Skin Quality - A Holistic 360° View: Consensus Results

Superficial Intradermal Injections of Cohesive Polydensified Matrix Hyaluronic Acid Fillers for the Improvement of Facial Pores and Skin Quality: A Split-Face Randomized Study

BACKGROUND

Various therapeutic options have been introduced for enlarged facial pores including low cross-linked hyaluronic acid (HA) fillers. Newer formulations of HA-based dermal fillers are continuously introduced into the market, but their effectiveness in reducing enlarged facial pores has not yet been determined.

OBJECTIVES

To compare the efficacy of HA-based dermal fillers (Cohesive Polydensified Matrix HA filler; CPM-HA20) versus CPM-HA20 with glycerol (CPM-HA20G) in terms of minimizing enlarged facial pores and skin quality improvement.

METHODS

Thirty subjects with enlarged facial pores were enrolled in this randomized, double-blinded, split-face study. Participants were randomly assigned to be injected with 1 mL of CPM-HA20 filler on one side of their medial cheek and 1 mL of CPM-HA20G on the contralateral side for 3 sessions spaced 4 weeks apart. Pore volume was objectively measured by an Antera 3D. Skin biophysical properties were evaluated. Participant satisfaction and adverse events were recorded.

RESULTS

Twenty-nine participants completed the study. Both treatment groups showed a reduction in the mean pore volume from the baseline through Week 32. The CPM-HA20G treated side showed a 24.2% higher reduction in mean pore volume from baseline compared to the CPM-HA20 treated side (p = 0.038). Both treatment groups showed improvement in skin hydration from baseline to Week 32. There was no significant difference in patient satisfaction between the CPM-HA20G and CPM-HA20 treated sides. Only mild adverse events such as pain, edema, and bruising were reported.

CONCLUSION

Three-monthly injections of CPM-HA20G and CPM-HA20 were effective in minimizing enlarged face pores and improving skin hydration. CPM-HA20G demonstrated superior efficacy in terms of pore size reduction. Adverse events were generally mild and tolerable.

Effective Skin Rejuvenation by a Novel Antioxidant Biostimulating Treatment

BACKGROUND

Facial skin aging is a cumulative result of both intrinsic and extrinsic stressors. Chemical peels are commonly performed noninvasive skin rejuvenation procedures targeting these stressors. Innovation in chemical peels has remained limited, creating an opportunity for the industry to evolve with next-generation technology.

AIMS

A novel topical antioxidant biostimulating treatment (ABT) was developed that utilizes a typical chemoexfoliation base as a vehicle to deliver a unique blend of antioxidant biostimulating acidic phytocompounds (ABAP). It was hypothesized that controlled delivery of ABAP could occur through a typical AHA/BHA chemical peel vehicle. These ABAPs, such as asiatic, ursolic, madecassic, and oleanolic acids, are known for skin rejuvenation in the papillary dermis.

PATIENTS/METHODS

The ABT was tested in both ex vivo and in vivo settings to elucidate its mechanism of action and determine its efficacy and safety on 32 female subjects aged 38-60 years with Fitzpatrick skin types I-V.

RESULTS

The ABT upregulated elastin and collagen after superficial wounding of the skin by over 25% when compared to untreated or vehicle controls. Clinical evaluation by an expert grader demonstrated that the ABT significantly improved fine lines, wrinkles, tactile laxity, and overall appearance after three ABT sessions. Clinical photography demonstrated an improvement in fine lines, wrinkles, skin smoothness, laxity, radiance, and overall appearance.

CONCLUSIONS

The ABT developed with ABAP technology was efficacious in improving facial skin aging for skin rejuvenation and safe for all skin tones.

A Multi-Center Clinical Trial to Evaluate the Efficacy of the Next Generation TriHex Technology Antiaging Regimen

BACKGROUND

Alastin Restorative Skin Complex Serum with TriHex Technology (Alastin Skincare Inc., Carlsbad, CA) has undergone reformulation to add Octapeptide-45 and magnolol for improving facial skin hydration, elasticity, plumping, and overall skin quality. Detailed science on TriHex Technology 2.0 and magnolol has been recently published. This open-label study was conducted to validate the science and demonstrate product efficacy and tolerability in individuals with moderate to severe facial skin aging.

METHODS

A multi-center clinical study was conducted from February to August 2024. A total of 44 eligible participants (43 female, 1 male), ages 35-69 years, and Fitzpatrick skin Types I-VI were enrolled in and completed the study following 12 weeks of Alastin Restorative Skin Complex Serum 2.0 with TriHex Technology (RSC 2.0) use twice daily, along with an Alastin Skincare Inc. supportive regimen (cleanser, moisturizer, sunscreen used as needed). A 1-week run-in phase using the supportive regimen only was conducted, and eligibility was reassessed at baseline. Follow-up visits were performed at Weeks 4, 8, and 12, where facial skin quality parameters were evaluated clinically and subject assessments and satisfaction questionnaires, biopsy collection, photography, and hydration and elasticity measurements were completed. Participants also maintained a study diary over the 12-week treatment period.

RESULTS

Significant improvements for all clinically evaluated facial skin parameters were achieved at Week 12. Histology revealed increased stimulation of new adipocytes, epidermal keratinocyte HA (CD44), and new dermal collagen and elastin fibers post treatment.

CONCLUSION

Alastin Restorative Skin Complex Serum 2.0 with TriHex Technology has been demonstrated to be safe and effective for improving overall facial skin quality, achieving notable improvements in volume, plumping, hydration, and extracellular matrix (ECM) collagen and elastin stimulation.

Microfocused Ultrasound With Visualization (MFU-V) Effectiveness and Safety: A Systematic Review and Meta-Analysis

Microfocused ultrasound with visualization (MFU-V) is an advanced, noninvasive cosmetic procedure widely performed for skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patient satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates with random effects models and corresponding 95% confidence intervals were calculated. Out of 4019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81%-94%; I2: 63%, n = 411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73%-91%; I2: 64%, n = 312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61%-94%; I²: 52%, n = 326), and 62% (95% CI: 37%-82%; I²: 3%, n = 172) when "neutral" as a response option was provided for patients. Skin quality (eg, wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35; I2: 97%, n = 785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patient satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive may result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Development and Validation of a Novel Holistic Skin Quality Assessment Scale

BACKGROUND

Radiant skin is a common patient request and the result of multiple contributing factors. Currently, there is no standardized methodological approach that facilitates assessment of skin quality from a holistic perspective.

AIM

To develop a holistic methodological process to assess skin quality using a scale that helps identify treatment priorities, facilitates conversation with the subject, and helps manage expectations, supports long-term treatment plans, and tracks treatment progress over time.

METHODS

Ten global experts (dermatologists and esthetic physicians) identified the main measurable aspects that contribute to skin quality, and these were combined to form the Skin Quality Assessment Scale (SQS). The scale comprises four overarching skin quality domains containing nine measurable aspects: texture (pores, lines, scars); discoloration (redness, pigmentation, dullness); firmness (laxity); and hydro-lipid balance (oiliness, dryness). Each aspect is graded on a 4-point severity scale (0 = none to 3 = severe). The SQS was validated by a large group of practicing clinicians.

RESULTS

Practicing clinicians (> 40, 78% dermatologists) were surveyed; prior to reviewing the scale, 67% did not use any scale but 81% believed a holistic SQS was needed. After reviewing the scale, 100% agreed the scale provides a holistic assessment of skin quality. In addition, 95% agreed the scale helps assess all key aspects of skin quality with subjects and 98% deemed it valuable for their clinic.

CONCLUSIONS

The SQS represents a holistic assessment tool that engages with and manages subjects' expectations, identifies treatment priorities, creates a long-term treatment plan, and visualizes the skin quality improvement over time.

Objectification of Skin Firmness: In Vivo Evaluation of 300 Women in Relation to Age

BACKGROUND

The concept of "skin quality" (SQ) has gained widespread attention, with a recent international consensus defining it and outlining four "emergent perceptual categories" (EPCs), each accompanied by specific parameters and associated measurement methods. No research has confirmed whether the parameters linked to these EPCs vary objectively with age. This gap in data is significant, as understanding how these parameters correlate with age could be essential for creating an objective, age-adjusted classification of SQ.

AIM

The aim of this study was to investigate the EPC skin firmness in female facial and non-facial skin in relation to age using biophysical measurements. Reference ranges for objective assessment were determined.

PATIENTS/METHODS

Three hundred healthy women (20-69 years) were divided into five age groups. The correlation between age and skin firmness measured by Cutometer and Corneometer (Courage+Khazaka electronic GmbH, Cologne, Germany) devices was evaluated across five anatomical sites: forehead, cheek, neck, décolleté, and the hand. Percentiles were used to generate reference ranges.

RESULTS

Statistical analysis discloses that R2 (Ua/Uf), R5 (Ur/Ue), and R7 (Ur/Uf) correlated with age for all five sites and are preferably assigned to the EPC skin firmness, whereby R2 and R7 showed the strongest correlation. For the neck, significant age-related changes were found in most of the Cutometer parameters. The stratum corneum (SC) hydration showed only low correlations with age.

CONCLUSIONS

R2, R5, and R7 are reliable indicators of age-related changes in skin firmness, with established reference ranges that can aid in treatment decisions and SQ assessments.

Facial Skin Quality Improvement After Treatment With CPM-HA20G: Clinical Experience in Korea

BACKGROUND

Intradermal injection of CPM-HA20G, a low-viscoelasticity hyaluronic acid (HA) dermal filler with glycerol, has been shown to be effective for facial rejuvenation in Caucasians, but research in Asians is limited.

AIMS

This study aimed to evaluate the effectiveness and safety of CPM-HA20G in enhancing facial skin quality in Korean women using a protocol developed by local aesthetic experts.

PATIENTS/METHODS

In this 24-week prospective, single-arm, open-label study, 20 women received CPM-HA20G injections in the immediate subdermal layer on the anterior cheek (1 mL per side; total 2 mL) in three sessions every 4 weeks. Evaluations included biophysical assessments covering the four emergent perceptual categories (EPCs) for skin quality and subjective assessment using the Global Aesthetic Improvement Scale.

RESULTS

Significant improvements in skin glow (skin gloss, epidermal hydration), skin firmness (dermal elasticity, dermal hydration), skin surface evenness (average pore volume, pore area, pore density, pore count, maximum pore depth, total pore volume, skin roughness, sebum secretion, and skin depression volume), skin tone evenness (skin color brightness, skin redness), and transepidermal water loss were observed at Week 12 and Week 24 following the first injection with CPM-HA20G. Most subjects and investigators reported improvements in overall aesthetic appearance with the treatment, with a 100% improvement rating from both groups at Week 12. No serious adverse reactions were observed.

CONCLUSIONS

Our study provides real-world insights into the effectiveness and safety of CPM-HA20G in improving facial skin quality in an Asian population, evaluated through both objective and subjective assessments.

Safety and Efficacy of an Injectable Solution Enriched With Sodium Hyaluronate, Amino Acids, and Peptides in Relation to Superficial Facial Connective Tissues (Dermis and Retinacular Cutis)

BACKGROUND

Skin aging research often focuses on the dermis, overlooking the significance of the retinacular cutis (RC) in aging. This study aimed to investigate the efficacy, safety, and effect of an injectable solution containing hyaluronic acid, amino acids, and peptides, on facial sagging and laxity by targeting the RC.

METHODS

This single-center observational study recruited 28 female volunteers aged 25-65 years. The participants received four monthly injections of the studied solution. Objective measures included skin hydration, elasticity, color, thickness, collagen density evaluated via DermaLab Combo and high-resolution ultrasound imaging. Subjective measures included participant satisfaction evaluated using the Global Aesthetic Improvement Scale (GAIS). Adverse effects were monitored throughout the study period.

RESULTS

Significant improvements were observed in skin hydration, elasticity, and collagen density after treatment. Hydration increased by 25.9% at T1 (30 days after last session), sustaining a 15.9% increase at T2 (120 days after last session). Elasticity improved by 29.2% at T1 and 20.7% at T2. Collagen density increased by 20.27% at T1 and 16.71% at T2. Self-reported GAIS scores showed consistent increases. Adverse effects were minimal and included only transient ecchymosis and mild pain.

CONCLUSION

Injections of the solution had a substantial hydrating effect, enhanced elasticity, and increased collagen density in the RC and dermis. Results persisted at the 120-day follow-up, indicating sustained benefits. Hence, this injectable solution may offer a safe and effective non-invasive treatment option for improving skin laxity and sagging, targeting the RC and other deep connective tissue such as retaining ligaments.

Panfacial Approach to Rejuvenation Using Calcium Hydroxylapatite: A Case Series Illustrating Calcium Hydroxylapatite Versatility Through Dilution and a Multilayered Treatment Approach

Dermal fillers can be used in a wide range of applications. Although the versatility of hyaluronic acid fillers stems from the wide array of available products, for the biostimulatory filler calcium hydroxylapatite (CaHA), dilution can be used to control product volumizing capacity and flow properties, facilitating use for panfacial rejuvenation. Here, the authors share case studies illustrating how CaHA at various dilutions can be used to achieve global aesthetic improvement as part of a multilayered approach to rejuvenation. As part of a continuing medical education activity, the authors treated patients with 1 to 3 sessions of CaHA at various dilutions. Six months after the patients' initial treatments, the authors reconvened to share their experiences and discuss patient results. Select case studies are presented. Though each patient recieved a unique treatment tilored to their own needs, several themes emerged. Although undiluted product can be used to provide deeper volume and structural support in areas like the chin, jawline, and temples, more dilute product (1:1 and 1:2) can be used to provide some volume and/or smooth transitions in the face, whereas hyperdilute CaHA can be used over an even wider surface area in the face, neck, or décolletage to tighten skin and improve skin quality (1:3 and 1:4 dilutions). In the cases presented, patients achieved improvement in appearance through treatment with multiple dilutions of CaHA, providing several examples of how CaHA may be used as part of a multilayered approach to facial rejuvenation.

Level of Evidence 5 Therapeutic

A Review of Aesthetic Considerations for Treating the Transgender Patient

BACKGROUND

As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques.

OBJECTIVE

The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population.

METHODS

A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques.

RESULTS

The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy.

CONCLUSION

The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Clinical Benefits of DaxibotulinumtoxinA for Injection: Beyond Glabellar Line Effacement?

BACKGROUND

Botulinum toxin type A (BoNTA) is standard of care for glabellar lines ameliorization. DaxibotulinumtoxinA for Injection (DAXI) is a new BoNTA with a unique formulation representing the latest advancement in BoNTA technology. There is an unmet need for patients to understand the full potential of BoNTA treatment and new technologies.

OBJECTIVE

To update clinical data supporting the use of DAXI for glabellar lines within the context of clinical experience.

MATERIALS AND METHODS

A narrative review of the literature and summary of clinical experience with DAXI.

RESULTS

The DAXI clinical trial program reflects clinical experience post-FDA approval, with DAXI demonstrating rapid onset, high patient response rates, and extended treatment duration versus conventional BoNTAs. Clinical observations suggest that DAXI has limited diffusion from the injection site, enabling more localized control of muscle activity and greater improvements in wrinkle severity. DAXI enables practitioners to exert greater finesse in their injections and in predicting changes to eyebrow shape and position and achieve improvement in skin quality.

CONCLUSION

Advances in BoNTA technology can provide patients with greater options for treatment outcomes. The potential for enhanced localized effects with DAXI may contribute to more precise and targeted effects on muscle activity and additional aesthetic benefits to patients.

Photoaging and cosmeceutical solutions in sun-overexposed countries: The experience of Australia and Brazil

Skin aging is the result of physiological changes determined by genetically driven processes and intrinsic factors, and exacerbated by a combination of multiple environmental factors, the main one being sun exposure. The effects of photoaging are particularly apparent on the face, where the appearance of aging signs can have a significant impact on the emotions conveyed and well-being. Photoprotection and facial skin care for managing photoaging signs are thus of particular importance for both physical and mental health. Countries, like Australia and Brazil, where the level of sun exposure is high and the populations have predominantly outdoor lifestyles, are particularly aware of the harms of photoaging and have implemented several measures to help reduce the risk of skin cancer in their populations. However, sun-seeking behaviours are difficult to change, and it takes time before interventions provide perceptible results. Australia still has some of the highest skin cancer incidence and mortality rates in the world. Solutions that target individuals can also be used for minimizing the clinical signs of facial aging and for improving skin quality, with the ultimate aim being not only to improve the appearance of the skin but also to mitigate the occurrence of pre-malignant and malignant lesions. This review summarizes the features of facial skin photoaging in photo-exposed populations, based on evidence gained from studies of Australian individuals, and discusses the various available solutions for skin photoaging, in particular those that are most popular in Brazil, which is a country with many years of experience in managing photoaged skin.

Development and Validation of a Composite Skin Quality Scale

Background

The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices.

Objectives

To develop and validate a 5-point photonumeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness.

Methods

The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed through intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs.

Results

Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side) and an ICC of 0.903 for both sides, indicating an almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853 and ICCs between 0.657 and 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established.

Conclusions

Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products.

Level of Evidence 3

Aesthetic Considerations for Treating Lesbian, Gay, and Bisexual Patients: A Review and Our Experience

Objectvie

The population of the United States continues to grow in diversity, particularly within sex and gender. In recent years, there has been a surge in aesthetic procedures in the Lesbian, Gay, Bisexual (LGB) community. Herein, we discuss a tailored approach to these patient populations and offer guidance to address their concerns both safely and effectively based on a comprehensive review of the literature as well as a roundtable series focusing on diversity in aesthetics.

Methods

A literature search was conducted on PubMed using the following terms: "aesthetics," "cosmetics," "lesbian," "gay," and "bisexual." Additionally, an eight-part roundtable series focusing on diversity in aesthetics was conducted from August 2021 to August 2022.

Results

The results of the literature search as well as the discussion from the roundtable series addressing the LGB community are reviewed within.

Limitations

We are limited by the paucity of data available in the existing literature. We also acknowledge differences within LGB subgroups and a need for individualization.

Conclusion

A tailored approach to the LGB patient with regards to fillers, neuromodulators, and energy-based devices may offer improved patient satisfaction and safety.

Skinly: A novel handheld IoT device for validating biophysical skin characteristics

BACKGROUND

Recent advancements in artificial intelligence have revolutionized dermatological diagnostics. These technologies, particularly machine learning (ML), including deep learning (DL), have shown accuracy equivalent or even superior to human experts in diagnosing skin conditions like melanoma. With the integration of ML, including DL, the development of at home skin analysis devices has become feasible. To this end, we introduced the Skinly system, a handheld device capable of evaluating various personal skin characteristics noninvasively.

MATERIALS AND METHODS

Equipped with a moisture sensor and a multi-light-source camera, Skinly can assess age-related skin parameters and specific skin properties. Utilizing state-of-the-art DL, Skinly processed vast amounts of images efficiently. The Skinly system's efficacy was validated both in the lab and at home, comparing its results to established "gold standard" methods.

RESULTS

Our findings revealed that the Skinly device can accurately measure age-associated parameters, that is, facial age, skin evenness, and wrinkles. Furthermore, Skinly produced data consistent with established devices for parameters like glossiness, skin tone, redness, and porphyrin levels. A separate study was conducted to evaluate the effects of two moisturizing formulations on skin hydration in laboratory studies with standard instrumentation and at home with Skinly.

CONCLUSION

Thanks to its capability for multi-parameter measurements, the Skinly device, combined with its smartphone application, holds the potential to replace more expensive, time-consuming diagnostic tools. Collectively, the Skinly device opens new avenues in dermatological research, offering a reliable, versatile tool for comprehensive skin analysis.

Polynucleotides HPT for Asian Skin Regeneration and Rejuvenation

Introduction

Even lightly compromised skin may impact self-esteem and social behaviour. After intradermal infiltration, natural-origin Polynucleotides High Purification Technology (PN HPT) promote new collagen and extracellular matrix production, translating into a physiological correction of the ageing skin. The study aimed to explore the benefits of intradermal PN HPT on the four perceptual skin quality categories "Skin Tone Evenness", "Skin Surface Evenness", "Skin Firmness", and "Skin Glow" in a representative sample of 30 Asian subjects (mean age 40.2± 11.4 years old).

Methods

Study protocol: three intradermal injections of a PN HPT-based Class III CE-marked medical device at T0 (baseline assessment and first treatment session), T1 (four weeks after baseline), and T2 (eight weeks after baseline), with efficacy and safety evaluations at T1, T2, T3 (four months after baseline) and T4 (six months after baseline). Quantitative and qualitative assessments: 3D skin analysis system QuantifiCare and Global Aesthetic Improvement Scale (GAIS, Investigator and Patient subscales).

Results

PN HPT treatment led to a meaningful and statistically significant improvement of the skin surface, firmness, pigmentation, and radiance, with no early- or late-onset adverse events and benefits persisting up to the sixth-month visit in all subjects. At T4, 33% and 43% of treated subjects felt "Much Improved" and "Very Much Improved" (optimal result); 56% and 44% of treated subjects felt "Satisfied" or "Very Satisfied". At T4, the mean Investigator GAIS scores were 3.33 out of 5.0 for the "Skin Tone Evenness" skin quality perceptual category, 3.46 for the "Skin Surface Evenness" category, 3.61 for "Skin Firmness", and 3.45 per for the radiance determinant of the "Skin Glow" category.

Conclusion

Intradermal treatment with the PN HPT-based medical device led to a meaningful improvement of the skin surface, firmness, pigmentation, and radiance with complete safety. The aesthetic benefits persisted up to the sixth-month visit in all subjects.

A Multi-center Trial Evaluating a Serum Comprised of Plant-based Adaptogens Targeting Skin Quality

Objective

The ability of the skin to maintain homeostasis declines with age. Adaptogens support the capacity of the skin to respond to stress. We sought to evaluate the efficacy of a novel serum comprised of plant-based adaptogens for improving photoaged skin following twice-daily application.

Methods

A multi-center, 12-week trial was conducted in participants aged 45 to 65 years, Fitzpatrick Skin Type (FST) I to VI, with mild-to-severe photoaging based on a 10-point grading scale (3 [Minimum] to 7 [Maximum]). Visible improvements were assessed in erythema, pore size, skin dullness, skin texture, and uneven pigmentation utilizing a six-point grading scale (0=None to 5=Severe). Global skin quality was measured utilizing our Global Skin Quality Index (GSQI). Sebum measurements were obtained in a subset of participants. Patient satisfaction and tolerability were recorded throughout the study.

Results

Fifty-three participants were enrolled and completed the study. Mean age was 56 years and 66 percent were White, 17 percent were Black, 8 percent were Hispanic, 6 percent were Asian/Pacific Islander, and 81 percent had moderate photodamage. At Week 12, significant mean percent improvements from baseline were demonstrated in erythema (50%), dullness (44%), texture (52%), pore size (23%), and uneven pigmentation (21%; all p<.0001). Significant GSQI improvements from baseline were observed at Week 12 (39%; p<0.0001). Significant mean reductions from baseline in skin surface sebum were demonstrated at Week 12 (-38%; p<0.0001). All adverse events (AEs) were mild and transient.

Conclusion

A novel serum comprised of plant-based adaptogens, demonstrated improvements from baseline in the appearance of erythema, dullness, texture, pore size, uneven pigmentation, and global skin quality over 12 weeks. Participants reported high levels of satisfaction, with mild, transient AEs reported.

Optimal Changes Seen in Patients After Treatment With Poly- l -Lactic Acid: A Retrospective Descriptive Study

BACKGROUND

Poly- l -lactic acid (PLLA) is a biostimulator that enhances collagen production and leads to volume restoration. It became popular because of its improvement of facial wrinkles and long-lasting effect, although the specific visible changes it causes in the facial area are not fully described.

OBJECTIVE

To identify and characterize the visible changes resulting from injecting PLLA into the facial area.

METHODS

A list of 678 patients who underwent 2 to 3 treatments with PLLA injections in this center between 2021 and 2022 were retrieved. After 2 rounds of evaluations, 31 independent international evaluators described the 3 main changes they observed in the before-and-after images (taken approximately 7 months after the last injection session) of the 12 patients with the most significant improvement.

RESULTS

A total of 1,015 descriptions were received. They were divided into categories based upon similarity. The main detected changes were better contouring and enhancement of the lateral face, a lifting effect and secondary impact on the nasolabial fold, and improvement of skin texture and skin firmness.

CONCLUSION

Poly- l -lactic acid injections were judged to be effective for contouring, lifting, and improving skin texture in the facial area. Further research is needed to validate these results and create an assessment scale for PLLA injections.

An absence of imperfections: A proposed framework for defining, assessing, and achieving skin glow

BACKGROUND

Skin glow is a subcomponent of skin quality. It has become entrenched in the cosmeceuticals and aesthetics lexicons as a synonym for health and youth, but is not well-defined as a scientific metric.

AIMS

To examine the concept of skin glow and determine if it is an objective concept that can be defined and quantified.

METHODS

Literature review was used to develop a survey on current concepts relating to skin quality. The survey results were analyzed descriptively and presented to a focus group comprising five dermatologists and four aesthetic physicians. This group then discussed the concept of skin glow, how to define it and what metrics could be used to assess it.

RESULTS

Surveyed practitioners (n = 38) ranked skin quality as the fourth most important factor related to a person's overall aesthetic first impression. Almost all (95%) respondents reported routinely assessing skin quality, citing serial photography (83%), and visual inspection (67%) as the main means of achieving this. The focus group defined skin glow as even reflectance from an unaffected papillary and reticular dermal collagen layer, which is created only when skin does not exhibit any characteristics that detract from this even reflectance. Due to its complexity, the focus group proposed a hierarchal framework for assessment, encompassing patient self-rating, practitioner severity rating, and supplemental use of validated measurement devices.

CONCLUSIONS

Skin glow can be defined and quantified. More work is warranted to develop a practical skin glow assessment tool suitable for use in the clinic setting.

Treatment Protocol on Using Microfocused Ultrasound with Visualization for Skin Quality Improvement: The Korean Experience

Facial skin quality profoundly influences an individual's perceived appearance and is an important aspect of facial rejuvenation. Facial pore enlargement is one of the most common concerns among Asian individuals that adversely impacts perceived skin surface evenness and affects overall skin quality. One of the major causes of enlarged pores is facial skin laxity. Microfocused ultrasound with visualization (MFU-V; Ultherapy; Merz North America, Inc., Raleigh, N.C.) is indicated for lifting and tightening of the face and neck, and improving the appearance of wrinkles on the décolletage. In addition, it is useful for addressing several aspects of facial rejuvenation, including facial pores, skin laxity, skin unevenness, etc., but there is limited literature on these applications. Thus, we present our proposed MFU-V treatment protocol for achieving a harmonious outcome for attractive skin, along with practical strategies for its application, illustrated in patients presenting with enlarged pores as their main concern. Drawing on our collective experience in using MFU-V for facial rejuvenation and the recently published skin quality framework that advocates addressing interrelated attributes of skin quality for optimal outcomes, we developed a treatment protocol for improving skin quality using MFU-V. This MFU-V treatment protocol reliably improves overall skin quality in patients presenting with enlarged pores, through MFU-V's effects on skin lifting and tightening, and consequent improvement in facial pores and skin texture. This treatment protocol can be readily used as part of a multimodal layering approach to yield successful outcomes in patients with various facial skin concerns.

The Protecting Activity of RIPACUT®: A New Therapeutic Approach Preserving Epithelial Health Based on the Combination of Iceland Lichen Extract, Silver Salt, and Sodium Hyaluronate

Epithelial integrity and function must be maintained in a dynamic healthy equilibrium, keeping unaltered the oxidative and inflammatory conditions and the microbiome of the cutaneous layers. Beside the skin, other mucous membranes can be injured, such as the nasal and anal ones, because of the contact with the external environment. Here, we detected the effects of RIPACUT^®, a combination of Iceland lichen extract, silver salt and sodium hyaluronate that individually act in diverse biological ways. The findings we obtained on keratinocytes, nasal and intestinal epithelial cells reveal that this combination showed a marked antioxidant activity, further assessed by the DPPH assay. Additionally, by analyzing the release of the IL-1β, TNF-α and IL-6 cytokines, we proved the anti-inflammatory effect of RIPACUT^®. In both cases, the main preserving action was due to Iceland lichen. We also observed a notable antimicrobial activity mediated by the silver compound. These data suggest that RIPACUT^® could signify the basis for an attractive pharmacological approach to maintaining healthy epithelial conditions. Interestingly, this may be extended to the nasal and anal areas where it protects against oxidative, inflammatory and infectious insults. Thus, these outcomes encourage the creation of sprays or creams for which sodium hyaluronate can guarantee a surface film-forming effect.

Efficacy and safety of hyaluronic acid filler on the treatment of horizontal neck lines

BACKGROUND

Injection of hyaluronic acid fillers (HA) fillers for horizontal neck line correction and rejuvenation has gained popularity in recent years despite conflicting reports on its efficacy and safety. Most published reports are retrospective studies that commonly use the sharp needle technique. In this prospective study, we therefore aimed to determine the efficacy and safety of an HA filler (Belotero Balance®, Merz Aesthetics) on the treatment of horizontal neck lines by blunt cannula injection technique.

MATERIALS AND METHODS

Thirty subjects were enrolled and treated with HA filler injections on the neck region using a blunt cannula injection technique into the deep dermis. Standardized photographic documentation was done at baseline, immediately after injection, and at 2-week, 1-, 3-, and 6-month follow-up after treatment. The rejuvenation effect was graded by the patients themselves and two blinded dermatologists using comparative photographs. Side effects were likewise recorded at each follow-up visit.

RESULTS

All 30 subjects completed treatment and attended every follow-up visit. The study participants comprised both females and males aged 20-69 years with mild, moderate, and severe neck lines based on the Horizontal Neck Wrinkle Severity Scale (HNWS) (Plast Reconstr Surg Glob Open, 2019, 7, 2366). All patients received approximately 3 ml of HA fillers for the entire treatment area. Both patient and physician ratings revealed peak benefits at 1-month post-treatment, with a significant decline at 3 months, which was sustained until 6 months after the procedure. Only one patient developed bruising related to the treatment, which resolved spontaneously without any additional medication.

CONCLUSION

The study demonstrated efficacy in improving the appearance of horizontal neck lines after one session of HA filler injection. The results showed peak improvement at 1 month, but with sustained rejuvenation effects up to 6 months after injection.

From Anatomical Modifications to Skin Quality: Case Series of Botulinum Toxin and Facial Fillers for Facial Feminization in Transgender Women

A transgender individual is someone who does not identify with his or her biological sex¹. During the transgender transition process, minimally invasive procedures (MIP) provide a versatile tool in the clinician’s therapeutic armamentarium, since the changes can be impactful for the patient, yet reversible, especially for the patient who is unsure about proceeding with a definite surgery. We report 5 cases of facial feminization of transgender women, illustrating the use of minimally invasive facial remodeling procedures for male-to-female transitioning patients.

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Microinjections with hyaluronic acid in combination with glycerol: How do they influence biophysical viscoelastic skin properties?

BACKGROUND

Skin quality improvement with hyaluronic acid microinjections is increasing as a clinical treatment indication and as a scientific issue. This present study assessed changes in biomechanical viscoelastic skin properties after microinjections with the skin quality booster CPM-HA20G (Belotero Revive).

MATERIALS AND METHODS

Fifteen subjects have been randomized in a 2:1 ratio to receive either three treatments (total 3 ml per side) or a single-dose treatment (total 1.5 ml per side) with CPM-HA20G at dermal level into the lower cheeks via microinjections. Treatments were provided 4 weeks apart. Biophysical measurements were performed describing the viscoelastic skin properties and the underlying skin structure. The measurements were performed before injection (week 0) and on follow-up visits 4, 8, 16, 24, and 36 weeks after the last injection treatment.

RESULTS

One (p = 0.028) as well as three (p = 0.003) consecutive treatments with CPM-HA20G improved statistically significant skin firmness (R0). For the multiple-treatment group improved significant differences were observed for skin fatigue (R3; p = 0.007) and skin density (p = 0.017) with stable skin thickness levels (p > 0.05), too. There were zero-to-weak correlations between skin thickness and biomechanical skin properties (R0, rs  = 0.084; R3, rs  = 0.093).

CONCLUSION

Overall, microinjections with CPM-HA20G improved biomechanical viscoelastic skin properties with a stronger and more pronounced effect in the multiple-treatment group. The observed changes may explain some of the skin quality improvements observed after treatment with CPM-HA20G.

Insights on Skin Quality and Clinical Practice Trends in Asia Pacific and a Practical Guide to Good Skin Quality from the Inside Out

OBJECTIVE

We sought to examine the current skin quality trends and gaps in clinical practice in the Asia Pacific region and develop a practical guide to improve skin quality.

METHODS

Medical practitioners from 11 countries in the Asia Pacific region completed an online survey on current trends in skin quality treatment. A panel of 12 leading experts convened for a virtual meeting to develop a practical guide for skin quality improvement.

RESULTS

A total of 153 practitioners completed the survey. The four most common skin quality issues were uneven skin tone, skin surface unevenness, skin laxity, and sebaceous gland hyperactivity and enlarged pores. Most practitioners reported using a combination of treatment modalities for each skin quality issue. It was also observed that each treatment modality could be used to treat several skin quality issues. A multimodal approach targeting different interrelated issues across the tissue planes was recommended for balanced results. The panel developed a practical guide for the appropriate combinations and sequence of treatments, and created treatment protocols for specific skin quality outcome goals. The guide employed an "inside-out" approach, treating the deeper tissue planes prior to the superficial layers to achieve harmonious results.

LIMITATIONS

Future studies are needed to support the recommended treatment protocols for skin quality improvement.

CONCLUSION

These findings provide valuable insights on current skin quality trends and gaps in clinical practice. The practical guide provides a framework for practitioners to customize their treatment plan according to each patient's needs.

Facial Skin Revitalization with Cohesive Polydensified Matrix-HA20G: Results from a Randomized Multicenter Clinical Study

Background:

There is a growing interest in the application of hyaluronic acid (HA) derivatives in skin quality improvement. The aim of this study was to confirm safety and effectiveness of cohesive polydensified matrix-hyaluronic acid + glycerol (CPM-HA20G; Belotero Revive) in revitalization of early-onset photodamaged facial skin.

Methods:

A total of 159 subjects with early signs of facial photodamaged skin were randomized in a 2:1 ratio to multiple- or single-dose treatment with CPMHA20G. Effectiveness assessments included biophysical measurements of skin hydration; elasticity, firmness, and roughness; investigator- and subject-assessed Global Aesthetic Improvement Scales; and FACE-Q Skin Changes and Treatment Satisfaction questionnaires.

Results:

In both treatment groups, skin hydration improved from baseline to all follow-up visits in subjects with dry or very dry skin. This improvement was significant at week 16 after initial treatment in the multiple-dose group (P = 0.0013). Investigator- and subject-reported outcomes showed that the majority of subjects across all skin hydration types benefited from treatment, with higher satisfaction rates observed in the multiple-dose group. According to investigator-assessed Global Aesthetic Improvement Scale, 90.7% of subjects at week 12 in the multiple-dose and 74.6% of subjects at week 4 in the single-dose group were rated as at least “improved.” All related treatment-emergent adverse events were transient, expected injection-site reactions of mild to moderate intensity.

Conclusions:

Effectiveness of CPM-HA20G for skin hydration in subjects with dry or very dry skin was demonstrated up to 9 months after last injection. Overall, CPM-HA20G demonstrated effective and safe use in facial skin revitalization among subjects with early-onset photodamaged skin.

Target-Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology

Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian-specific strategies that correct underlying structural deficiencies and cumulative age-related changes. The presented Target-Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians. A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment. With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling. Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption-induced volume loss.