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The use of biologicals for clinical use is rapidly increasing. One of the logical questions is what constitutes a biological? The official definition of biological products by the Food and Drug Administration is "Biological products can be composed of sugars, proteins, or nucleic acids, or a combination of these substances. They may also be living entities, such as cells and tissues. Biologics are made from a variety of natural resources-human, animal, and microorganism-and may be produced by biotechnology methods.", (Copyright © 2018 Elsevier Inc. All rights reserved.)

The use of stem cells in regenerative medicine and specifically facial rejuvenation is thought provoking and controversial. Today there is increased emphasis on tissue engineering and regenerative medicine, which translates into a need for a reliable source of stem cells in addition to biomaterial scaffolds and cytokine growth factors. Adipose tissue is currently recognized as an accessible and abundant source for adult stem cells. Cellular therapies and tissue engineering are still in their infancy, and additional basic science and preclinical studies are needed before cosmetic and reconstructive surgical applications can be routinely undertaken and satisfactory levels of patient safety achieved., (Copyright © 2018 Elsevier Inc. All rights reserved.)

There are many factors that contribute to the aging neck. We have recently begun employing a percutaneous suture spanning the submentum combined with a posterior platysma pull. We present our initial results with this technique. In this retrospective study, subjects underwent the combined procedure with and without concomitant rhytidectomy. Cephalometric analysis was used to compare the preoperative cervicomental angle (CMA) and hyomental distance (HMD) with postoperative values at 4 weeks. Subjects also were queried on their postoperative satisfaction. Twenty-five subjects were included in this study. At 4 weeks postoperatively, we achieved significant reductions in the average CMA (134.8 versus 122.8, p = 0.002). The postoperative HMD significant increased an average of 1.9 cm (8.5 versus 10.4, p = 0.009). We achieved a 92.3% satisfaction score at 33 weeks (range = 25 to 44). The combination of a percutaneous suture across the submentum and a posterior platysma pull is a safe and effective method of addressing the many facets of the aging neck. Our initial results are easily reproducible and entail minimal morbidity to the patient., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO(2)) laser resurfacing of the face and neck. Methods Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO(2) laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase-polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. Results We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO(2) laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. Conclusion This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO(2) laser resurfacing.

Objective: To report the results of a dose-response study using a novel photorejuvenation regimen consisting of intense pulsed light-activated photodynamic therapy and radiofrequency energy in patients with Fitzpatrick skin types I through III., Methods: A combination intense pulsed light and radiofrequency device (Syneron Medical Ltd, Yokneam, Israel) was used in combination with the topical photosensitizer aminolevulinic acid (ALA) (Levulan Kerastick; DUSA Pharmaceuticals Inc, Wilmington, Mass). Duplicate titration trials were performed on the dorsal forearm skin of 3 patients with Fitzpatrick skin types I through III. Multiple treatments, with varying times of application of ALA (30 minutes and 1, 2, and 3 hours) and intense pulsed light fluence (24-30 J/cm(2)), were completed to determine a minimal erythema dose and a maximal tolerated dose based on epidermal reaction (erythema and crusting) and patient discomfort. Radiofrequency energy levels were constant in all treatment groups., Results: The ALA application time of 1 to 2 hours for all skin types and fluence levels of 26 to 28 and 24 to 26 J/cm(2) for Fitzpatrick skin types I/II and III, respectively, were determined to be the minimal erythema dose. The ALA application times of 2 to 3 hours and fluence levels of 28 to 30 and 26 to 28 J/cm(2) for skin types I/II and III, respectively, were determined to be the maximal tolerated dose and resulted in severe erythema and crusting. The presence of severe erythema and discomfort precluded longer ALA exposure and higher fluence levels. No epithelial breakdown was observed at any treatment levels., Conclusion: The dose-response results defining the minimal erythema dose and the maximal tolerated dose of intense pulsed light-activated photodynamic therapy and radiofrequency energy have led to the development of 2 photorejuvenation protocols based on skin type and severity of photodamage.