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Background: The microneedle fractional radiofrequency system (MFRS) is able to rejuvenate facial appearance by heating and coagulating certain depth of skin tissue. Objective: To evaluate the safety and efficacy of a novel vacuum‐assisted MFRS for facial contour tightening. Methods: This prospective, randomized, split‐face study included 21 patients who underwent three treatments with a vacuum‐assisted MFRS at 1‐month intervals. Half of the face was treated with the MFRS; the other half was untreated (control). Facial volume changes and wrinkles were objectively measured using a three‐dimensional imaging system and VISIA‐CR. Results: Volume changes of the treated midface were −0.24 ± 0.75, −0.59 ± 0.92, and −0.55 ± 0.65 mL at 1, 3, 6 months follow‐up; however, measurements of the control side were 0.08 ± 0.70, −0.08 ± 0.53, and − 0.10 ± 0.86 mL, indicating significant reductions (p < 0.05). The number of facial wrinkles on the treated side was significantly reduced to 12.44 ± 4.85 at 3 months and sustained at 6 months (11.11 ± 4.100) compared to the control side (14.89 ± 5.26 and 13.22 ± 4.44, respectively; p < 0.05). No long‐term side effects occurred. Conclusion: The vacuum‐assisted MFRS is safe and effective and is recommended for improving facial tightening and reducing wrinkles. This technology is sufficient to ensure the insertion depth, thus helping to improve the treatment accuracy and safety. The MFRS provides sustained effects for at least 6 months. [ABSTRACT FROM AUTHOR]

Background: Monoclonal immunoglobulin deposition disease (MIDD) is characterized by the deposition of nonamyloid monoclonal immunoglobulin and its free fragment light chain and/or heavy chain in systemic tissues and organs, and the kidney is most vulnerable organs. MIDD can be divided into three types: light-chain deposition disease (LCDD), light and heavy chain deposition disease (LHCDD), and heavy-chain deposition disease (HCDD), of which LHCDD and HCDD are rarer (Bridoux et al. in Kidney Int 2015;87:698–711; Preud'homme et al. in Kidney Int 1994;46:965–72). Poor outcome in most HCDD, but in this paper, we will report a case of HCDD with good long-term renal survival and review the literature for reference. Case presentation: A 32-year-old man presented to our department with skin laxity and nephritic syndrome, accompanied by an significant increase of serum creatinine and received short-term hemodialysis treatment. Both the blood and urine free light chain ratio increased significantly. Renal biopsy showed mesangial nodular glomerulosclerosis on light microscopy, and immunofluorescence staining showed positivity for γ-heavy chain (HC), with negative light chain (LC) staining; the diagnosis was considered HCDD. After six courses of bortezomib combined with dexamethasone chemotherapy and thalidomide 100 mg/day, the renal function gradually recovered, while also with proteinuria and hematuria significantly improved. The blood and urine free light chain ratio decreased to normal. Until now, the patient has been followed for four years, and long-term renal survival has been observed. Conclusion: Herein, we report a case presenting with proteinuria, hematuria, renal impairment, and skin laxity, and a renal biopsy showed linear IgG deposition in the glomerular basement membranes and tubular basement membrane. However, they ultimately proved to have HCDD. Bortezomib combined with dexamethasone, and oral thalidomide led to a good long-term renal survival. We also provide a review of currently available literature, and this is the first large-scale review summarizing the characteristics of HCDD up to date. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To describe the use of coronofrontal rhytidectomy (CFR) for the treatment of severe pseudoptosis and superior entropion in dogs, and to provide guidelines for the selection of surgical technique depending on presentation.A review of medical records of dogs that underwent rhytidectomy from 2002 to 2023 was carried out, including signalment, clinical signs, type of rhytidectomy, concurrent surgical techniques, re‐interventions, post‐operative complications, follow‐up time, and outcome.Twenty dogs with a median age of 5.1 years were included in this study. English Cocker Spaniel was the most common breed (8 dogs:40%) and males were overrepresented (13 dogs: 65%). Besides pseudoptosis and visual impairment (100%), the other most common clinical signs were entropion and/or ectropion (19 dogs: 95%), conjunctivitis (17 dogs: 85%), euryblepharon (12 dogs: 60%) and non‐ulcerative keratitis (10 dogs: 50%). CFR was performed in 12 dogs (60%), frontal rhytidectomy in 5 (25%), coronal in 2 (10%), and modified shared in 1 (5%). Concurrent surgical techniques were performed in 17 dogs (85%), being lateral canthoplasty (13 dogs; 65%), and Celsus–Hotz (10 dogs; 50%) the most common. The median follow‐up time was 115 days with no complications and good outcomes reported in all dogs. At last re‐recheck, complete correction of the eyelid positioning was obtained in 92% (11/12) and 87.5% (7/8) of the cases that underwent CFR and other rhytidectomy techniques, respectively.CFR is an effective surgical treatment for severe pseudoptosis and superior entropion in dogs. The provided guidelines will assist in the selection of the most appropriate eyelid lifting technique. [ABSTRACT FROM AUTHOR]

Background: Micro‐focused ultrasound (MFU) is a technique for skin rejuvenation and lifting, targeting the facial SMAS—a fibrous network encompassing the platysma muscle and parotid fascia. Objective: This study aims to propose a novel and cost‐effective method (suggested by Fatemi) for Ultherapy, comparing its effectiveness with the conventional approach. Materials and Methods: A prospective double‐blind clinical trial was conducted with 30 female volunteers randomly assigned to two groups: The control group (conventional method) and the experimental group (new method). Ultherapy procedures utilized MFU technology with low energy and a higher frequency. Results: Statistically significant differences in lifting effects and improvement in skin laxity were observed between the two groups. The new method, with a focus on the parotideal area of the SMAS, demonstrated superior outcomes and higher patient satisfaction. Conclusion: The parotideal region's accessibility, increased thickness, and safety profile make it an ideal target for Ultherapy. This not only reduces the risk of nerve injury but also yields effective collagen remodeling and skin‐lifting results. [ABSTRACT FROM AUTHOR]

Abstract Background Monoclonal immunoglobulin deposition disease (MIDD) is characterized by the deposition of nonamyloid monoclonal immunoglobulin and its free fragment light chain and/or heavy chain in systemic tissues and organs, and the kidney is most vulnerable organs. MIDD can be divided into three types: light-chain deposition disease (LCDD), light and heavy chain deposition disease (LHCDD), and heavy-chain deposition disease (HCDD), of which LHCDD and HCDD are rarer (Bridoux et al. in Kidney Int 2015;87:698–711; Preud’homme et al. in Kidney Int 1994;46:965–72). Poor outcome in most HCDD, but in this paper, we will report a case of HCDD with good long-term renal survival and review the literature for reference. Case presentation A 32-year-old man presented to our department with skin laxity and nephritic syndrome, accompanied by an significant increase of serum creatinine and received short-term hemodialysis treatment. Both the blood and urine free light chain ratio increased significantly. Renal biopsy showed mesangial nodular glomerulosclerosis on light microscopy, and immunofluorescence staining showed positivity for γ-heavy chain (HC), with negative light chain (LC) staining; the diagnosis was considered HCDD. After six courses of bortezomib combined with dexamethasone chemotherapy and thalidomide 100 mg/day, the renal function gradually recovered, while also with proteinuria and hematuria significantly improved. The blood and urine free light chain ratio decreased to normal. Until now, the patient has been followed for four years, and long-term renal survival has been observed. Conclusion Herein, we report a case presenting with proteinuria, hematuria, renal impairment, and skin laxity, and a renal biopsy showed linear IgG deposition in the glomerular basement membranes and tubular basement membrane. However, they ultimately proved to have HCDD. Bortezomib combined with dexamethasone, and oral thalidomide led to a good long-term renal survival. We also provide a review of currently available literature, and this is the first large-scale review summarizing the characteristics of HCDD up to date.

BACKGROUND: The development of microfocused ultrasound and fractional radiofrequency-based devices has expanded the range of cosmetic treatment options for patients with skin of color. Fractional non-ablative laser treatments can also be safely performed in skin types III-VI with appropriate settings and adjunctive topical treatments. OBJECTIVE: We sought to review the available literature on the use of energy-based devices for treatment of facial skin conditions in skin types III-VI. METHODS: A PubMed search was performed on studies from 2010-2021 assessing safety and efficacy of fractional ablative and non-ablative lasers, radiofrequency, and microfocused ultrasound-based treatments for conditions such as acne scars, melasma, benign pigmented lesions, rhytids, and skin laxity in skin types III-VI. RESULTS: Seven randomized trials, fourteen prospective cohort studies, and six retrospective reviews were included. Combination treatment with fractional radiofrequency and non-ablative laser has demonstrated efficacy in the treatment of acne scars in skin of color with minimal adverse effects. Laser-assisted drug delivery with low-density 1927-nm thulium or diode lasers has been shown to reduce the number of treatments required for significant clearance of melasma as compared with other modalities. Microfocused ultrasound has been shown to safely treat skin laxity in skin of color. LIMITATIONS: There is a paucity of studies which include patients with skin type VI, limiting our overall understanding of the safety of these treatments in skin of color. CONCLUSION: There are numerous available studies demonstrating safety and efficacy of energy-based devices for the treatment of facial skin conditions in skin types III-VI, but the significant variation among their designs, methods of assessment, and study populations highlights the need for larger meta-analyses to further interpret their results. [ABSTRACT FROM AUTHOR]

Objective: With more than 1.5 million performed procedures, liposuction was the second most performed esthetic surgical procedure all over the world in males and in females in the year 2020. The objective of this open‐label, evaluator‐blinded study was to assess the efficacy and safety of an energy‐based device that combines multipolar radiofrequency with pulsed electromagnetic field (PEMF) in patients that underwent liposuction. Materials and Methods: A total of 30 subjects, of whom 24 were females (80%), with a mean age of 48.4 ± 11.0 years (range: 27–69 years) and a mean weight of 69.5 ± 11.7 kg underwent unilateral treatment with radiofrequency and application of PEMF after bilateral liposuction. One month after the last of a total of six weekly treatments, skin elasticity, visco‐elasticity and net elasticity, as well as subject reported satisfaction on a 5‐point scale ranging from −1 (worse) to 3 (very much improved) and esthetic improvement ranging from 0 (very unsatisfied) to 4 (very satisfied) rated by three independent reviewers were assessed. Results: Three independent and blinded reviewers rated the improvement of the treated side on average as 1.17 + 0.07 compared with baseline. Subjects were very satisfied with their treatment, with a mean score of 3.24 (0.03) out of 4 at the 1‐month follow‐up visit. Cutometer measurements showed no significant changes. Conclusion: This study revealed that the subjective satisfaction with the results of the application of RF and PEMF after liposuction is high, while at the same time the esthetic appearance as rated by independent raters improved on the treated side. [ABSTRACT FROM AUTHOR]

Background: A growing demand for aesthetic treatments for localized abdominal unwanted fat has developed as a healthy lifestyle is not always able to improve abdomen appearance. Aims: The purpose of this retrospective nonrandomized observational study was to evaluate the efficacy and safety of a new device delivering microwaves energy for unwanted fat reduction, using three‐dimensional (3D) imaging analysis. Methods: Twenty patients (both female and male) were treated in the abdominal area. Subjects received 4 treatments with the study device. Follow‐up evaluations were conducted to estimate safety and efficacy. A Numerical Rating Scale (NRS) was used for pain assessment. Patient's 3D imaging analysis was performed at baseline and at 3 months follow‐up. Finally, a satisfaction questionnaire was filled in by all the patients. Results: All subjects completed the whole cycle of treatments and presented for the follow‐up visits. Analysis of 3D imaging yielded a significantly reduction in circumference (cm) and volume (cm3), passing, respectively, from 85.2 ± 8.1 cm and 1950.6 ± 471.0 cm3 at baseline to 80.8 ± 8.2 cm and 1728.9 ± 490.9 cm3 (p < 0.001) at 3‐months follow‐up after the last treatment. According to the NRS results, the treatment was well tolerated. From the analysis of the satisfaction questionnaire the 90% of patients are interested in carrying out the same treatment in other body areas. Conclusion: With the use of three‐dimensional imaging techniques, the efficacy of a new system delivering microwaves energy for the reduction of abdominal volume correlated to a subdermal fat reduction while preserving/improving skin tightening, was quantitatively and objectively demonstrated. [ABSTRACT FROM AUTHOR]

Cleidocranial dysplasia (CCD) is a rare genetic skeletal syndrome. The most common features are open fontanelles, hypertelorism, mid-face retrusion, hypoplasia, or aplasia of the clavicles leading to excessive shoulder mobility, dental abnormalities such as supernumerary, and impacted teeth. This case report describes a 31-year-old male with CCD with several unusual symptoms like generalized joint hypermobility, skin laxity, and smooth skin, which leads to set a diagnosis of hypermobile Ehlers-Danlos syndrome (hEDS). To our knowledge, this is the first case report in the literature that describes a patient with these 2 distinct syndromes CCD and hEDS.

BACKGROUND: With many treatments available for managing cellulite, non-invasive procedures are increasingly sought after. Radiofrequency (RF) and targeted pressure energy (TPE) are new techniques developed to counter aesthetic signs of aging. The combination of RF and TPE for cellulite thus requires a more robust investigation. OBJECTIVE: We sought to determine the effectiveness and safety of combined/simultaneous RF and TPE for skin tightening and reducing the appearance of cellulite. METHODS: Thirty subjects aged 46.5±9.0 (31-74) years, BMI 19.8-36kg/m2 were enrolled and treated for cellulite on the hips, thighs, abdomen and arms. Each subject received four treatments, over 2 to 4 consecutive weeks. The circumference of the treated areas was measured at baseline, after the ffnal treatment session, and at follow-up visits one month, three months and six months following treatment. The efficacy of the therapy was evaluated based on the Cellulite Severity Scale, Global Aesthetic Index Scale, and the Subject Satisfaction Questionnaire. Occurrence of side effects and adverse events was monitored, therapy comfort was analyzed. RESULTS: Cellulite severity improved from moderate to mild cellulite (p<0.001) in 95 percent of patients. Blinded, independent, evaluators reported aesthetic improvement in 90 percent of subjects. Signiffcant circumference decrease in the abdomen, hips, and thighs was observed six months after treatment (p<0.01). Eighty-six percent of subjects were satisffed with improved cellulite appearance, and 82 percent of patients reported improved skin laxity. No severe side effects or adverse events occurred. CONCLUSION: The simultaneous TPE+RF procedure was able to non-invasively improve cellulite appearance in the majority of subjects and may be recommended for skin tightening on various body parts. [ABSTRACT FROM AUTHOR]

Marie-Odile Christen Behavior, Paris, FranceCorrespondence: Marie-Odile Christen, Behavior, 27 Avenue Marceau, Paris, 75116, France, Tel +33 680998336, Email christen.marieodile3@gmail.comAbstract: The number of aesthetic procedures performed worldwide continues to grow together with an increase in the population seeking the restoration or preservation of a youthful appearance. Requests for non-surgical body rejuvenation are increasing. Patients are looking for safe and effective minimally invasive aesthetic procedures. Soft-tissue dermal fillers can meet these expectations. Based on the beneficial outcomes of these treatments in many facial areas, a new trend is developing to target body areas. Different dermal fillers are available and include collagen stimulators initially developed to restore facial volume. Furthermore, they are associated with long-lasting efficiency, a high level of patient satisfaction and a good safety profile, with mainly minor adverse events reported. In appropriate conditions of use, they are now used for body rejuvenation in clinical practice. Their use is expanding and allows addressing various issues including volume loss, skin laxity, cellulite, striae distensae and wrinkles. This review focuses on poly-L-lactic acid (PLLA), used in the first collagen stimulator and one of the most investigated in facial and in off-facial body applications. The available published data, although still limited, are presented by body area, neck and chest, buttocks, abdomen, upper arms, thighs, knees, and hands. Key features of the concerned zones and the main clinical signs affecting the body part as well as the injection modalities are provided along with the aesthetic results. This represents the state of the art on which to base further developments necessary for optimal and safe outcomes of treatment with the PLLA-based collagen stimulators and others in this class for body rejuvenation.Keywords: poly-L-lactic acid, PLLA, volume augmentation, body contouring, dermal filler, collagen stimulator, buttocks, body rejuvenation, skin laxity, skin quality

BACKGROUND: Microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite (CaHA) filler are modalities for improving skin laxity. Their use in combination on body sites other than the face is expanding. OBJECTIVE: To investigate the effectiveness and safety of combination MFU-V and dilute CaHA (dCaHA) for lower anterior thigh and knee laxity over 12 and 24 weeks. METHODS: Twenty women (40-71 years) with moderate to severe laxity of the anterior thigh and knee were enrolled in this split-body trial. Subjects received dual-depth (3.0mm, 1.5mm) or triple-depth MFU-V (4.5mm, 3.0mm, 1.5mm) to the inferior anterior thigh (127-381 lines) along with dCaHA (1:1 normal saline) injection (0.5-3mL). Clinical effectiveness was monitored using photography, qualitative clinician and subject assessments, and quantitative analysis of skin topography by three-dimensional imaging and dermal thickness by optical coherence tomography. RESULTS: At 12 and 24 weeks, the treated thigh and knee experienced significant improvement in qualitative clinician scales (p<0.01), with subjective improvement on photography and subject-reported assessments; no significant changes were noted by quantitative measures. Adverse events were reported in 68 percent of patients, including mild bruising (n=12) and swelling (n=10). CONCLUSION: Combining MFU-V and dCaHA is safe and results in clinical improvement of anterior thigh and knee laxity. [ABSTRACT FROM AUTHOR]

Background: Although much has been published on the use of poly‐L‐lactic acid (PLLA) and calcium hydroxyapatite (CaHA) for off‐face indications, questions remain regarding their exact mechanisms of action in subcutaneous tissue and their comparative efficacy. Objective: To present the clinical and histological results of the PLLA and CaHA injections into the opposing arms of the same patients. Methods: Five women received superficial subcutaneous injections of PLLA into the left arm and CaHA into the right arm. After three sessions, the clinical and histological outcomes were analyzed. Results: After the first session, three patients showed improvement in the right arm (CaHA), but at the end of study, two patients showed better results in the left arm (PLLA). Histologically, moderate to intense lymphocytic and giant cell infiltrate, as well as collagen and elastic fiber neoformation, were observed equally near the particles of both products. Dermis had no inflammatory or fiber alterations. Conclusion: In this study, there were no clinical differences between these two fillers. Despite current thinking and previous histological studies, we found both products produced moderate to intense inflammatory reaction, as well as collagenic/elastogenic fiber neoformation, only in the subcutaneous tissue of the immediate vicinity and surrounding the individual filler particles. [ABSTRACT FROM AUTHOR]

In this introductory article to this special supplement in radiofrequency (RF), we aim to summarize the scientific foundation of RF therapy and its role in aesthetic dermatology. Monopolar, bipolar, and multipolar RF systems are described in detail, along with the different delivery methods such as stamping, dynamic or continuous movement, fractional, fractionated (FR) needling, and non‐contact devices as well as the minimally invasive platforms that use subdermal probes. The characteristics of different tissues and the technical parameters that influence the effect of RF therapy, such as the penetration of energy, are summarized. This article expands on the various treatment applications for these devices and the mechanism of action behind skin and adipose tissue remodeling, and also discussed are safety concerns, treatment endpoints, and specific considerations when using RF therapy to provide effective treatment outcomes with reduced patient downtime. [ABSTRACT FROM AUTHOR]

Demand for facial contouring procedures has increased dramatically in recent years. Common regions of concern for patients seeking a rejuvenated, more youthful appearance include the cheeks, jawline, submental area, and neck. Radiofrequency technology offers a non‐invasive and effective method of improving skin laxity and subcutaneous fat in these areas. The Evoke system from InMode Aesthetics is a radiofrequency modality designed to address the lower face and neck that stimulates collagen remodeling for skin tightening and thermal lipolysis for improved facial contour. While alternate technologies for radiofrequency facial remodeling are commercially available, Evoke is the first of its kind in introducing a reliable, operator‐independent hands‐free device developed based on InMode's proprietary Acquire, Control, and Extend technology targeting the deep fibro‐septal network to provide optimal and consistent outcomes. [ABSTRACT FROM AUTHOR]

Dermatologic patients are expressing increasing interest in minimally invasive procedures to address a wide range of common concerns from skin laxity to acne and scarring. Fractional radiofrequency (RF) microneedling offers an effective method for addressing a variety of dermatologic conditions with reduced downtime compared with historically more invasive procedural approaches. This article aims to describe the technology utilized in fractional RF microneedling (Morpheus8, InMode Aesthetics) and its studied applications in dermatology for treatment of the face. [ABSTRACT FROM AUTHOR]

Background: Supra-brow and sub-brow blepharoplasty are two types of upper eyelid blepharoplasties that are commonly performed in middle-aged Asian women to correct skin laxity of the upper eyelid; the postoperative scar formation of the two procedures may be different. Therefore, we designed this retrospective study to explore the differences in postoperative scarring between patients receiving supra- or sub-brow blepharoplasty. Methods: We identified 52 patients who underwent supra-brow blepharoplasty and 54 patients who underwent sub-brow blepharoplasty. For each patient, the scar quality was assessed using photographs, the Observer Scar Assessment Scale (OSAS), and the Patient Scar Assessment Scale (PSAS) 1 year following surgery. Results: For OSAS, higher scores for pigmentation, thickness, relief, pliability, surface, and overall opinion were observed in patients who underwent supra-brow blepharoplasty (p < 0.05) except for the "vascular score" (p = 0.148). The average overall opinion scores of the supra- and sub-brow blepharoplasty were 3.90 ± 0.41 and 2.33 ± 0.48, respectively, indicating that acceptance of postoperative scars in patients who underwent supra-brow blepharoplasty was worse than that in patients who underwent sub-brow blepharoplasty. Significantly higher scores were observed in all items of PSAS items for patients with supra-brow blepharoplasty (p < 0.05). Conclusions: The postoperative scars in patients who underwent supra-brow blepharoplasty were more obvious than those in sub-brow blepharoplasty. From the perspective of postoperative scar formation, sub-brow blepharoplasty may be a more suitable choice for patients. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Talitha Possagno Chaves Bellote,1 Helio Amante Miot2 1Instituto La Beaute (Private Clinic), Curitiba, PR, Brazil; 2Departamento de Dermatologia da FMB-Unesp, Botucatu, SP, BrazilCorrespondence: Helio Amante MiotDepartamento de Dermatologia da FMB-Unesp, Rua Magnólia, 400, Jd. Bom Pastor, Botucatu, SP, 18.607-670, BrazilTel +55 14 38134727Email heliomiot@gmail.comBackground: Microfocused ultrasound with visualization (MFU-V) is a recently developed technology that improves the laxity of the skin due to its capacity of precise focal heating of the dermis and deep layers, consequently inducing neocollagenesis and elastin remodeling.Purpose: This case series aimed to assess the efficacy of MFU-V in improving skin laxity, leading to the slimming of the lower third of the face in women who desired to naturally improve the shape of their faces.Patients and Methods: Four women between 29 and 36 years were submitted to a specific protocol with 4-MHz – 4.5-mm and 7-MHz – 3.0-mm transducers (Ulthera®) at the buccinators region in one session, and patients were evaluated after 180 days. GAIS (Global Aesthetic Improvement Scale) was assessed through standardized photographs (D0 vs D180).Results: All subjects perceived the slimming of the face after 180 days, as well as the improvement of skin laxity and contour. The practitioner and all the patients were highly satisfied with the results. The assessment of GAIS (D0 vs D180) resulted in score 3 (very improved) for three participants, and score 2 (improved) for one woman. All the patients classified pain experienced during the procedure as mild to moderate.Conclusion: We reported a technique that uses microfocused ultrasound with visualization leading to the slimming of the lower third of the face. Further systematic studies should be performed to understand the mechanism underneath the results and to maximize its performance.Keywords: collagen, microfocused ultrasound, neocollagenesis, skin laxity, Ulthera®

Increased laxity of the skin can be caused by aging, significant weight loss, or defects in the elastic tissue. A 38-year-old female presented with increased laxity of the skin over the neck, thighs, and abdomen for 6 years, associated with headache and blurring of vision for a week. On cutaneous examination, prominent skin folds, laxity, and wrinkles were noted over the neck, abdomen, thighs, and groin, with yellowish papules along the neck creases. Ocular examination revealed features suggestive of angioid streaks. Skin biopsy showed fragmented elastic fibers and intervening calcium deposits on Verhoeff Van Gieson and Von Kossa stains. Based on these findings, a diagnosis of pseudoxanthoma elasticum (PXE) was made. The patient was started on oral and topical sunscreens and eye protection and advised regular follow-up. Diagnosing the condition early based on skin findings can help prevent further multi-system manifestations by taking appropriate preventive measures as this condition is progressive and has no cure.

The periocular region is challenging for cosmetic laser surgeons. Surgery and laser resurfacing have traditionally been used to correct periorbital lines and wrinkles. Although effective, the associated downtime with these methods has made many people reluctant to decide for such treatments. More recently, the non-ablative long-pulse 2940 nm Er:YAG laser is being used to improve the structure and function and hence the appearance of skin in the periorbital region. The objective of this study is to evaluate the safety and efficacy of long-pulse 2940 nm Er:YAG laser for non-ablative treatment of periorbital static wrinkles and skin laxity. This is a prospective analysis of 30 patients treated for periorbital rejuvenation using three sessions of non-ablative long-pulse Er:YAG laser over a 3-month period. All patients were assessed according to Fitzpatrick's classification of periorbital wrinkles to class I, II, or III and were treated with 2940 nm Er:YAG laser using a fluence of 3.75 J/cm2, a repetition rate of 1.7-2 Hz, and with the SMOOTH™ pulse mode (250 ms). The treatment sessions were performed on each patient, 4 weeks apart. Patient improvement was assessed before each laser session as well as at 12 months after the final treatment. Blind photographic evaluations were performed by three independent physicians using unlabeled before and after photos arranged in non-chronological order. Reviewers were asked to determine the before and after photos. Patients were asked to answer a questionnaire measuring satisfaction 4 weeks after each session, and to report any adverse reactions. There was statistically and clinically significant improvement in the Fitzpatrick classification of the periorbital wrinkles. Blinded evaluators correctly identified the before and after photos in all cases. All patients reported mild edema and erythema, which persisted for 1 to 2 days, and superficial peeling of the skin for 4 to 6 days after each laser treatment. No long-term adverse effects were reported. The non-ablative long-pulse 2940 nm Er:YAG laser seems to be a safe and effective treatment for periocular rejuvenation with minimal and tolerable adverse reaction. The improvement attained from the laser sessions was persisting after 1 year denoting the long-term efficacy of the procedure. [ABSTRACT FROM AUTHOR]

Increased laxity of the skin can be caused by aging, significant weight loss, or defects in the elastic tissue. A 38-year-old female presented with increased laxity of the skin over the neck, thighs, and abdomen for 6 years, associated with headache and blurring of vision for a week. On cutaneous examination, prominent skin folds, laxity, and wrinkles were noted over the neck, abdomen, thighs, and groin, with yellowish papules along the neck creases. Ocular examination revealed features suggestive of angioid streaks. Skin biopsy showed fragmented elastic fibers and intervening calcium deposits on Verhoeff Van Gieson and Von Kossa stains. Based on these findings, a diagnosis of pseudoxanthoma elasticum (PXE) was made. The patient was started on oral and topical sunscreens and eye protection and advised regular follow-up. Diagnosing the condition early based on skin findings can help prevent further multi-system manifestations by taking appropriate preventive measures as this condition is progressive and has no cure. [ABSTRACT FROM AUTHOR]

Background: Microfocused ultrasound with visualization (MFU-V) is a recently developed technology that improves the laxity of the skin due to its capacity of precise focal heating of the dermis and deep layers, consequently inducing neocollagenesis and elastin remodeling. Purpose: This case series aimed to assess the efficacy of MFU-V in improving skin laxity, leading to the slimming of the lower third of the face in women who desired to naturally improve the shape of their faces. Patients and Methods: Four women between 29 and 36 years were submitted to a specific protocol with 4-MHz – 4.5-mm and 7-MHz – 3.0-mm transducers (Ulthera®) at the buccinators region in one session, and patients were evaluated after 180 days. GAIS (Global Aesthetic Improvement Scale) was assessed through standardized photographs (D0 vs D180). Results: All subjects perceived the slimming of the face after 180 days, as well as the improvement of skin laxity and contour. The practitioner and all the patients were highly satisfied with the results. The assessment of GAIS (D0 vs D180) resulted in score 3 (very improved) for three participants, and score 2 (improved) for one woman. All the patients classified pain experienced during the procedure as mild to moderate. Conclusion: We reported a technique that uses microfocused ultrasound with visualization leading to the slimming of the lower third of the face. Further systematic studies should be performed to understand the mechanism underneath the results and to maximize its performance. [ABSTRACT FROM AUTHOR]

Despite being a common concern, there are very few minimally invasive treatments targeting neck skin laxity (NSL) reported in the literature. To assess the efficacy of hyperdiluted calcium hydroxyapatite (hy‐CaHA) for the treatment of NSL, according to the NSL scale, and to estimate safety. Twenty patients showing NSL were treated with hy‐CaHA 1:2. To evaluate the efficacy of hy‐CaHA treatment for NSL, pictures of treated subjects were collected before and 3 months after treatment and graded according to the NSL scale, and T‐student's test was applied to estimate differences. Hy‐CaHA for the neck was effective according to the previously unreported NSL scale (p < 0.001) and safe. There were no major adverse events reported. This study supports the efficacy (according to the NSL scale) and safety of hy‐CaHA (1:2) for NSL. Our results also highlight the utility of the newly developed NSL scale, being a useful tool to evaluate the level of NSL before treatment and to measure the outcome. [ABSTRACT FROM AUTHOR]

Background: The aging of facial structures depends on genetic, anatomic, chronologic, and environmental factors that affect the skin and underlying tissues. Microfocused ultrasound with visualization (MFU‐V) has emerged as a safe and effective treatment for skin laxity. As the nutritional status may contribute to skin aging, it would be interesting to evaluate whether different dietary patterns can also influence the response to MFU‐V treatment for skin laxity. Aims: The aim of this study is to compare the outcome of MFU‐V therapy between omnivore and vegan patients. Methods: Twenty‐seven vegan and twenty‐seven omnivorous women who underwent MFU‐V treatment for laxity of lower face and neck were enrolled. The clinical outcome was evaluated using the FLR (Facial Laxity Rating) scale after 3 and 6 months from treatment. Results: At baseline, no significant differences were found in terms of FLR scale in both treated sites. After 3 months, reduction in FLR scale was significantly lower for vegans both on face (P =.04) and neck (P =.004). At 6 months, vegan patients had a worse clinical outcome on lower face (P =.001) and neck (P <.001). Conclusion: The present study suggests that a vegan diet may negatively influence the outcome of a MFU‐V treatment. [ABSTRACT FROM AUTHOR]

Background and objective. The constant rise in consultations for brachial flaccidity has generated a growing interest in perfecting the technique to avoid the frequent complications and unsatisfactory results. Our objective is to describe a variant of the of T-brachioplasty surgical technique based on a deep and resistant anchorage as an alternative to diminish scar complications and to analyze outcomes. Methods. Retrospective, observational and descriptive study that included 15 patients with brachial flaccidity grades IIIA, IIIB and IIIC according to the Appelt´s classification from June 2015 to June 2019 The design of this surgical variant includes a T-shaped incision with an area of deep de-epidermization of at least 1 cm width surrounding the incision that will act as dermal anchorage, facilitating closure and providing a better plane of resistance than the techniques previously described, which will decrease the rate of subsequent scar complications (postoperative dehiscence and non-esthetic scars). Results. All patients were female patients, 47 years old average. The most frequent cause of flaccidity was aging (60%) and post-obesity weight loss (40%); the IIIA grade of flaccidity was 66% (10 cases), the IIIB grade was 13% (2 cases), and the IIIC grade was 20% (3 cases). Surgical technique used in every case included a de-epidermization area of at least 1 cm surrounding the incision that acted as dermal anchorage at the time of closure. The procedure was well tolerated in every case. General complication rate was 20% (3 patients): 13% (2 patients) presented a dehiscence at the central T stitch and 6.6% (1 patient) developed hypertrophic scars. One patient (6.6%) required a surgical revision. Conclusions. Dermal anchorage is a tool of great value at the time of providing support in an area that lacks support structures. We recommend using this tool whenever possible considering it is easy to perform, does not demand longer surgical time, facilitates closure and reduces scar complications. [ABSTRACT FROM AUTHOR]

Background: Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy. Aims: To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women. Patients/Methods: Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index. Results: The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects. Conclusions: Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety. [ABSTRACT FROM AUTHOR]

Background: Periocular darkening, popularly known as “dark circles,” is a common condition globally. Pigment deposition, shadowing due to laxity, superficial location of vasculature and prominent nasojugal groove are recognized causative factors. Very few studies exist on its clinicopathological correlation, especially in the Asian population. Materials and Methods: Eighty-two consecutive patients attending skin outpatient department (OPD) with periocular hyperpigmentation (POH) who agreed to follow the study protocol were included in this descriptive study, conducted in Maharashtra, India. They were evaluated clinically and also investigated with histopathology, special staining and immunohistochemistry of the periocular skin to study the various factors involved in the pathogenesis. Results: 19.51% of the patients had a positive family history of POH, 90% gave history of exhaustion of periocular muscles, 41.46% had anemia, 8.54% gave history of aggravation during pregnancy and 7.32% had menstrual irregularities. Laxity of skin was present in 82.92% patients, visible veins in 50%, and sunken eyes with prominent infraorbital rim and shadowing in 26.82%. Periocular darkening due to pigment was present in only 17% patients, with mixed dermoepidermal pigmentation being present in majority (70.73%). Clinicopathological concordance was significant in case of dermal pigmentation (Fisher’s exact test P-value

To evaluate the efficacy and safety of a newer microfocused ultrasound (MFU) device on the lower face laxity. Subjects who underwent MFU therapy for skin tightening were enrolled in the study. The primary outcome measure was overall improvement in skin laxity of the lower face that was evaluated by improvement on jawline irregularities, marionette line, and submental laxity. Assessments were obtained from two blinded dermatologists paired pre‐ and post‐treatment photographs with Investigator‐Global‐Aesthetic‐Improvement‐Scale (IGAIS) and from subjects with Subject‐GAIS (SGAIS). A total of 24 subjects were evaluated on a median of 4.3 months after 1 session MFU application. According to IGAIS, 5 subjects (20.9%) demonstrated improvement and 15 subjects (62.5%) had no change. Four subjects (16.7%) were scored as worsening. According to SGAIS, 11 subjects (45.9%) reported an improvement whereas 9 subjects (37.5%) reported no change. There was a statistically significant difference between the improvement rate assessed by the investigators and the subjects, where investigators scored lower (P =.006). No serious adverse effects were observed. The relatively high improvement rate observed by the subjects' self assessments compared to investigators evaluation from the photographs suggested that we need to find new evaluation methods other than photography which may reflect what subjects feel but we cannot see. [ABSTRACT FROM AUTHOR]

Despite an increasing request for skin rejuvenation above the knee, very few treatment options have been reported in literature. To evaluate the efficacy and safety of 1:4 hyperdiluted calcium hydroxylapatite (CaHA) in the treatment of skin laxity and dimples of the skin above the knees. A retrospective evaluation of hyperdiluted CaHA treatment for skin laxity and dimples above the knee was performed. Efficacy was classified as blinded evaluation of pre (T0) and 3‐month post‐treatment (T1) photographs by three investigators according to the validated knee cellulite severity score (KCSS) and patient satisfaction. Safety was evaluated through pain scores and adverse events evaluation. A significant reduction of KCSS at T1, as compared to T0, mainly in subjects with lower KCSS at T0, was observed (P <.05). All blinded assessments resulted in a correct identification of T0 and T1 pictures and evaluations of all investigators were found to be consistent and reliable. All patients were satisfied. Only minor adverse events (swelling, erythema, bruising, and skin irregularities) were reported, lasting 2 to 3 weeks after treatment. Our preliminary results highlight the efficacy and safety of hyperdiluted CaHA in the treatment of skin laxity and cellulite above the knees. [ABSTRACT FROM AUTHOR]