJECTIVE

To compare the clinical course of acne treatment between DL and FMR.

METHODS

Twenty-five Korean patients with mild-to-moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated.

RESULTS

Both DL and FMR demonstrated steady improvement of acne and seborrhoea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow-up. Patients' subjective assessments for seborrhoea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety profile, no significant difference was observed between two regimens, while mild postinflammatory hyperpigmentation was observed only in DL side.

CONCLUSION

Both DL and FMR demonstrated efficacies for acne and seborrhoea, with reasonable safety profile. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.

Optimizing Male Periorbital Rejuvenation

BACKGROUND

Facial rejuvenation continues to be an increasing trend among males. The periorbital region deserves special mention given the overall differences in aesthetics between sexes.

OBJECTIVE

To examine the aesthetics of the upper eyelid, lower eyelid, lateral canthus, and brow with respect to male periorbital rejuvenation.

METHODS

The upper eyelid, lower eyelid, lateral canthus, and brow are examined, highlighting aesthetic differences in males and females.

RESULTS

The authors outline principles so as to maintain a masculine appearance when treating the male upper eyelid, lower eyelid, lateral canthus, and brow.

CONCLUSION

With guiding principles, the male upper lid, lower lid, brow, and lateral canthus can be managed to achieve optimal, consistent results.

Vaginal rejuvenation: current perspectives

Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed.