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Liao IC, He C, Liu XL, Barresi-Thornton R, Wangari-Olivero J, Qian MK, Neo B, Betts R, Ding C, Juchaux F, Chen Y, Marat X, Zheng Q, Bouez C. The application of a multi-component reaction peptide as a model regenerative active to enhance skin wound-healing postlaser procedure in a double-blinded placebo-controlled clinical trial. J Cosmet Dermatol 2024; 23:898-910. [PMID: 37924217 DOI: 10.1111/jocd.16053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Esthetic procedures are currently among the most effective options for consumers seeking to correct aging signs such as fine lines, wrinkles, and skin tone unevenness. Currently, there is a scientific need for an adjunct active to be paired with esthetic procedures to encourage wound recovery and address postprocedure pigmentation concerns. OBJECTIVE Toward that goal, this study assessed the efficacy of a peptide created from a multi-component reaction (multi-component peptide, MCP) as a model active for postprocedure care and evaluated its ability to promote skin healing in an ablative laser-induced wound model on the forearm. METHODS The mechanism of action of MCP was investigated using tubo assays, 2D melanocyte, and fibroblast cultures, reconstructed skin equivalents, and ex vivo skin explants. The MCP formula and the clinical benchmark formula of Aquaphor were assessed head-to-head by applying the products topically in an ablative laser-induced wound model (n = 20 subjects). The promotion of wound healing was evaluated by the investigator assessment of epithelial confluence, crusting or scabbing, general wound appearance, erythema, and edema. RESULTS MCP was determined to be beneficial to postprocedure skin recovery and healing by four main mechanisms of action: barrier repair as determined in an ex vivo tape-stripping model, reduction of inflammation and postinflammatory hyperpigmentation, reduction of elastase activity, and stimulation of fibroblast through the mTOR pathway. The formula containing 10% MCP enhanced the kinetics of epithelial confluence and improvement of the crusting or scabbing appearance of the laser-generated wounds in a laser-induced mini-zone wound healing study on the forearm. CONCLUSION This study demonstrates the use of MCP as a proof of concept regenerative active that when incorporated into an optimized postprocedure skincare formula can improve skin healing and enhance the appearance of skin after injury with relevance to ablative aesthetic procedures.
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Affiliation(s)
- I-Chien Liao
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Chunyan He
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Xue Lucia Liu
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | | | | | - Mark Kun Qian
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Boonhoe Neo
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Richard Betts
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Chunmei Ding
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | | | - Ying Chen
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Xavier Marat
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Qian Zheng
- L'Oreal Research and Innovation, Clark, New Jersey, USA
| | - Charbel Bouez
- L'Oreal Research and Innovation, Clark, New Jersey, USA
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Tahiliani S, Mysore V, Ganjoo A, Udare S, Rajendran SC, Reddy R, Rathore VS, Bhatia S, Verma S, Katke V, Patil CY. Practical Aspects of Acne Scar Management: ASAP 2024. Cureus 2024; 16:e55897. [PMID: 38595878 PMCID: PMC11003649 DOI: 10.7759/cureus.55897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/11/2024] Open
Abstract
Acne scars are one of the most common complications of acne. They can significantly affect the patient's quality of life. Often, several types of atrophic acne scars are observed simultaneously; therefore, consideration must be given to the type of scar while choosing the treatment modality. Effective treatment is not only important to prevent and improve acne scars but also crucial in preventing psychosocial effects. Treatment of acne scars requires an algorithmic approach that targets each component of the scars, and combination therapy on a patient-specific basis may offer the best chance for significant improvement. The goal of the current article is to discuss the practical aspects of management of atrophic acne scars using the vast modalities of treatment available. The panel of dermatologists and plastic surgeons, each one with at least 20 years of experience in acne scar treatment, participated in a series of 'Practical Aspects of Acne Scar Management' (ASAP) meetings: ASAP 2024. ASAP meetings were organized by "Scar Forum India" from March 2023 to July 2023 in four Indian cities (Mumbai, Delhi, Bengaluru, and Kolkata), each one for a duration of at least three hours. During these meetings and discussions, panelists reviewed and discussed the acne scar-related literature, their clinical experience in its management, available treatment options, along with recent advances. Consequently, a summary of the discussion and practical approach for the management of acne scars is developed. It was concluded that, though there is no specific guideline available to optimize acne scar management despite the multitude of treatment options, the best results can be achieved through the synergy of multiple treatment modalities and using the algorithmic approach.
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Affiliation(s)
- Sushil Tahiliani
- Dermatology, Dr. Sushil Tahiliani Clinic, Mumbai, IND
- Dermatology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, IND
| | - Venkatraman Mysore
- Dermatology, The Venkat Centre for Skin and Plastic Surgery, Bengaluru, IND
| | - Anil Ganjoo
- Dermatology, Skinnovation Clinics, New Delhi, IND
| | - Satish Udare
- Dermatology, Dr. Udare Skin and Hair Clinic, Navi Mumbai, IND
| | - S C Rajendran
- Dermatology, Cosmetic Skin Care Clinic, Bengaluru, IND
| | - Raghunatha Reddy
- Dermatology, Roots Institute of Dermatological Sciences, Bengaluru, IND
| | - V S Rathore
- Plastic Surgery, Kaayakalp Clinic, Kolkata, IND
| | | | | | - Vaishali Katke
- Medical Affairs, A. Menarini India Pvt Ltd., Mumbai, IND
| | - Chetan Y Patil
- Medical Affairs, A. Menarini India Pvt Ltd., Mumbai, IND
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3
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Ding Y, Zhang C, Xiang LF. Application of integrated skincare in medical aesthetics: A literature review. J Eur Acad Dermatol Venereol 2023. [PMID: 38131201 DOI: 10.1111/jdv.19606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Integrated skincare combines clinically proven skincare products with professional medical aesthetics to provide a comprehensive solution for beauty pursuers. Studies have demonstrated that a combination of medical aesthetic procedures and maintenance therapies is more effective than either treatment alone. This review outlines the current applications of integrated skincare, including different regimens of energy-based aesthetic devices and active ingredients in cosmeceuticals or chemical peels. Additionally, the benefits and limitations of integrated skincare are discussed. Lastly, this review highlights the potential for improved satisfaction and long-term maintenance of the desired outcomes through appropriate integrated skincare procedures.
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Affiliation(s)
- Yuecen Ding
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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4
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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Fabi SG, Galadari H, Fakih-Gomez N, Mobin SN, Artzi O, Dayan S. Aesthetic considerations for treating the Middle Eastern patient: Thriving in Diversity international roundtable series. J Cosmet Dermatol 2023; 22:1565-1574. [PMID: 36744586 DOI: 10.1111/jocd.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/05/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Middle East has a significant influence on the global aesthetic market. Within the United States and globally, patients with Middle Eastern heritage have a wide range of ethnic and cultural backgrounds that affect their perceptions of beauty and motivations to seek cosmetic treatment. AIMS The aim of this roundtable was to discuss similarities and differences in anatomy and treatment preferences of Middle Eastern patients and explore how these differences may influence aesthetic practices. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. RESULTS The results of the fourth roundtable in the series, the Middle Eastern Patient, are described here. A discussion of treatment preferences is included, and specific procedural information is provided for commonly treated areas in this population (forehead, infraorbital area, and jawline). CONCLUSIONS Middle Eastern patients have a variety of aesthetic preferences, which are influenced by a wide range of cultural backgrounds, making it difficult to develop general statements about this demographic. There is an unmet need for research into this diverse group of patients to help physicians understand and incorporate their unique needs and desires into clinical practice.
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Affiliation(s)
| | | | - Nabil Fakih-Gomez
- Chief of Department of Facial Plastic Surgery & Cranio-Maxillo-Facial Surgery. Fakih Hospital, Lebanon
| | - Sheila Nazarian Mobin
- Department of Plastic and Reconstructive Surgery; Founder at Nazarian Plastic Surgery, Spa26, The Skin Spot, and the Nazarian Institute in Beverly Hills, Beverly Hills, California, USA
| | - Ofir Artzi
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Steve Dayan
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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6
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Fabi SG, Hernandez C, Montes JR, Cotofana S, Dayan S. Aesthetic considerations when treating the Latin American patient: Thriving in diversity international roundtable series. J Cosmet Dermatol 2023; 22:593-602. [PMID: 36468194 DOI: 10.1111/jocd.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The Hispanic/Latin American population is the fastest growing non-Caucasian group in the United States. Within this group, demand for aesthetic procedures is on the rise. High ethnic variability among these patients influences treatment approaches and patient priorities. Understanding these ethnic differences is central to providing optimal care. AIMS To discuss similarities and differences in anatomy and treatment preferences of Hispanic/Latin American patients both within the United States and internationally and explore how these differences may influence or inform aesthetic practices. PATIENTS/METHODS In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. In this roundtable, held in Medellin, Columbia, expert clinicians from across Latin America and the United States were invited to contribute and share best practices. RESULTS The results of the second roundtable in the series, the Latin American Patient, are described here. A special emphasis is placed on procedures that address the most commonly encountered concerns in these patients. CONCLUSIONS Hispanic and Latino patients represent a broad demographic with unique anatomical features, aesthetic preferences, and treatment priorities. Clinicians should consider these differences when treating this patient population.
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Affiliation(s)
| | | | - José Raúl Montes
- Ophthalmology Department, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Jose Raul Montes Eyes & Facial Rejuvenation, San Juan, Puerto Rico
| | | | - Steve Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
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Weinstein Velez M, Prezzano J, Bell M, Widgerow A. A Single Center, Prospective, Randomized, Blinded Study to Evaluate the Efficacy and Safety of a Topical Tripeptide/Hexapeptide Anhydrous Gel When Used Pre- and Post- Hybrid Fractional Laser for the Treatment of Acne Scars. Clin Cosmet Investig Dermatol 2022; 15:2763-2774. [PMID: 36561095 PMCID: PMC9766513 DOI: 10.2147/ccid.s392459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Background Acne scarring remains a significant problem. Laser therapy has produced varying results with deeper ablative therapies occasionally associated with side effects including delayed healing, infection, scarring, erythema, acne, milia, edema and dyspigmentation. Objective Can adjuvant topical therapy impact the healing process and outcome of patients treated with fractional laser for acne scarring? Methods and Materials Ten patients were randomized to receive either Regenerating Skin Nectar with TriHex Technology®- RSN or a bland moisturizer. Patients underwent two laser procedures one month apart with Hybrid Fractional Laser. The topical was applied twice daily for 2 weeks prior to the first laser procedure, and through completion of the study. Seven study visits occurred over a 90-day period. Measurements were conducted in lesional and non-lesional areas - transepidermal water loss (TEWL), erythema, photography, Goodman and Baron qualitative scale, Global Aesthetic Improvement Scale and patient questionnaires - to assess functional recovery and aesthetic outcomes in the scarred areas. One patient from each cohort consented to biopsy before the procedures and 90 days after the first procedure. Results Reduced TEWL scores in the RSN group were evident at all time points with statistically significant reductions occurring 4 days after first and second procedures indicating more efficient fluid conservation at a critical point in the healing trajectory. Erythema index demonstrated a consistent decrease in the RSN cohort over the control from day 4 through day 90 on lesional and non-lesional skin. Acne scar assessment scores improved in the RSN cohort compared with the control at all time points. Biopsy results showed early elastin regeneration in the RSN biopsy with controlled non-hypertrophic collagen formation evident. Conclusion The use of RSN pre- and post- laser resurfacing significantly decreased postprocedural TEWL and erythema, and increased aesthetic improvement in acne scars and patient satisfaction, when compared with bland moisturizer.
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Affiliation(s)
| | - James Prezzano
- Department of Dermatology, University of Rochester, Rochester, NY, USA,Fayetteville Dermatology, Fayetteville, NY, USA
| | - Michaela Bell
- Clinical Research Dept, Alastin Skincare, Inc. (A Galderma Company), Carlsbad, CA, USA
| | - Alan Widgerow
- Clinical Research Dept, Alastin Skincare, Inc. (A Galderma Company), Carlsbad, CA, USA,Plastic Surgery Dept, Center for Tissue Engineering, University of California Irvine, Irvine, CA, USA,Correspondence: Alan Widgerow, Email
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8
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Lee WW, Fagien S, Murdock J, Bell M, Widgerow AD. A Multi-Center Evaluation of Restorative Eye Treatment and INhance With Trihex Technology to Improve Aesthetic Outcomes When Used Pre- and Post-Blepharoplasty. Aesthet Surg J Open Forum 2022; 5:ojac089. [PMID: 36727033 PMCID: PMC9879749 DOI: 10.1093/asjof/ojac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Restorative Eye Treatment with TriHex Technology (RET) is a topical eye product with peptides and botanicals that reduce the appearance of crow's feet, under-eye bags, and dark circles. INhance with TriHex Technology (IH) is a topical product that has been clinically proven to accelerate the clearance of bruises and aid in the reduction of swelling. TriHex Technology has been shown to regenerate collagen and elastin. Objectives Evaluate the use of RET compared to a bland moisturizer prior to blepharoplasty and the bilateral use of INhance postoperatively. Methods Blepharoplasty patients were randomized to use either RET or a bland moisturizer, twice daily, on the designated periocular skin for 4 weeks prior to the procedure. Postoperatively, participants applied IH bilaterally, at least 4 times a day, and returned for follow-up on Days 1 or 3, 7, and 14. The removed upper-eyelid skin (13 patients) underwent independent dermatopathological evaluation. Results Investigators noted no differences in peri-operative complications but observed faster improvement in swelling, bruising, discomfort on the treated side. 85% of participants had less edema and bruising on the RET pretreated side. Biopsy results revealed improved extracellular matrix appearance on the RET pretreated side. Participants agreed that IH alleviated their swelling and noted that their skin felt and appeared more hydrated. Conclusions A regimen designed for eyelid surgery employing a pretreatment product component and a post treatment product appear to have a positive impact on measured outcomes in blepharoplasty patients including effects on bruising, swelling and patient comfort. Level of Evidence 4
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Affiliation(s)
- Wendy W Lee
- Oculofacial Plastic & Reconstructive Surgery, Orbit and Oncology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven Fagien
- Aesthetic Eyelid Plastic Surgery, Boca Raton, FL, USA
| | | | | | - Alan D Widgerow
- Corresponding Author: Dr Alan D. Widgerow, 9 Waterway Irvine, CA 92614, USA. E-mail: ; Instagram: @alanwidge
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Casas LA, Claytor RB, Zeidler KR, Shridharani SM, Cohen SR, Khanna JJ, Gould DJ, Yates EK, Lultschik S, Bell M, Widgerow AD. A Multicenter, Randomized, Double-Blind, Split-Body Clinical Trial Evaluating the Efficacy and Outcomes of a Topical Product Pre and Post Aesthetic Surgical Body Procedures. Aesthet Surg J Open Forum 2022; 4:ojac054. [PMID: 35979375 PMCID: PMC9376671 DOI: 10.1093/asjof/ojac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Skin preconditioning prior to and following procedures, has previously been demonstrated to hasten and optimize healing, and decrease the symptoms and signs associated with invasive surgery. These trials involved the use of multiple topical products. In an effort to control costs and to increase patient compliance, a single surgical product was developed, with actives aimed at decreasing swelling, bruising, induration, and internal fibrous banding. Objectives This multi-center trial was designed to measure the efficacy of this single product in these mentioned parameters. Methods A double-blind, randomized, split body, clinical study was undertaken in 29 patients involving 38 surgical procedures. Assessments included photography, biopsies, ultrasound imaging, and blinded investigator and participant assessments. Results Differentiated results between test comparator sides became apparent at postop day 10-14 (as previously observed). Thus, blinded investigator and participant assessment scores demonstrated statistical significance exclusive to the test product side at postop day 10-14 for ecchymoses and then extending to skin discoloration, edema, induration and subcutaneous fibrous banding, at weeks 3, 4, 6, and 12. Ultrasound evaluation confirmed the earlier dissolution of fibrous banding on the test side in the subcutaneous tissue at the 3-6-week postop period. In addition, biopsies assessing the pre-conditioned period prior to surgery confirmed that the topical test product stimulated a remodeled extracellular matrix without comparative changes on the opposite side. Conclusions A single peri-surgical product designed for the use with invasive surgery produced significant differences in ecchymosis, skin discoloration, edema, induration and ongoing resolution of fibrous banding over many weeks. This study validation provides an additional adjunct to surgical procedures. Level of Evidence 2
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Affiliation(s)
- Laurie A Casas
- Section of Plastic & Reconstructive Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - R Brannon Claytor
- Division of Plastic Surgery, Main Line Health Systems, Bryn Mawr, PA, USA
| | | | | | | | | | | | - Essie K Yates
- NOVA Southeastern University, Fort Lauderdale, FL, USA
| | | | | | - Alan D Widgerow
- Corresponding Author:Dr Alan D. Widgerow, 3129 Tiger Run Ct. Suite 109, Carlsbad, CA 92010, USA. E-mail: ; Instagram: @alanwidge
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Lee WR, Hsiao CY, Chang ZY, Wang PW, Aljuffali IA, Lin JY, Fang JY. Cutaneous Delivery of Cosmeceutical Peptides Enhanced by Picosecond- and Nanosecond-Domain Nd:YAG Lasers with Quick Recovery of the Skin Barrier Function: Comparison with Microsecond-Domain Ablative Lasers. Pharmaceutics 2022; 14:pharmaceutics14020450. [PMID: 35214181 PMCID: PMC8880571 DOI: 10.3390/pharmaceutics14020450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/07/2023] Open
Abstract
Picosecond or nanosecond-domain non-ablative lasers generate faster photothermal effects and cause less injury than microsecond lasers. In this study, we investigated the enhancing effect of 1064 nm picosecond- and nanosecond-domain neodymium (Nd):yttrium–aluminum–garnet (YAG) lasers on the cutaneous delivery of cosmeceutical peptides. Microsecond-domain fractional ablative CO2 and fully ablative erbium (Er):YAG lasers were also used for comparison. In the Franz diffusion cell study, pig or mouse skin was treated with a laser before exposure to palmitoyl tripeptide (PT)-1, PT-38, and copper tripeptide (CT)-1 at a concentration of 150 μM. Psoriasiform, atopic dermatitis (AD)-like, and photoaged skins were also developed as permeation barriers. The non-ablative laser elicited the ultrastructural disruption of the stratum corneum and epidermal vacuolation. All laser modalities significantly increased the skin permeation of peptides in vitro. The non-ablative laser chiefly enhanced peptide delivery to the receptor compartment, whereas the ablative laser mainly increased the intracutaneous peptide deposition. The picosecond- and nanosecond-domain Nd:YAG lasers elevated the amount of PT-1 in the receptor up to 40- and 22-fold compared with untreated skin, respectively. Laser treatment promoted peptide delivery in barrier-deficient and inflamed skins, although this enhancement effect was less than that observed in healthy skin. Fluorescence microscopy indicated the capability of the non-ablative laser to deliver peptides to deeper skin strata. The ablative laser confined the peptide distribution in the epidermis. Confocal microscopy showed that peptides penetrated the skin along the microdots created by the fractional Nd:YAG and CO2 lasers. The skin barrier function determined by transepidermal water loss suggested quick recovery when using a nanosecond-domain laser (within 4 h). A longer period was needed for the skin treated with the fully ablative Er:YAG laser (76–84 h). Nanosecond non-ablative laser-facilitated peptide delivery may become an efficient and safe approach for cosmeceutical applications.
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Affiliation(s)
- Woan-Ruoh Lee
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei 110, Taiwan;
- Department of Dermatology, Taipei Medical University Shuang Ho Hospital, New Taipei City 234, Taiwan
| | - Chien-Yu Hsiao
- Department of Nutrition and Health Sciences, Chang Gung University of Science and Technology, Kweishan, Taoyuan 333, Taiwan;
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Kweishan, Taoyuan 333, Taiwan
- Aesthetic Medical Center, Department of Dermatology, Chang Gung Memorial Hospital, Kweishan, Taoyuan 333, Taiwan
| | - Zi-Yu Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Pei-Wen Wang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan;
| | - Ibrahim A. Aljuffali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Jie-Yu Lin
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Kweishan, Taoyuan 333, Taiwan;
| | - Jia-You Fang
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Kweishan, Taoyuan 333, Taiwan
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Kweishan, Taoyuan 333, Taiwan;
- Department of Anesthesiology, Chang Gung Memorial Hospital, Kweishan, Taoyuan 333, Taiwan
- Correspondence:
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Widgerow AD, Ziegler ME, Casas LA. Topical Skin Treatment and Its Influence on Surgical Healing: Review of Literature and Underlying Physiology. Aesthet Surg J Open Forum 2021; 3:ojab029. [PMID: 34476397 PMCID: PMC8405846 DOI: 10.1093/asjof/ojab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
TriHex Technology (Alastin Skincare, Carlsbad, CA) has been shown clinically to promote healing and outcomes post procedures and has been demonstrated clinically to improve lipid droplet dissolution and patient-reported outcomes post procedure. Histologically, the formulations have proven to regenerate collagen and elastin. The use of the technology to prepare the skin for surgical procedures combined with its use post procedure was assessed through clinical study outcomes, histological evidence, and gene expression analyses and demonstrated remodeling of the extracellular matrix (ECM), accelerating healing, and initiation of anti-inflammatory genes. While the improvement in clinical signs and outcomes has been validated, the changes taking place at a molecular level need to be explored. The interaction of cells (adipocytes, macrophages, fibroblasts) and the ECM proteins (collagen, elastin) secondary to the effects of the topical agent application are discussed. It appears that the manipulation of fat during body contouring surgery and the resultant adipocytolysis precipitates a molecular profile that can be positively directed toward hastened healing by using adjuvant topical applications as preconditioning prior to surgery and after the surgical procedure. Here, we review the literature and underlying physiology relating to these products and describe how interleukin 6 appears to be the primary facilitator of these effects.
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Affiliation(s)
| | - Mary E Ziegler
- Center for Tissue Engineering, University of California Irvine, Irvine, CA, USA
| | - Laurie A Casas
- Division of Plastic and Reconstructive Surgery, The University of Chicago Medicine and Biological Sciences, Glenview, IL, USA
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12
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Casas LA, Bell M, Claytor B, Ziegler ME, Widgerow AD. An Analysis of Patient-Reported Recovery Outcomes of Topical Tripeptide/Hexapeptide Formulations Utilized in a Prospective Randomized Double-Blind Split Neck and Body Study. Aesthet Surg J Open Forum 2021; 3:ojaa052. [PMID: 33791673 PMCID: PMC7984834 DOI: 10.1093/asjof/ojaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physicians strive to improve the postsurgical experience and optimize patient-reported recovery outcome measures (PROMs) following elective cosmetic surgical procedures. Our previous pilot feasibility study demonstrated that twice daily postoperative topical body treatment with tripeptide and hexapeptide (TransFORM Body Treatment with TriHex Technology [TFB, Alastin Skincare, Inc., Carlsbad, CA]) reduced PROMs of swelling, induration, soft tissue fibrosis, and pain as well as improved visible and palpable skin quality. OBJECTIVES Evaluate whether adding a tripeptide/hexapeptide anhydrous gel (Regenerating Skin Nectar with TriHex Technology [RSN, Alastin Skincare, Inc., Carlsbad, CA]) pre- and post-procedure to the existing postsurgical regimen of TFB significantly improves 6 PROMs in patients undergoing neck and body contouring cosmetic surgical procedures. METHODS Ten female patients underwent 15 neck and body contouring procedures and were blindly randomized to 1 of 2 topical treatment protocols (1 [TFB] and 2 [RSN/TFB]) pre- and post-procedure. Patient-reported scores of 5 skin parameters (skin discoloration, ecchymosis, edema, induration, and subcutaneous fibrous banding) and pain scores using the Visual Analog Scale were collected at 8 intervals for 12 weeks post-procedure. RESULTS The treatment side that used both topicals showed significantly reduced scores of edema, induration, and subcutaneous fibrous banding compared with the side that only used 1 topical, on days 5-7 and 10-14 (P < 0.05). All patients observed slower soft tissue recovery on the side that was treated with TFB alone and opted to break the code and use both topical treatments. CONCLUSIONS Patients had statistically significant improved patient-reported measures of skin edema, skin induration, and subcutaneous banding on the operated side that used both topicals. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Laurie A Casas
- Corresponding Author: Laurie A. Casas, MD, Casas Aesthetic Plastic Surgery, 2050 Pfingsten Road Suite 270 Glenview, IL, USA. E-mail: ; Instagram: @drlauriecasas
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Wang JV, Christman MP, Feng H, Ferzli G, Jeon H, Geronemus RG. Tripeptide and hexapeptide topical as adjunct to nonablative fractional resurfacing for photodamage: A randomized split-face trial. J Cosmet Dermatol 2020; 19:3245-3250. [PMID: 33051975 DOI: 10.1111/jocd.13795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve postprocedural recovery following treatments. AIMS A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing. PATIENTS/METHODS A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14 days prior to first laser treatment and continuing until 60 days after. All subjects received 2 treatments to entire face approximately 1 month apart with 1927 nm thulium nonablative fractional laser. Clinical measures and immediate postprocedural recovery were assessed. RESULTS For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60 days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60 days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed. CONCLUSION Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to nonablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate postprocedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects.
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Affiliation(s)
- Jordan V Wang
- Laser & Skin Surgery Center of New York, New York, NY, USA
| | | | - Hao Feng
- Laser & Skin Surgery Center of New York, New York, NY, USA
| | | | - Hana Jeon
- Laser & Skin Surgery Center of New York, New York, NY, USA
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Nelson AM, Ortiz AE. Effects of anhydrous gel with TriHex peptides on healing after hybrid laser resurfacing. J Cosmet Dermatol 2020; 19:925-929. [PMID: 31957958 DOI: 10.1111/jocd.13270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/11/2018] [Accepted: 03/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hybrid fractional laser skin resurfacing is a procedure that combines fractional nonablative and ablative wavelengths to improve photoaging. The postoperative period involves overt skin swelling, redness, and roughness. OBJECTIVE A single-center, randomized trial was performed to compare the effect of a standard Skincare regimen, with and without an anhydrous gel with TriHex peptides (a proprietary tripeptide and hexapeptide blend), on recovery after hybrid laser resurfacing of the face. METHODS Five subjects were assigned to a split-face protocol. Use of the skin regimen began approximately 2 weeks before the hybrid laser resurfacing and ended 7 days after. Subjects were evaluated by a physician for postprocedural healing. Additionally, the subjects were photographed and completed surveys to assess postprocedural healing and overall preference for Skincare regimen. RESULTS Based on physician assessment, mean redness on postoperative days 1 and 4 and mean roughness on the postoperative days 3 and 4 were significantly (P < .05) improved on the side of the face using the anhydrous gel with TriHex peptides compared with the side using a standard skin regimen. Based on subject assessment, 4 out of 5 subjects thought that their skin and complexion appeared better on the anhydrous gel-treated side and preferred the Skincare regimen with the gel. CONCLUSIONS These data suggest that using the anhydrous gel with TriHex peptides before and after hybrid fractional laser skin resurfacing can minimize the postoperative redness and roughness that are typical and expected for this procedure.
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Affiliation(s)
- Aislyn M Nelson
- Department of Dermatology, University of California, San Diego, CA
| | - Arisa E Ortiz
- Department of Dermatology, University of California, San Diego, CA
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Nonsurgical Adjuncts Following Facelift to Achieve Optimal Aesthetic Outcomes. Clin Plast Surg 2019; 46:613-623. [DOI: 10.1016/j.cps.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Widgerow AD, Cohen SR, Fagien S. Preoperative Skin Conditioning: Extracellular Matrix Clearance and Skin Bed Preparation, A New Paradigm. Aesthet Surg J 2019; 39:S103-S111. [PMID: 30958551 PMCID: PMC6482000 DOI: 10.1093/asj/sjz022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper introduces the concept of “skin bed preparation” prior to surgical procedures. Following the theory of chronic wound bed preparation and adapting the skin model to one of chronic wound changes related to extrinsic and intrinsic factors, a topical formulation aimed at recycling the extracellular matrix (ECM) from accumulated waste products is evaluated and discussed. The clearance of these products and stimulation of new replacements has the potential to change the regenerative milieu of the skin so that when procedures are carried out, cellular signaling and cross-talk at the dermal level are improved and healing is optimized. By introducing a combination of peptides and other synergistic active agents, a sequence of clearance, regeneration, and remodeling is initiated. This is confirmed and validated by a series of biopsies and clinical studies that demonstrate changes in the ECM as early as 2 to 3 weeks after application. Clinical studies related to resurfacing procedures show accelerated healing and improved symptomatic relief compared with standard of care by preconditioning the skin 2 weeks prior to the procedure. A similar approach is suggested as a potential advantage for invasive surgical procedures based on similar scientific principles elucidated on in the text.
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Affiliation(s)
- Alan D Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, CA
| | - Steven R Cohen
- Clinical Professor of Plastic Surgery, University of California, San Diego, CA
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Reivitis A, Karimi K, Griffiths C, Banayan A. A single-center, pilot study evaluating a novel TriHex peptide- and botanical-containing eye treatment compared to baseline. J Cosmet Dermatol 2018; 17:467-470. [DOI: 10.1111/jocd.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Alex Reivitis
- Rejuva Medical Aesthetics; LLC; Providence St. John's Health Center; Los Angeles CA USA
| | - Kian Karimi
- Rejuva Medical Aesthetics; LLC; Providence St. John's Health Center; Los Angeles CA USA
| | - Chester Griffiths
- Rejuva Medical Aesthetics; LLC; Providence St. John's Health Center; Los Angeles CA USA
| | - Ashley Banayan
- Rejuva Medical Aesthetics; LLC; Providence St. John's Health Center; Los Angeles CA USA
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