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Background The variable relationship between the orbicularis supercilii and frontalis muscles may cause side effects with botulin toxin; steadily frowning is the usual recommendation. Eliminating the need to frown until all injections are over might enhance efficacy and lessen the neurotoxicity risks related to muscle exhaustion. Objectives The goal of this study was to investigate whether the digital caliper–assessed distances between the medial and lateral corrugator injection sites and the midline differed significantly in patients persistently frowning from patients resting. Methods Seventy-six individuals with glabellar wrinkles treated with botulinum toxin in the authors' private practices for glabellar lines voluntarily contributed their retrospective data about the positions of injection sites. The investigators had freely chosen to inject the medial and lateral sections of the corrugator supercilii during persistent maximum frown or at rest. Results The mean differences in distances between the medial and lateral injection points and the estimated midline were clinically trivial (1.0 ± 1.28 and 1.5 ± 2.53 mm, respectively), although the distances between the relaxed and contracted medial and lateral injection sites exceeded 1.8 and 2.5 mm in 33.9% and 46.4% of patients, respectively. Distance differences, not significant before 40 years old, were statistically significant only for the lateral injections in older patients (on average, 1.9 ± 3.01 mm). Conclusions The average distances from the medial and lateral injection points and the midline appear minimally different in patients who frown until all injections are over and, conversely, patients who rest. Persistently frowning might be advisable only in patients older than 40. Facial asymmetries may be a confounding factor. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Introduction: The mandibular profile undergoes progressive wasting with aging, and the deepening of nasolabial folds (NLFs) has a leading role. Hyaluronic acid (HA) efficiently controls tissue hydration and permeability to small and large molecules. NLFs are an acknowledged HA target; at the same time, another class of agents, PN‐HPT® (Polynucleotides Highly Purified Technology), enjoy growing acknowledgement in aesthetic medicine. This exploratory, prospective study probed the rationale of sequentially associating PN‐HPT® as a first priming agent acting in the skin followed by HA dermal filler injections for correcting moderate to severe NLFs. Methods: Following strict inclusion and exclusion criteria, the authors screened Caucasian ambulatory women aged 40–65 with moderate to severe NLFs and randomly selected two NLFs for each enrolled woman. Due to the purely explorative nature of the study, the authors initially planned to enroll no >10 women. According to a split‐face design, the selected right‐side NLFs received 4 ml of PN‐HPT® intradermally in the initial priming phase ("NLF Rx group"); the selected left‐side NLFs received 4 ml of saline (placebo) ("NLF Lx group"). After 3 and 6 weeks, all patients received 2 ml of subdermal cross‐linked HA over both NLF areas (4 ml overall). The total study follow‐up was 6 months after the first injection, with objective assessments, based on the qualitative and quantitative Antera 3D® and Vectra H2® skin imaging technologies, after 6 weeks and 3 and 6 months. Results: Because of the favorable early outcomes, the authors let enrollment progress between January and June 2020 up to a total of 20 women and 40 NLFs. All treated women completed the six‐month follow‐up without reporting side effects, even clinically minor. The Antera 3D® device demonstrated that wrinkles and skin texture significantly improved in the NLF Rx after 6 weeks (monotherapy phase) and 3 and 6 months (PN‐HPT® priming + HA phase) compared with baseline. HA levels, measured with the quantitative Vectra H2® assessment technology in the right NLFs, were significantly higher than contralaterally at both 3 and 6 months. Conclusions: Although conceived only as an exploratory investigation, the study confirmed that PN‐HPT® monotherapy might be a valuable and effective option to rapidly improve the skin dermis texture and quality in individuals with moderate to severe NLFs. Acting as a priming agent in the skin, PN‐HPT® prolong the clinical efficacy of cross‐linked HA. Well‐designed trials in larger treatment groups will hopefully confirm these early promising results. [ABSTRACT FROM AUTHOR]

Introduction: Mainly in the past, foreign body complications, including granuloma, were pretty frequent after semi‐permanent polymethyl‐methacrylate (PMMA) implants. Results: The authors describe a twenty‐year history of recurring post‐PMMA complications interspersed by long uneventful years, with acute edematous side effects evolving into unpleasant skin dystrophia with persistent cutis laxa. The case report also discusses a simple clinical algorithm to discriminate among foreign body complications with particular attention to granulomas. Conclusions: The authors conclude by discussing the benefits of the anti‐dystrophic treatment with natural‐origin remodeling PN‐HPT® (Polynucleotides Highly Purified Technology). [ABSTRACT FROM AUTHOR]

Introduction: Mainly in the past, foreign body complications, including granuloma, were pretty frequent after semi‐permanent polymethyl‐methacrylate (PMMA) implants. Results: The authors describe a twenty‐year history of recurring post‐PMMA complications interspersed by long uneventful years, with acute edematous side effects evolving into unpleasant skin dystrophia with persistent cutis laxa. The case report also discusses a simple clinical algorithm to discriminate among foreign body complications with particular attention to granulomas. Conclusions: The authors conclude by discussing the benefits of the anti‐dystrophic treatment with natural‐origin remodeling PN‐HPT® (Polynucleotides Highly Purified Technology). [ABSTRACT FROM AUTHOR]

Background: Wasting of soft tissues leads to flattening and deflation of the aging midface skin. Polynucleotides Highly Purified Technology (PN‐HPT®) demonstrated dermal hydration and elasticity as well as fibroblasts vitality and activity. Aims: To probe the value of PN‐HPT® in middle third rejuvenation in an open‐design, exploratory prospective cohort study in 40 real‐life ambulatorily treated women. Methods: Three treatment sessions—at baseline (2‐ml prefilled syringe containing 10 mg/ml PN‐HPT®, 10 mg/ml hyaluronic acid, 200 mM mannitol) as intradermic gel, and after 3 weeks (2‐ml prefilled syringe containing 20 mg/ml PN‐HPT® intradermic gel) and 6 weeks (same treatment as baseline). The protocol allowed supplemental treatment with specifically formulated PN‐HPT® (7.5 mg/ml) when needed in periocular and eyelid areas. Assessments: sequential photographs of the facial middle third at baseline, third treatment session and 6–8 weeks after the third treatment session; scoring of overall skin quality and texture, skin quality determinants (wrinkles and skin roughness, skin elasticity, skin brightness), scar appearance, and subjective satisfaction with impromptu 10‐cm Visual Analogue Scales. Results: Significant improvement of overall skin quality and texture (from 7.0 ± 1.06 at baseline session to 7.8 ± 0.99 at follow‐up), associated with highly significant improvements of wrinkles and skin roughness, elasticity, and brightness (–17.1%, +39.6%, and +51.1%, respectively). The severity scores of post‐acne scars decreased from 7.6 ± 1.32 to 4.2 ± 2.13. Individual satisfaction score at the end of treatment: 0.8 ± 0.28. Conclusions: PN‐HPT® candidate as a valuable option for facial middle third rejuvenation. Further trials will hopefully confirm these early results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Twelve-month extension of a previous spontaneous exploratory study investigating safety and efficacy of a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women with symptoms o! vaginal laxity, with special reference to dysuria, urinary incontinence and unsatisfactory sexual life (vaginal laxity arm ot the study); B) postmenopausal women with vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM) and VVA/GSM-related symptoms (VVA/GSM arm of the study). DQRF treatment schedule in both study amis: 4 to 6 procedures of 15 to 20 min every 14 days (vaginal laxity, range 12-17 days; VVA/GSM, range 13-16). Operative temperatures in vaginal target tissues during procedure: vaginal laxity, 42 °C (range 40-43 °C); VVA/GSM, 40 °C (range 40-42 °C). METHODS: In the vaginal laxity arm ol the study, 25 women with subjective sensation of vaginal introitai laxity (very to slightly loose). Assessment of urinary incontinence, satisfaction with sexual relationship and contribution of pelvic organ prolapse: Vaginal Laxity Questionnaire (VLQ, Italian certified translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation). Further evaluation of sexual gratificali00: Sexual Satisfaction Questionnaire (SSQ). In the VVA/GSM arm of the study, 32 women with objective evidence of VVA and vaginal dryness and/or dyspareunia as most bothersome symptoms. Assessment of VVA/GSM symptoms and overall satisfaction with sexual lite: specifically designed 10-cm visual analogue scales. RESULTS: All 4 to 6 planned DQRF sessions were well tolerated in both the vaginal laxity and VVA/GSM arms of the study, with no troubling pain, thermal injury or other immediate adverse effects during all the procedures. All screened women completed the planned DQRF treatment sessions in both arms of the extension study. There was no participant attrition with only a few occasionally missing visits over the 12-month lollow-up period. Improvements were rapid in sell-perception of introitai looseness and related symptoms like dysuria/urinary incontinence and unrewarding sexual relationship (vaginal laxity patients) and atrophy-related symptoms including painful and unsatisfactory sexual activity (VVA/GSM patients). Participating women consistently reported wide-spectrum strong clinical improvements by the end ol the planned DQRF sessions. Clinical improvements remained steady for the whole follow-up period in postmenopausal women; a statistically non-significant tendency to slight deterioration in VLQ. PISQ-12 and SSQ mean scores was detected after 6 to 9 months of follow-up in the vaginal laxity arm of the study. CONCLUSIONS: Safety was excellent during all DQRF procedures and over the 12 months following the end of the treatment sessions. VLQ, PISQ-12 and SSQ scores (women with vaginal laxity), VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (women with VVA/GSM symptoms) improved rapidly, reaching almost normal levels by the last DQRF session and suggesting rapid, but also persistent, vaginal rejuvenation in both indications. A late tendency to some slight deterioration in women treated for vaginal laxity suggests such women might benefit from new DQRF treatments 6 to 9 months after the previous cycle. [ABSTRACT FROM AUTHOR]

A new approach to the study of the distribution pharmacokinetics of variably bound β-lactams is to plot the concentration time course of their free (dialysable) and total (free and bound) forms. In the present study, the 6-h concentration time course was plotted of the total and free concentrations of cefotaxime and ceftriaxone in scrum and pleural exudate in 12 patients per group, after iv dosing with 1 g of either cefotaxime or ceftriaxone. Samples were taken at 0.5, 1, 1.5, 2, 3, 4 and 6 h after dosing. The results of a study of similar design, but conducted over 24 h in ten patients per group, following iv dosing with either cefotaxime 1 g 12-hourly or ceftriaxone 1 g daily are also reported. Samples were taken at 0.5, 1, 1.5, 2, 4, 6, 8, 12, 14, 16 and 24 h after dosing. Areas under the curve of free cefotaxime in pleural fluid were greater than those of free ceftriaxone, in both the 6 h (+ 54.6%) and 24 h studies (+ 29.8% after 12 h and +71.0% after 24 h). The free cefotaxime/free ceftriaxone Cmax ratio was 1.75 in the 6 h study. Cefotaxime was superior to ceftriaxone in terms of the diffusion of the free (antibacterially active) fraction into a typical inflammatory exudate. Assessment of the effects of protein binding must be taken into account in antibiotic pharmacokinetic profiles. [ABSTRACT FROM PUBLISHER]

Background: Wasting of soft tissues leads to flattening and deflation of the aging midface skin. Polynucleotides Highly Purified Technology (PN-HPT ® ) demonstrated dermal hydration and elasticity as well as fibroblasts vitality and activity., Aims: To probe the value of PN-HPT ® in middle third rejuvenation in an open-design, exploratory prospective cohort study in 40 real-life ambulatorily treated women., Methods: Three treatment sessions-at baseline (2-ml prefilled syringe containing 10 mg/ml PN-HPT ® , 10 mg/ml hyaluronic acid, 200 mM mannitol) as intradermic gel, and after 3 weeks (2-ml prefilled syringe containing 20 mg/ml PN-HPT ® intradermic gel) and 6 weeks (same treatment as baseline). The protocol allowed supplemental treatment with specifically formulated PN-HPT ® (7.5 mg/ml) when needed in periocular and eyelid areas., Assessments: sequential photographs of the facial middle third at baseline, third treatment session and 6-8 weeks after the third treatment session; scoring of overall skin quality and texture, skin quality determinants (wrinkles and skin roughness, skin elasticity, skin brightness), scar appearance, and subjective satisfaction with impromptu 10-cm Visual Analogue Scales., Results: Significant improvement of overall skin quality and texture (from 7.0 ± 1.06 at baseline session to 7.8 ± 0.99 at follow-up), associated with highly significant improvements of wrinkles and skin roughness, elasticity, and brightness (-17.1%, +39.6%, and +51.1%, respectively). The severity scores of post-acne scars decreased from 7.6 ± 1.32 to 4.2 ± 2.13. Individual satisfaction score at the end of treatment: 0.8 ± 0.28., Conclusions: PN-HPT ® candidate as a valuable option for facial middle third rejuvenation. Further trials will hopefully confirm these early results., (© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The intense pulsed light (IPL) and laser technologies are widely used for skin rejuvenation and for treating several dermatological disorders such as skin dyschromia and acne, and for non-ablative dermal remodeling of rhytides and hypertrophic scars. Technological evolution is rapid. The High Power Pulsed Light™ [HPPL™] and Incoherent Fast Light™ technologies [IFL™, Novavision Group S.p.A., 20826 Misinto (MB), Italy] are recent innovations in the field of IPL technologies; IFL™ is a further evolution of the already advanced HPPL™ system. The paper presents a selection of case histories of dermatological lesions treated with the HPPL™ and IFL™ technologies. All study materials were appropriately peer-reviewed for ethical problems.

The High Power Pulsed Light™ [HPPL™] and Incoherent Fast Light™ technologies [IFL™, Novavision Group S.p.A., 20826 Misinto (MB), Italy] are recent innovations in the field of unwanted hair removal with intense pulsed light devices. IFL™ is a further improvement over the already advanced characteristics of the HPPL™ technology. A selection of photoepilation case histories with the HPPL™ and IFL™ technologies is presented; a short introduction highlights the main features of the two technologies. All study materials were appropriately peer-reviewed for ethical problems.