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ObjectiveWe sought to evaluate the impact of the coronavirus-19 (COVID-19) pandemic on sun-seeking and sun-safe behaviors.MethodsWe conducted an online, cross-sectional, population-based survey.ResultsIn total, 1,001 respondents participated in the survey and reported being exposed to 12 or more hours of sunlight (i.e., direct and indirect ultraviolet light, and blue light) each day. Participants self-reported a net increase in all types of light exposure since the onset of the COVID-19 pandemic, especially to blue light (+38%). Notably, while the effects of direct sunlight were well known among survey respondents, they were less aware of the potential damaging impact of indirect sunlight and blue light.LimitationsAs the survey was only conducted among residents of the United States, results might not be generalizable to all geographical regions.ConclusionSocial outreach strategies are required to improve sun-safe behaviors. Future behavioral interventions should encourage the implementation of broad-spectrum sun protection.

Background: The growing popularity of aesthetic procedures involving fillers, biostimulators, and neurotoxins has prompted concerns about patient safety. To address these concerns, a global Safety Task Force (STF) was formed. Aims: The inaugural STF meeting prioritized vascular compromise prevention and management, guiding clinical trial design and materials for future meetings, and collecting data from experts on current safety methods. Methods: The STF was formed and consisted of 16 experts from nine different countries, with each possessing distinct expertise in various fields related to aesthetic injectables. Current safety data, protocols, knowledge gaps and future research priorities were discussed and voted upon. Results: The establishment of a global database for tracking filler‐related AEs was favored by 93% of participants. Discussions revolved around the database's scope, data standardization, and whether non‐medical contributors should be included. Aspiration as a safety technique garnered support from 73% of participants. Approximately 43% of participants incorporate ultrasound in their injections, with divergent opinions on its impact and potential when used as a standard of practice versus in AE management. Most physicians on the task force incorporated cannula use for some of their injections (93%). There were varying perspectives on treatments for vascular adverse events (VAE), the primary causes, and the adoption of new protocols in the field. Conclusions: The STF meeting underscored the need for a coordinated effort to address complications related to HA fillers, including VAE management and hyaluronidase protocols. Reliable treatment endpoints were evaluated, but improved measurement methods are needed. Future meetings will focus on addressing delayed complications, furthering safety in this field. [ABSTRACT FROM AUTHOR]

Purpose: Optimizing outcomes of aesthetic treatments with injectable products usually requires a consideration of the entire face to ensure balance, along with combination treatments that align with the patient's goals. To help injectors, a method of assessing the patient and developing an individualized, holistic treatment plan was developed. This methodology is termed Assessment, Anatomy, Range, and Treatment (AART™) and Holistic Individualized Treatments (HITs™). This article aims to describe and evaluate the novel and systematic AART-HIT™ methodology. Methods: The AART-HIT™ methodology, including its associated diagnostic tool the Facial Assessment Scale (FAS™), were developed to aid injectors in completing a patient assessment in which the entire face is evaluated, the relevant anatomy is considered, the science behind the available range of products is understood, and the treatment plan is individualised for the patient. Specifically, the HITs™ are methodologic tools for practitioners to perform a standardized, full facial assessment and to create an individualized treatment approach to holistically address a patient's aesthetic concerns. The use of this methodology in clinical practice was assessed via a survey, deployed to twenty-eight clinicians. Results: Over 85% of participants agreed that the AART-HIT™ methodology was adequate for their needs. Additionally, 100% of participants agreed that the temporal sequencing of HITs™ and the FAS™ diagnostic tool was useful in clinical practice. Furthermore, over 70% of participants agreed that the anatomical locations identified in each HIT™ were sufficient, while over 80% responded that the HITs™ adequately represented the range of products. Finally, over 85% of participants agreed that the HITs™ covered different ethnic skin types and various patient ages and, over 80% of participants responded that they would not add additional elements to any of the 5 HITs™. Conclusion: The AART-HIT™ methodology, including the FAS™ were comprehensive enough for clinical use in providing a personalised treatment plan for individual patients. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic acid (HA) fillers are used to treat an array of aesthetic indications. Proper filler selection is paramount for successful patient outcomes. However, many important physiochemical and physical properties that impact HA gel behavior remain undefined.Purpose: To evaluate the hydrophilicity, cohesivity and particle size of eight commercial HA fillers manufactured by either Non-Animal Stabilized Hyaluronic Acid (NASHA) or Optimal Balance Technology (OBT) techniques.Methods and Materials: Three individual in vitro experiments were performed to assess HA swelling capacity, cohesion, and particle size. Image analyses, blinded evaluation using the Gavard-Sundaram Cohesivity Scale, and laser diffraction technology were utilized, respectively.Results: Compared to fillers manufactured with NASHA technology, OBT products demonstrated greater swelling capacity, cohesion, and wider particle size distributions. Strong positive correlations between swelling factor, degree of cohesivity, and increasing widths of the particle size distributions were observed.Conclusions: The hydrophilicity, cohesivity and particle size distributions vary among HA fillers manufactured with different techniques. The creation of new labels identifying products based on their unique combination of physiochemical and physical characteristics may help guide appropriate selection of HA fillers to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Hollowing of the infraorbital region represents a common concern among aesthetic patients. In the past decade, an increasing number of patients have resorted to noninvasive aesthetic procedures to treat these concerns. The objective of this study was to evaluate the safety profile of infraorbital hyaluronic acid injections for aesthetic rejuvenation. Methods: Through a systematic review and meta‐analysis of prospective clinical trials, investigators sought to answer the research question "Does the use of needle versus cannula during infraorbital HA injections result in the same incidence rate of adverse events?" The primary outcomes of interest were the incidence rates of ecchymosis and edema in subject groups treated with a needle or cannula. Results: Subjects treated with needles had a statistically significant greater incidence rate of ecchymosis, compared to those treated with cannula. Conversely, subjects treated with cannula had a statistically significant greater incidence rate of edema, compared to those treated with needles. Conclusions: The incidence rates of adverse events following the administration of hyaluronic acid injections in the infraorbital region vary depending on whether a needle or cannula is used; with needles being associated with a greater risk of ecchymosis and cannulas being associated with a greater risk of edema. These findings should be discussed with patients prior to treatment consultation. Finally, as with most techniques, it is usually prudent to develop expertise with one technique before using a second, especially in cases where both approaches can be used and have different adverse event profiles. [ABSTRACT FROM AUTHOR]

Background: Periorbital deformities can be corrected utilizing hyaluronic acid injections. However, previous studies have not evaluated the effect of utilizing different injection techniques (eg, a needle vs cannula) on efficacy and safety.Objectives: The authors sought to investigate the efficacy and safety of HA for the correction of periorbital deformities when utilizing either needle or cannula-assisted injections.Methods: This was a prospective, randomized-controlled (with crossover), evaluator-blinded study. Forty-two patients with a mean age of 44.82 ± 11.62 years were recruited. Patients underwent 2 treatment sessions, spaced 2 weeks apart, and attended 1 follow-up visit at Week 4, following the last treatment. Patients were randomized in a 3:3:1 ratio, whereby 18 patients received injections by needle, 18 received injections by cannula, and 6 were randomized to act as their own control at baseline. Those in the control group were randomized (n = 3) to needle or cannula injections at Week 4 and proceeded with the same visit schedule as those treated at baseline. At Weeks 2 and 4 posttreatment, patient satisfaction was evaluated and information on adverse effects was collected. A blinded reviewer assessed patient imagery utilizing standardized efficacy scales.Results: Chi-square tests did not reveal any associations between treatment group and efficacy, safety, or patient satisfaction scores (P ≥ 0.05). Adverse effects reported in patient diaries were mild to moderate in nature and expected.Conclusions: For the treatment of infraorbital deformities, hyaluronic acid injections performed utilizing either a cannula or needle result in similarly high efficacy and safety ratios.Level Of Evidence:2: [ABSTRACT FROM AUTHOR]

Background: Several studies have started investigating the safety of temporal rejuvenation using soft tissue fillers. However, as the temporal region is highly vascularized, adverse events due to intravascular injection are of primary concern. The scarcity of treatment guidelines to date have focused primarily on avoiding the superficial and middle temporal arteries. The aim of the present anatomical study was to describe the topography of the deep temporal arteries (DTAs) with reference to superficial landmarks, to aid clinicians who perform temporal injections. Methods: The tissue layers of eight fresh‐frozen cephalic cadavers were dissected and assessed, bilaterally in the temporal region (N = 16). Distance (D) of the anterior (D1 and D3) and posterior (D2 and D4) arteries was measured from (i) the zygomaticofrontal suture line at the lateral orbital rim (D1 and D2) and (ii) the junction of the superior border of the zygomatic arch and lateral orbital rim (D3 and D4). The distance between the anterior and posterior DTAs was also recorded, at the two regions (D5). Results: Bifurcations of the DTAs were observed in 18.75% (3/16) and 12.5% (2/16) of cases, for the anterior and posterior branches, respectively. On average [mean (standard deviation)], D1 (anterior DTA to the zygomaticofrontal suture line at the lateral orbital rim) = 1.56 cm (0.59); D2 (posterior DTA to the zygomaticofrontal suture line at the lateral orbital rim) = 2.98 cm (0.70); D3 (anterior DTA to the junction of the superior border of the zygomatic arch and lateral orbital rim) = 1.14 cm (0.63); D4 (posterior DTA to the junction of the superior border of the zygomatic arch and lateral orbital rim) = 2.37 cm (0.62); and D5 (distance between the anterior and posterior DTAs) = 1.54 cm (0.68). Conclusion: To help avoid vascular adverse events while performing temporal injections, aesthetic clinicians should be conscientious of safety implications related to the anatomical location of the DTAs and their ramifications. [ABSTRACT FROM AUTHOR]

This is the first study to evaluate Health Canada's national reporting database, MedEffect™, to assess the safety and efficacy of esthetic injectables. Describe adverse reactions (ARs) associated with soft tissue fillers and neurotoxins. Investigators reviewed MedEffect™ for reports associated with esthetic injectables from January 1 1965 to March 31 2018. Descriptive analyses of the reports were completed, including information on reporters', patients', and AR characteristics. A total of 1459 individual reports containing 5714 ARs were evaluated. The majority (n = 5705; 99.84%) of reported ARs were related to neurotoxins and only 0.16% (n = 9) were related to soft tissue fillers. Most reports were submitted by health professionals (n = 4930; 86%), indicated that the product was ineffective (n = 2428; 42.5%) and that the result of ARs were unknown (n = 4835; 84.6%). ARs associated with the use of neurotoxins and soft tissue fillers are underreported in Canada. More complete and representative information regarding ARs is necessary for the development and validation of treatment algorithms and management strategies. [ABSTRACT FROM AUTHOR]

Background: Paradoxical adipose hyperplasia (PAH) is a rare, moderate-to-severe adverse event associated with cryolipolysis (CoolSculpting, CS).Objectives: The aim of this study was to describe the incidence, diagnosis, and treatment of PAH occurring after CS for nonsurgical fat reduction.Methods: A multicenter evaluation of all patients who underwent CS treatment between January 2015 and December 2019 at 8 Canadian medical centers was conducted. Data abstracted included symptoms, management strategy, outcome, operator characteristics, device characteristics, patient characteristics, body region, and CS treatment details. Incidence of PAH was calculated based on the number of treatment cycles.Results: Our findings revealed incidence rates between 0.05% and 0.39%, which are slightly higher than the manufacturer's quoted rate of 0.025% (1 per 4000 cycles). Incidence rates at all sites were dramatically reduced by over 75% with the implementation of newer models of CS units. Of patients who developed PAH, 55% were male and 77.8% were of European ethnic origin. The majority of cases (76.9%) were associated with older models of CS units.Conclusions: Development of PAH may be related to a combination of factors, including older models of CS units and applicators, as well as individual characteristics that predispose certain patients.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: Injections of hyaluronic acid (HA) for tissue augmentation are one of the most common aesthetic treatments performed worldwide. However, few studies have compared the safety and efficacy of small- and large-particle HA (SP-HA; LP-HA). Aim: To assess and compare the safety and efficacy of SP-HA and LP-HA for the correction of nasolabial folds (NLFs). Methods: A prospective, split-face, triple-blind study design was used. Ten female subjects were recruited. Patients underwent treatment at baseline, an optional touch up at Week 2, and a follow-up visit at Week 4. At weeks 2 and 4, a blinded reviewer assessed the patients using the Global Aesthetic Improvement Scale (GAIS) and Wrinkle Severity Rating Scale (WSRS); and subjects completed the Patient Satisfaction Questionnaire (PSQ). At all visits, 3-dimensional imagery and ultrasonography of patients' NLFs were captured. Adverse events (AEs) were evaluated by the Investigator and recorded by subjects in diaries. Results: The GAIS response rate, defined as ≥ "improved" from baseline, was between 90 (2 weeks) and 100% (1 month) for SP-HA and was 100% for LP-HA, at both visits. Paired-samples t tests revealed significant differences in the change in WSRS scores between groups, at both visits (P < .01). Differences in the clinical effect and lifting capacity of both products were observed in 3-dimensional imagery and ultrasonography. Treatment volumes varied, with 61.32% more SP-HA being required than LP-HA for achieving a ≥ one-grade WSRS improvement. There were no severe AEs throughout the trial, nor AEs related to the investigational device. Conclusions: LP-HA demonstrates better efficacy for correcting bony resorption in the nasal pyriform region. [ABSTRACT FROM AUTHOR]

Background: The effect of hand dominance on the skin topography and parameters associated with skin health and aging is unknown. Methods: Healthy adult volunteers were recruited. The following four strata were enrolled: Group 1: male, right handed; Group 2: male, left handed; Group 3: female, right handed; and Group 4: female, left handed. The differences between groups on their surface evaluation of living skin (SELS) parameters were evaluated. These variables included (a) roughness (SER); (b) smoothness (SESM); (c) scaliness (SESC); and (d) wrinkles (SEW). Results: A total of twenty subjects were recruited, with five in each stratum. Significant differences between groups were found for SESC [F(7,31) = 2.742, P =.024, partial eta squared = 0.382] and SEW [F(7,31) = 3.705, P =.005, partial eta squared = 0.456]. An evaluation of the descriptive statistics revealed that males had a higher mean SESC value than females and a lower mean SEW value. Moreover, the dominant hand of both sexes had a higher mean SEW value than non‐dominant hands. Conclusions: Given the evidence of sex and handedness differences in wrinkle genesis and desquamation severity, these factors should be considered in the dermatological treatment and counseling of patients. [ABSTRACT FROM AUTHOR]

Background: Findings indicate that standard injection techniques for hyaluronic acid (HA) soft tissue fillers result in considerable variations in the applied boluses. Furthermore, despite the knowledge that the varying biophysical properties of HA fillers (eg, G′, cohesivity, viscoelasticity) can affect their ease of injection, the impact of device attributes on an injector's volumetric accuracy is currently unknown. Objectives: (a) Evaluate the ability of aesthetic physicians to accurately inject a specific amount of HA filler; (b) investigate the effect of physician experience on injection accuracy; and (c) investigate the impact of different HA gel properties on an injector's performance. Methods: Thirteen physicians with aesthetic experience were recruited. Subjects were blindfolded and asked to deposit 0.2 cc of four HA fillers under two conditions: (a) onto a scale and (b) into a porcine membrane. The amount of gel deposited/injected was then measured. An accurate injection was defined as 0.2 cc ± 15%. Results: Subjects were rarely able to dispense accurate amounts of injectate (42/208 injections or 20.19%) and often underestimated their injection quantities. Variations in the accuracy distributions between groups were observed. An injector's experience, the conditions under which injections were performed and the product choice were all variables found to affect the accuracy distributions. Conclusions: The findings of this study provide evidence that the use of visual and/or audible stimuli is necessary for dispensing accurate volumes. This has clinical implications for treatment efficacy and patient satisfaction during free hand injections. To ensure more accurate and reproducible results, the investigators propose a possible modification to the standard injection technique. [ABSTRACT FROM AUTHOR]

Background: The first FDA-cleared, long-lasting, minimally invasive device for improving the appearance of cellulite was recently launched in Canada as a novel, tissue stabilized-guided subcision (TS-GS) system (Cellfina, Merz North America, Inc., Raleigh, NC). Clinicians from 2 of the first Canadian sites offering this procedure were interested in evaluating treatment efficacy and patient satisfaction after its first year on the market.Objectives: The authors sought to evaluate the efficacy of TS-GS and the level of patient satisfaction associated with the procedure.Methods: Medical charts of female patients treated with the TS-GS system in 2017 were retrospectively analyzed at 2 Canadian centers. Measurements at baseline and 3 months posttreatment were assessed for patient satisfaction and physician-rated efficacy. Patient satisfaction was assessed using a 5-point Likert-type scale, and efficacy was evaluated through physician review of 2-deminsional and 3-dimensional photography, the Nürnberger-Müller Scale for cellulite, and the Global Assessment of Improvement Scale.Results: We reviewed 25 patient charts. At month 3, 95.6% of patients were satisfied with treatment results and physician evaluations revealed that on average, patients displayed a 1-point improvement in their cellulite grades. Moreover, Global Assessment of Improvement Scale scores indicated that all patients had visible improvement in the global appearance of cellulite. No serious adverse events were observed within 3 months postprocedure.Conclusions: The physician ratings, patient satisfaction, and photographic evidence support the efficacy of the TS-GS system to manage grades 1 to 3 cellulite in women's thighs and buttocks. These findings indicate the safety of the TS-GS system.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background: IncobotulinumtoxinA (Xeomin Cosmetic®) has been used previously in the management of masseteric hypertrophy. However, a standardized injection technique has not been established. The goal of the present study was to evaluate the efficacy and safety of two injection techniques in the management of masseteric hypertrophy using incobotulinumtoxinA. Methods: Thirty female patients with masseteric hypertrophy were recruited and evenly randomized to receive bilateral treatments of either a single-injection technique (SIT) or a multiinjection technique (MIT). Improvement of masseteric hypertrophy was assessed at week 16 using standardized measurements and photographs. Patients completed a 5-point satisfaction questionnaire while physicians completed the Global Aesthetic Improvement Scale (GAIS) and 10-point photonumeric masseter prominence rating scale. Results: There were no significant differences in physician ratings on the photonumeric scale and GAIS between the SIT and MIT groups. Results of the standardized measurements also revealed no significant difference between injection techniques. Majority of patients at every visit reported being "satisfied" with treatment results. Clinically, the number and severity of adverse events were similar between groups. Conclusion: This study supports the noninferiority of both SIT and MIT with regard to efficacy and safety in the management of masseteric hypertrophy, using incobotulinumtoxinA. [ABSTRACT FROM AUTHOR]

Background: Understanding the differences in soft tissue filler rheology and how these properties can impact clinical results is a fundamental concepts for any injector. This study aimed to assess the tissue integration characteristics of hyaluronic acid (HA) fillers manufactured with different technologies (Non-Animal Stabilized HA [HA-N] or Optimal Balance Technology [HA-O]) using ultra-high-frequency ultrasound., Methods: Twelve female participants with mild-to-moderate midface volume loss and temporal hollowing were enrolled and treated with HA-N and/or HA-O. Participants were seen at five visits (screening/baseline [treatment], and Weeks 1 [optional touch-up], 4, 6, and 8 [follow-up visits]). Ultrasound was used to evaluate the degree of product integration., Results: On ultrasound, HA-N presented with distinct borders, minimal tissue integration, and a capacity to displace tissues. Conversely, HA-O tended to spread horizontally within the same tissue plane and integrated within tissues. The volumizing capacity of the HA-O fillers was dependent on particle size., Conclusion: HA-N is suited for deep injections in areas such as the upper lateral cheek and under the muscle of the temporal region when a lifting effect is desired; HA-O is best suited for subcutaneous injections, in areas of dynamic movement or for patients with thin skin; and can be injected subcutaneously or supraperiosteally when a volumizing effect is desired., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)