Search

Background: Previous studies concerning the effect of botulinum toxin in masseter muscle have mainly reported effects observed through inspection of facial features or differences in pain levels. One systematic review of studies utilizing objective measurements reported that long-term muscular effect of botulinum neurotoxin injections into masseter muscle was inconclusive. Objective: To evaluate the duration of reduced maximal voluntary bite force (MVBF) after botulinum toxin intervention. Methods: The intervention group was comprised of individuals seeking aesthetic treatment for masseter reduction (n = 20), the reference group (n = 12) comprised of individuals with no intervention. Intervention through 25 units of Xeomin® (Merz Pharma GmbH & Co KGaA, Frankfurt am Main, Germany) botulinum neurotoxin type A injected into the masseter muscles bilaterally (totalling 50 units). A reference group did not receive any intervention. MVBF was measured in Newtons using a strain gauge meter at the incisors and first molars. MVBF was measured at baseline, at 4 weeks, 3 months, 6 months, and after 1 year. Results: Both groups were similar in terms of bite force, sex and age at baseline. MVBF remained similar compared to baseline in the reference group. At 3 months, a significant reduction at all measurement points was observed in the intervention group; at 6 months, this reduction was no longer significant. Conclusion: A single intervention of 50 units of botulinum neurotoxin results in a reversible MVBF reduction of at least 3 months, although a visually discernable reduction may be more long-lasting.

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.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.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.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.

Monopolar radiofrequency (MRF) is a valuable modality for tightening and contouring mild-to-moderate facial skin laxity. Few studies have evaluated new-generation MRF devices for lower facial laxity in Asians. This study aims to evaluate the efficacy and safety of MRF for treating lower facial laxity in Asians.This prospective cohort study enrolled 30 volunteers with Fitzpatrick Skin Types III-V and mild-to-moderate skin laxity. Subjects received a single MRF treatment. Self-assessments and adverse events were recorded. Two blinded dermatologists graded improvements (6-point scale) after treatment and 1, 3, and 6 months later.All subjects completed the study. Treatment energy levels ranged from 2 to 4. The average number of shots was 412 ± 49, delivered in 3-4 passes with 15-30% overlap. All patients reported improvement in lower facial laxity immediately after treatment. Most patients had mild-to-moderate improvement over the 6-month follow-up. Continuous improvement was observed at the 1-, 3-, and 6-month follow-ups (P 0.01). Significant improvement was seen at the 6-month follow-up compared with the 1-month follow-up (P 0.01). Subjects tolerated the procedure well: the average pain score was 3.13 out of 10, and no serious adverse events were observed.The new-generation MRF device we tested was effective and safe for mild-to-moderate lower facial laxity in Asian skin. The latest MRF technology offers improved safety to prevent complications. Appropriate patient selection, setting, and protocols are mandatory to achieve optimal clinical outcomes.TCTR20210326002.

The Coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical practices worldwide. Due to the transmissibility of the SARS-CoV-2 virus, the risks and benefits of conducting non-emergent and aesthetic procedures have shifted. This study primarily aimed to investigate the different factors affecting the physician's decision to conduct dermatologic surgery procedures during the COVID-19 pandemic based on their own vaccination status. Secondly, this study also aimed to determine the level of institutional trust in the respondents' respective governments and ministries of health.This was a questionnaire-based cross-sectional study conducted from October to December 2021. The survey was electronically distributed to members of the Cyber Conference of Aesthetic Dermatology and Skin Surgery in APAC (CyAsia) and members of dermatological societies across nine countries in Asia. The survey asks the participants' tendencies to perform procedures based on patient willingness to undergo nasal swabbing prior to the procedure, the type of procedure to be performed (cancer removal vs. filler augmentation), and the type of vaccine received by the physician (inactivated, viral vector, mRNA or protein-based).A total of 351 participants completed the questionnaire. Data were analyzed using a conditional logistic regression model according to the participants' country of origin, specialty, age, level of trust in the national government, and level of trust in their respective health ministries. Tendencies to conduct dermatologic procedures were highest for doctors who received mRNA vaccines and lowest among doctors who received inactivated vaccines. Willingness of the patients to undergo pre-procedure nasal swabbing was also a significant factor in deciding to treat, whereas the type of procedure performed was a non-significant factor.This study highlights the important factors that influence the decision to conduct dermatologic procedures during the COVID-19 pandemic.

Laser lipolysis is a rapidly growing noninvasive body-contouring treatment in Asians. There is increasing demand for leg contouring, especially in areas where unwanted fat deposits are prominent despite diet and exercise. Medial fat knees are one of the esthetic concerns of women today and can be a challenging problem in terms of treatment. There are few noninvasive options to remove fat from these areas. This study aims to evaluate the safety and efficacy of a 1060-nm diode laser for medial knee fat reduction.Nineteen subjects with localized unwanted fat on the medial knees were enrolled into this study. All of them were treated with a single session of 1060-nm diode laser at a power setting of 1.0-1.4 W/cmAll subjects were female, with mean age of 32.3 ± 5.3 years and body weight of 59.8 ± 11.6 kg. The average power setting was 1.3 ± 0.1 W/cmThe 1060-nm diode laser is effective and safe for knee circumference and medial knee fat layer thickness reduction.ClinicalTrials.gov identifier, TCTR20220219002. Retrospectively registered on February 19, 2022.

The stratum corneum of the epidermis is the principal barrier in topical drug delivery. Currently, iontophoresis is incorporated in dermatology management to increase transdermal drug delivery.To evaluate the efficacy and safety of handheld iontophoresis device in enhancing transdermal vitamin C delivery.This was a prospective split-face clinical trial with a total of 24 subjects, who presented with photoaging skin. All subjects were treated with the handheld iontophoresis device on the left side of their face, twice a week for 8 weeks. Primary outcomes were the improvement in pore tightening and skin hydration. Evaluations were done at baseline, 2-, 4-, 6-, and 8-week follow-up. Subjects' self-improvement scores and adverse reactions were also recorded.Out of 24 subjects, 17 (70.8%) completed the study protocol. Pore tightening in the iontophoresis group had significant improvement at 2- and 8-week follow-up when compared to the baseline (p = 0.019 and 0.026). Skin hydration on the iontophoresis group improved significantly at 4-week follow-up when compared to the baseline (p = 0.024). In the iontophoresis group, an image of the skin captured using VisioscanThe handheld iontophoresis device is safe and can be used as an adjunctive home treatment in enhancing transdermal vitamin C delivery.

Background: Port-wine stain (PWS) is a congenital capillary malformation associated with negative effects on the quality of life and psychological health of the patients. Pulsed dye laser (PDL) is the current treatment of choice for PWS, however there is little information on the factors determining the treatment price of PWS. We aim to explore the factors determining the treatment price of PWS.Methods: Data were collected through telephone surveys and self-reported questionnaires from hospitals, chain clinics, and doctor’s offices that offered PWS treatment from February 1 to March 30, 2021. Data were analyzed by descriptive statistics and multivariate analysis using a log-linear regression model.Results: A total of 104 observations were gathered. The estimated base price of the treatment without any additional features is 98.34 USD. Treatment by dermatologists has an additional charge of 28.41 USD or 28.9%. Some private clinics offer a lower price of 28.7% (or 28.27 USD) by illegally having non-medical doctors perform the treatment. Treatment with 595-nm PDL and 585-nm PDL and 1064-nm Nd:YAG lasers have an additional charge of 34% (or 33.45 USD) and 38% (or 37.41 USD), respectively. The location and type of medical facility can also affect the price of the treatment. Conclusion: Many factors determine the base price and shadow price of PWS treatment. By using Factors determining a higher cost of laser fee are non-government facilities, location within the capital city, and higher location cost like clinics in the shopping complexes. Lastly, the type of laser and medical personnel provider can also affect the price of the treatment.

Rungsima Wanitphakdeedecha,1 Kristy Elleza R Evangelista,1,2 Chadakan Yan,1 Chalermkwan Apinuntham,1 Thanya Techapichetvanich,1 Sasima Eimpunth,1 Nittaya Lektrakul,3 Woraphong Manuskiatti1 1Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Dermatology, Research Institute for Tropical Medicine, Manila, Philippines; 3Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Rungsima Wanitphakdeedecha, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, 10700, Thailand, Tel +66 2 419 4333, Fax +66 2 411 9922, Email rungsima.wan@mahidol.ac.thBackground: Submental fat is a noticeable fat in the submental region that is of great concern aesthetically, especially to female patients. A 1060-nm diode laser is a clinically proven device for the laser lipolysis of subcutaneous fat cells. This study aimed to evaluate the safety and efficacy of a 1060-nm diode laser for submental fat reduction.Methods: Twenty subjects with unwanted localized submental fat were treated with a single session of a 1060-nm diode laser with an energy setting between 0.95 and 1.40 W/cm2, depending on each patient’s tolerance. Submental fat thickness measurements were documented at baseline, and 1, 3, and 6 months after treatment. Clinical photographs, ultrasound images, and adverse events were evaluated at each follow-up visit. Subjects responded to a satisfaction questionnaire at the end of the study.Results: The subjects had a mean age of 34.55 ± 6.19 years, a mean body weight of 70.66 ± 10.55 kilograms, and most (95%) were women. The average energy setting was 0.95– 1.40 W/cm2, with a pain score of 3.90 ± 1.30 on a 0-to-10 scale. A significant reduction in submental fat thickness measured by ultrasound was noted at post-treatment month 3 (falling to 0.46 ± 0.13; P = 0.013). However, there was a slight increase in the submental fat thickness at the 6-month follow-up (to 0.48 ± 0.12); the change in the thickness relative to the baseline was nonsignificant (P = 0.121). Most subjects reported an improvement 6 months after the treatment. No severe adverse events were observed throughout the study period.Conclusion: Our study demonstrated the potential role of 1060-nm Diode laser for the treatment of localized submental subcutaneous adiposities. It is a promising alternative treatment modality for patients seeking an in-office, nonsurgical procedure for fat reduction without severe complications.Keywords: 1060-nm, diode laser, lipolysis, submental fat

This study aimed to evaluate the efficacy of early antiviral treatment in preventing clinical deterioration in asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus 2 infected (COVID-19) patients in home isolation and to share our experiences with the ambulatory management of nonsevere COVID-19 patients. This retrospective study included mild COVID-19 adult patients confirmed by real-time reverse transcription-polymerase chain reaction. They received care via an ambulatory management strategy between July 2021 and November 2021. Demographic data, clinical progression, and outcomes were collected. Both descriptive and inferential statistics were performed to illustrate the cohort's characteristic and outcomes of the study. Univariable and multivariable logistic regression models were employed to investigate the associations between clinical factors and disease progression. A total of 1940 patients in the Siriraj home isolation system met the inclusion criteria. Their mean age was 42.1 ± 14.9 years, with 14.2% older than 60 years, 54.3% female, and 7.1% with a body weight ≥ 90 kg. Only 115 patients (5.9%) had deterioration of clinical symptoms. Two-thirds of these could be managed at home by dexamethasone treatment under physician supervision; however, 38 of the 115 patients (2.0% of the study cohort) needed hospitalization. Early favipiravir outpatient treatment (≤ 5 days from onset of symptoms) in nonsevere COVID-19 patients was significantly associated with a lower rate of symptom deterioration than late favipiravir treatment (50 [4.6%] vs 65 [7.5%] patients, respectively; P = .008; odds ratio 1.669; 95% confidence interval, 1.141-2.441). The unfavorable prognostic factors for symptom deterioration were advanced age, body weight ≥ 90 kg, unvaccinated status, higher reverse transcription-polymerase chain reaction cycle threshold, and late favipiravir treatment. The early delivery of essential treatment, including antiviral and supervisory dexamethasone, to ambulatory nonsevere COVID-19 patients yielded favorable outcomes during the COVID-19 pandemic in Thailand.

Background: Thailand’s fourth and fifth waves of coronavirus disease 19 (COVID-19) started in July and December 2021, respectively, and greatly overloaded the nation’s public health system. The massive imbalance between health resources and patient demand for services was one of the most significant challenges hampering the country’s response to the catastrophic COVID-19 pandemic. Hospital-based facilities were overwhelmed with an exponential rise in new patient numbers, with a rapidly growing backlog of patients with delayed care or even acceptance within the healthcare system. In response, “outpatient self-isolation” (SI), “home-based isolation” (HI), and “community-based isolation” (CI) strategies were adopted to stabilize COVID-19 cases with mild to moderate symptoms. We present the lessons learned from the system management of HI by drawing on the experiences gained at a university hospital that provided patient-to-professional remote support during the pandemic. The vast majority of patients were assigned to HI immediately after being diagnosed with COVID-19. This system enabled remote consultation, needed medications, and survival-kit supplies to be initiated and delivered to patients’ homes. Conclusion: Our investigation indicates that the HI teleconsultation system was a productive approach to COVID-19 management. It allowed a prompt response to patients’ needs and provided timely access to medical support, especially for patients with mild to moderate symptoms.

BACKGROUND Striae distensae are atrophic dermal scars that can cause psychosocial distress among affected patients. Despite numerous available therapeutic modalities, no gold standard treatment has been established. OBJECTIVE To evaluate the long-term efficacy and safety of a fractional 1064-nm picosecond laser for the treatment of striae alba in individuals with dark skin types. MATERIALS AND METHODS Twenty volunteers with Fitzpatrick skin types IV-V who presented with striae alba were enrolled. Subjects were treated with a fractional 1064-nm picosecond laser for four sessions at 4-week intervals. The skin texture, average melanin index (MI), and melanin variation score were assessed using Antera 3D® before treatment, at 1 month after the second treatment, and at 1, 3, and 6 months after the last treatment. Two independent investigators evaluated clinical improvement by comparing pretreatment and posttreatment photographs. The patient satisfaction rates were likewise assessed. Adverse effects were recorded during the entire study period. RESULTS Significant improvement of skin texture was seen at 1 month after the final treatment (p

BACKGROUND Enlarged facial pores are one of the common skin signs of photoaging that patients seek treatment for. However, objective data and long-term assessment on the efficacy and safety of therapeutic procedures for this condition are limited. OBJECTIVE To objectively evaluate the efficacy and safety of a 1064-nm picosecond laser with microlens array (MLA) for pore tightening. METHODS Twenty-five patients with enlarged pores received three treatments with a 1064-nm picosecond laser coupled with MLA at 4-week intervals. Patients were evaluated using objective (measurement of pore volume using three-dimensional photography) and subjective (clinical evaluation by two blinded dermatologists) assessments at baseline and at the 1-, 3-, and 6-month follow-ups. Adverse effects were also recorded during each visit. RESULTS After three treatments, there was a significant reduction of pore size from baseline (p

Introduction Asian patients often seek to address lower facial aging through clinical interventions that increase anterior projection and jawline contouring. The Definisse™ (also known as Happy Lift™) thread lift treatment uses barbed absorbable threads to suspend tissues and induce biostimulation. We evaluated the efficacy and safety of absorbable barbed threads for lower facial reshaping in Thai patients. Methods This prospective, evaluator-blinded study enrolled 27 Thai patients diagnosed with mild to moderate facial laxity. Patients underwent thread implantation along the mandibular angle with one of two double needle thread lengths (12 and 23 cm) to create a “J stitch”. Primary outcome was the clinical improvement in facial laxity as graded by two blinded dermatologists at baseline, immediately after treatment, and at 1 week and 1, 2, 3, 6, and 12 months follow-up. Objective measurements included volume in the jawline, nasolabial folds, and submental area. Patients’ self-assessment scores and adverse reactions were recorded. Results Of the 27 patients recruited to the study, 25 (92.6%) attended all follow-up visits. Clinical improvement of facial laxity was observed immediately after thread implantation. There was significant volume improvement in the jawline, nasolabial folds and submental area at almost all follow-up visits (p

Introduction Port-wine stain (PWS) is a congenital malformation that does not resolve spontaneously and can cause a physiological or psychological burden to the patients. At present, most of the studies done on PWS are focused on the treatment rather than the quality of life and psychological effects of the disease. Material and methods A comprehensive literature search was done in MEDLINE using PubMed database, Embase®, and Cochrane. All observational studies were included in this review. Results A total of 17 relevant articles with 2,135 PWS patients were included in this review. There were 36 measurement tools used to assess the quality of life and the psychological effects among PWS patients. The results showed that patients with facial PWS had a significant negative effect on their quality of life and had also suffered from psychological disabilities. The PWS lesion tends to worsen with age and may cause further adaptation problems towards the social environment, especially in children. Conclusion Early treatment, psychological assistance, and patient support are the key management in improving the quality of life of patients with PWS. Quality of life must be regularly assessed together with the improvement of treatment.

Background Port-wine stain (PWS) is a congenital malformation that does not resolve spontaneously and can lead to social and self-stigma. However, little is known about how PWS affects the patients' quality of life (QoL) and psychosocial well-being. In this article, we examine the existing empirical evidence on self-stigma caused by PWS. Methods A systematic review was done using MEDLINE, PubMed, Embase, and Cochrane databases on January 15, 2021 to retrieve all case reports, cohort studies, and clinical trials written in English. The keywords used in this literature search included port-wine stain, quality of life, self-stigma, and social stigma. Results From the 74 initial records, eight articles were quantitative studies that assessed the QoL and self-stigma experienced by PWS patients. With regard to perceived stigma or the patients' understanding of how others think and act toward them, we found that the parents of children with facial PWS tend to have more perceived stigma than the children. For anticipated stigma or expectations of future stigma, young patients with PWS have less or no concern about their skin conditions. In terms of enacted stigma or experiences with discriminatory acts, there were significant differences in the QoL score between patients with facial PWS and those with non-facial PWS. Conclusion This study suggests that self-stigma caused by PWS affects young patients and their parents. The parents in particular tend to suffer more than their children from perceived and anticipated stigma. Psychological support and early treatment can improve the livelihoods of young patients and their parents.

Tatre Jantarakolica,1 Rungsima Wanitphakdeedecha,2 Chadakan Yan,2 Yuri Yogya,2 Surachet Sirisuthivoranunt,2 Supisara Wongdama,2 Phumithep Phumariyapong,2 Tatchalerm Sudhipongpracha3 1Faculty of Economics, Thammasat University, Bangkok, Thailand; 2Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3College of Interdisciplinary Studies, Thammasat University, Bangkok, ThailandCorrespondence: Rungsima Wanitphakdeedecha, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkok, 10700, Thailand, Tel +66-2419-4333, Fax +66-2411-9922, Email rungsima.wan@mahidol.ac.thBackground: Port-wine stains are congenital vascular abnormalities that impact children’s and parents’ quality of life (QoL). There are currently no established criteria for assessing the quality of life in PWS patients. Utility measures such as willingness-to-pay (WTP) and time trade-off (TTO) can be used to quantify disease burden, impact on QoL, and assess the cost-effectiveness of interventions.Methods: This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaire included sociodemographic data and preference-based measurement, WTP and TTO. The primary outcome was a WTP and TTO for PWS laser treatment. The subsample analysis for the primary outcome was based on gender (male and female) and age (< 5 years and ≥ 5 years). The household income was measured for time trade-off outcome.Results: Out of 46 respondents, WTP for the base case at 40% improvement cost 6109.01 baht per visit. Patients were willing to spend their time 9.95 hours per visit for a clinical improvement of 40%. Female was willing to pay and spend more time than male, while those aged≥ 5 years were willing to pay and spend more time than those aged < 5 years. High household income > 100k per month willing to spend less time than lower income groups.Conclusion: There were obvious correlations between WTP and TTO with clinical outcomes. Utility indicators such as WTP and TTO can be used to measure disease burden, impact on QoL, and assess the cost-effectiveness of interventions. WTP and TTO could provide a more personalized approach to improving QoL, considering each patient’s unique treatment plan and priority. This could help with patient uncertainty and long-term planning strategies to increase the QoL cost-effectively.Keywords: port-wine stain, time trade-off, willingness to pay

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.

Recent reports have surfaced from the United States Food and Drug Administration hearings in December 2020 regarding the COVID-19 vaccines and study participants who developed facial and/or lip swelling after receiving the newly developed drug. Despite an incidence rate of 0.02% in the vaccine arm of the Moderna mRNA-1273 trial, concerns have been expressed about the association of adverse reactions following soft tissue filler injections and the COVID-19 vaccines. The International Society for Dermatologic and Aesthetic Surgery (ISDS) understands these concerns and has designed the following study.A global survey was designed to capture the incidence of adverse events related to: (1) previous soft tissue filler injections, (2) soft tissue filler injections during positive testing for COVID-19, and (3) soft tissue filler injections during and after receiving any of the COVID-19 vaccines globally available.The information of 106 survey participants from 18 different countries was analyzed. 80.2% (n=85) never experienced any adverse reaction following their soft tissue filler injection whereas 15.1% (n=16) experienced swelling and 4.7% (n=5) experienced pain that lasted longer than two days. Of those who received at least one dose of the COVID-19 vaccine (n=78), 94.9% reported not to have experienced any adverse reaction related to their previous soft tissue filler injection, whereas 5.1% (n=4) reported to have perceived pain that lasted longer than two days.The data collected does not support the concern for an increased risk of developing adverse reactions following soft tissue filler injections associated with the COVID-19 vaccines compared to that risk associated with other previously described triggers or the default risk following soft tissue filler injections. J Drugs Dermatol. 20(4):374-378. doi:10.36849/JDD.2021.6041.

Introduction Port-wine stain (PWS) is a progressive capillary malformation that does not resolve spontaneously without treatment. Pulsed dye laser (PDL) is currently the gold standard treatment for PWS, although it is difficult to attain complete clearance and recurrences are common. This study determined the cost-effectiveness of PDL treatment among Thai patients with facial PWS. Methods This was a retrospective chart review of 109 Thai patients with facial PWS and treated with PDL at Siriraj Hospital, Thailand from January 2008 to December 2017. The primary outcome of the study was the cost-effectiveness of PDL treatment in the clinical improvement of facial PWS. Results Ten PDL treatment sessions will have an expected clinical improvement of 60%. At the 10th treatment, the marginal incremental improvement with respect to visit is approximately equal to one. The succeeding treatment sessions will only give an additional improvement of 5–10%. Conclusion A total of 10 PDL treatment sessions was considered cost-effective as it can achieve 60% clinical improvement among Thai patients with facial PWS.

Background Picosecond lasers are increasingly being investigated in treating pigmentation disorders because they may provide better treatment efficacy and comfort compared with nanosecond lasers. Objective This study aims to evaluate the efficacy and side effect of a novel 670-nm picosecond laser in the removal of benign pigmented lesions (BPLs) in individuals with Fitzpatrick skin types (FST) III and IV. Materials and methods Fifteen subjects with solar lentigines and 7 subjects with ABNOMs received a single treatment with a 670-nm picosecond laser. Blinded physicians assessed the pigment clearance using a 5-category grading system scale. All subjects were evaluated at 1 month, 3 month, and 6 month after a single treatment. Adverse events were recorded at every follow-up visit. Results All subjects with lentigines had complete clearance (95%-100%) of lesions during 3-month follow-up after a single treatment session of 670-nm picosecond laser, whereas 75% of the subjects with ABNOMs noted fair lightning (25%-49%) of lesions. Mild hypopigmentation and hyperpigmentation were observed in 9% and 14% of the subjects, respectively, which resolved within 3 months after the treatment. Conclusion The novel 670-nm picosecond laser is a safe and effective treatment for BPLs in subjects with FST III and IV with low rates of transient adverse effects.

BACKGROUND AND OBJECTIVES Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy-based devices (EBD) for this condition are limited, with a short duration of follow-up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark-skinned patients. STUDY DESIGN/MATERIALS AND METHODS Nineteen subjects (aged 26-47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1-month after each treatment and at 1, 3, and 6 months after the final treatment. RESULTS The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1-month after the third treatment and continued until 3 months after the fourth (final) treatment (P

This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma.Thirty adult participants with melasma (Fitzpatrick skin types III-V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients' self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points.All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients' self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate).The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma.This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.

A few studies have evaluated the efficacy and safety of noninsulated radiofrequency microneedling (RFMN) to treat periorbital wrinkles in Asian patients. Recently, wound healing accelerators, polynucleotides (PNs), have received attention in wound management. However, their efficacy and safety have not been fully elucidated following RFNM. This study aimed to evaluate the efficacy and safety of noninsulated RFMN for periorbital wrinkles and the synergistic effect of PNs after RFMN.Thirty subjects with Fitzpatrick skin types III to V and facial wrinkles (Fitzpatrick grades I and II) were enrolled. All volunteers were treated over the entire face with noninsulated RFMN for three sessions at 2-week intervals. The left and right sides of each patient's face were randomly assigned to receive PNs (treatment group) or normal saline solution (control group). The indentation and maximum depth of wrinkles were objectively measured using Antera 3D. Subjective self-evaluations were obtained at baseline, 2 weeks after the third treatment, and at 1, 2, 3, and 6 months after the final treatment. In addition, pain scores, immediate reactions, and other adverse effects were evaluated.Twenty-nine subjects completed the treatment protocol. Most presented with grade II wrinkling (69%). At 2-month follow-up, Antera 3D image analysis revealed faster improvement for the treatment group. At 6-month follow-up, the majority of subjects reported an improvement of 25-75% in their periorbital wrinkles. The average pain score was 2.2 out of 10. No serious adverse events (infection, pigmentary alteration, persistent erythema, or scarring) were observed.Noninsulated RFMN is safe and effective for treating periorbital wrinkles and can be used as a modality for transdermal drug delivery. Topical polynucleotides as an adjunctive treatment provide additional benefits for periorbital wrinkle treatment.TCTR20201105007.

Background Botulinum neurotoxin A (BoNT/A) has been used for cosmetic indications for many decades. Consumption of BoNT/A usage has been markedly increased for a few years. Even new formulations of BoNT/A to decrease immunogenicity have been released, repeated treatment to maintain efficacy outcome is inevitable and could finally provoke immune response. In the past, prevalence of botulinum treatment failure (BTF) in cosmetic indication was rare leading to less medical concern. Current decade, case reports on BTF, especially antibody-induced botulinum toxin treatment failure (ABTF) have been increasingly revealed as well as risk factors associated with ABTF have been intensively studied. Aim In this article, we will review antibody-induced botulinum toxin treatment failure (ABTF), risk-associated ABTF, prevalence and recent case reports of ABTF, and new approach to deal with ABTF. Methods Literature search was conducted using PubMed. The relevant literatures published between January 2000 and May 2020 concerning BTF and ABTF including investigation for ABTF were included and analyzed. Results Possible causes of BTF were summarized. ABTF could be a tip of iceberg of BTF, its prevalence and currently 10-year case reports of ABTF were published evidence. Risk factors and investigation methods for ABTF were also summarized. Based on previous studies and our experience, novel approach to management of ABTF was described. Conclusion Effective management of BTF is to explore causes of treatment failure. Antibodies against BoNT/A complex could be one of many possibilities. Laboratory in vitro tests could be alternative tools to decrease adverse effect and rebooting immune responses in BTF patients.

BACKGROUND The use of light-emitting diode (LED) in combination wavelength for facial rejuvenation has been previously reported. Nowadays, there has been a growing market for home-use cosmetic devices because of its low cost and convenience. AIMS To evaluate the efficacy and safety of home-use LED device on facial rejuvenation. METHODS This was a prospective split-face clinical trial with a total of 24 subjects, who presented with photo aging skin. All subjects were treated with the home-use LED device on the left side of their face, twice a week for 8 weeks. Primary outcomes measured in the study were the changes in the biophysical properties of the skin assessed with the following parameters: skin elasticity, skin hydration, texture, and wrinkles. Evaluations were done at baseline, 2-, 4-, 6-, and 8-week follow-up. Subjects' self-improvement scores and adverse reactions were also recorded. RESULTS All 24 subjects completed the study and attended all follow-up. Skin elasticity was significantly higher in the LED group compared to the control during the 6- and 8-week follow-up (P

Background Recently, macro-focused ultrasound (MFU) has become a popular noninvasive esthetic treatment for facial laxity. However, there are no studies done that evaluated the use of MFU with a 2.0 mm transducer for upper facial lifting. Aims To evaluate the efficacy and safety of MFU with a 2.0 mm transducer in the treatment of upper facial laxity in Thai patients. Methods This was a prospective, evaluator-blinded pilot study with 34 Thai patients diagnosed with mild to moderate facial laxity. Patients were treated with a single session of MFU with 2.0 mm transducer at the forehead, lateral and just below the eye area. Primary outcome was the clinical improvement of upper facial laxity graded by 2 blinded dermatologists at baseline, 1-week, 1-, 3-, and 6-month follow-up. Objective measurements including eyebrow height, upper facial volume, and textural irregularities were evaluated. Patients' self-assessment scores and adverse effects were also recorded. Results Out of 34 patients, 27 (79.4%) attended all follow-ups. Clinical improvement of upper facial laxity was observed as early as 1-week follow-up. Eyebrow height elevation was significantly increased at every follow-up (P = .000) with an average of 1.22 mm at 6-month follow-up. Wrinkles improved significantly at 1-week and 6-month follow-up (P = .002 and P = .010, respectively). Skin roughness showed significant improvement at 6-month follow-up (P = .004). Majority of the patients (53.6%) reported marked improvement at 3-month follow-up. No serious adverse event was noted. Conclusion Macro-focused ultrasound is a safe and effective treatment for upper facial laxity and skin textural irregularities in patients with mild to moderate degree of laxity.