IMCAS

Combined treatment of phototherapy, chemical peeling and topical combination of adapalene/benzoyl peroxide in patients with papulopustular acne

Objectives: The evaluation of triple combination treatment of phototherapy, chemical peeling with mandelic acid 50% and topical use of adapalene/benzoyl peroxide cream, in patients with mild to moderate acne vulgaris that need an alternative treatment.

Introduction: Acne vulgaris is an inflammatory skin disorder with a significant impact in the quality of life. Although isotretinoin consists the mainstay of treatment there are a lot of patients that prefer local treatments. Light-based interventions and chemical peels present as alternative options over the past decade. We present a case series of 50 patients who underwent a triple combination treatment of phototherapy, 50% mandelic acid peel and adapalene/benzoyl peroxide cream.

Materials / method: We selected 50 patients with mild to moderate acne who were not willing to undergo systemic treatment. Treatment protocol was as follows. Combined 417nm blue and 633nm red light therapy was applied for 20 minutes and was alternate with mandelic acid 50% for 10 minutes every 4 weeks for 24 weeks. Between the office visits topical cream of adapalene/benzoyl peroxide was used. Patients were advised to stop the cream one week before the office visit and to start applying it one week after.

Results: All patients noticed a significant improvement on the inflammatory lesions and the sebum production after 2 cycles of combined treatment. Upon completion of full protocol 33 of 50 patients had great results with full clearance and only small flares ups (2 to 3 inflammatory lesions) during menstruation.

Conclusion: Triple combination of phototherapy, chemical peeling and topical cream of adapalene/benzoyl peroxide could be an alternative in patients who do not want, or they are not suitable to undergo any systemic treatment.

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No-Laboratory Epidermal Cell Paste (NLEP) technique - A novel modification of non-cultured epidermal cell suspension

Objectives: To evaluate the efficacy of no-laboratory epidermal cell paste technique (NLEP) , a novel modification of NCES, in stable vitiligo.

Introduction: Vitiligo is an acquired disorder of pigmentation due to loss of melanocytes. Autologous non-cultured epidermal cell suspension (NCES) is an established cellular grafting method for treatment of stable vitiligo. However, the need for laboratory equipment during preparation of epidermal cell suspension leads to restriction of its utility to specialized centres. To broaden the spectrum of its utility, we need to opt for a minimalistic approach with no need of laboratory equipment where the epidermal cell suspension can be prepared in the office of a dermatologist.

Materials / method: We recruited 7 patients with 9 stable vitiligo lesions and no-laboratory epidermal cell paste technique was performed on the lesions. Briefly, a thin epidermal graft was taken which underwent cold trypsinization in simple refrigerator. It was then washed with Phosphate buffered saline (PBS) and separation of melanocytes and keratinocytes was done. Reconstitution was done in minimal amount of PBS so as to make a epidermal cell paste which was transplanted over the recipient site along with the smash graft obtained from the dermal tissue. Patient evaluation was done at 8 weeks post-surgery.

Results: Evaluation was done for the following parameters- extent of repigmentation , colour match and patient satisfaction. Excellent (≥90%) repigmentation was achieved in 77.7 % of lesions. Colour match was observed in 66.6 % lesions. Patient satisfaction based on patient global assessment score was reported be around 22.66 .

Conclusion: No-laboratory epidermal cell paste (NLEP) method is a safe and effective modification of conventional NCES and utilizes a melanocyte-keratinocyte cell paste without the use of any trypsin inhibitor, incubator or centrifuge machine. In addition, an early onset of repigmentation can be achieved and the thick paste can be used over difficult to treat sites with minimal chances of trickling down or leakage. Moreover, the dermal graft tissue which was utilized in our patients may have an added benefit due to the presence of dermal mesenchymal stem cells.

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Technical evaluation and in-vitro studies of different CaHA-containing dermal fillers: considering the impact of particle characteristics on biostimulation (Sponsored by MERZ AESTHETICS)

Objectives: The aim of this study was to examine different CaHA-containing products with the focus on the particle characteristics and the in-vitro ability to stimulate collagen production.

Introduction: Modern dermal fillers are comprised of Calcium Hydroxylapatite (CaHA) particles suspended in a polymeric gel carrier such as carboxymethyl cellulose (CMC) or hyaluronic acid (HA). CaHA containing dermal fillers are used to improve the signs of aging by restoring lost volume and increase via biostimulatory mechanisms the amounts of collagen and elastin1. Size, shape, smoothness and regularity of the CaHA particles may vary between products. These characteristics may influence biostimulatory effects like collagen production.

Materials / method: CaHA/Carboxmetyl cellulose (CMC) with and w/o Lidocaine and CaHA/Hyaluronic acid (HA) with Lidocaine were assessed for CaHA-particle characteristics. Visual Characterization: CaHA particles were isolated from commercially available products and analyzed by Scanning Electron Microscopy (SEM) for size, shape and surface characteristics. Biostimulating properties: Isolated CaHA-particles were co-cultivated with primary human fibroblasts at different concentrations for 7 days to analyze their ability to stimulate collagen I and III expression.

Results: The structural properties of particles differ between CaHA/CMC and CaHA/HA. CaHA/HA showed defects in microspheres including broken particles and fissures while CaHA/CMC particles were smooth and free from visual imperfections. In addition, CaHA/HA particle size distributions showed that around 18 % of the structures analyzed are smaller than 25 μm. In contrast, CaHA/CMC spheres showed homogeneity in size with 93% of particles within the range of 25-45 μm. Freeze dried images showed the polymer/particle interactions. CaHA/HA displayed the particle debris embedded in the polymeric matrix.

Conclusion: In-vitro experiments indicate that both particles induce similar levels of collagen III expression while stimulation of collagen I is only found for CaHA/CMC. CaHA/CMC and CaHA/HA showed different CaHA particle characteristics and biostimulating properties. These differences in the biostimulatory characteristics of CaHA particles might be correlated to the physical characteristics and homogeneity of CaHA particles.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

The treatment for vulvovaginal atrophy symptoms in breast cancer patients under tamoxifen therapy: is the RF-electroporation synergy a good option? (Sponsored by TOP QUALITY)

Objectives: The primary purpose of this study was to narratively report the evidence regarding the efficacy and safety of radiofrequency and electroporation treatment as an effective therapeutic choice for genital symptoms in women suffering from VVA in a specific setting of breast cancer patient treated with tamoxifen.

Introduction: Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after and during adjuvant therapy for patients affected by breast cancer. In particular, the VVA is present also in breast cancer survivors on therapy with tamoxifen.

Materials / method: All patients, at the time of admission, were under tamoxifen treatment and had a VVA which was evaluated during a gynecological exploration, and they referred symptoms as dyspareunia, vaginal dryness, burning and itching. They were treated with a device that combines radiofrequency and electroporation: they performed 7 sessions, once a week for 7 weeks, each session was composed by 10 minutes of radiofrequency followed by 10 minutes of electroporation, both using a 2% hyaluronic acid vaginal solution (in cream or gel) on the device's handpiece. Every session lasted 20 minutes totally.

Results: As it can be seen in Figure 3, after 6 months from the end of the treatment, for some patients the perception of symptoms is slightly increased, in
particular localized at the level of the vulvar fourchette, but for others they have remained constant, demonstrating that the treatment gives results even in longer time. However, after 6 months of treatment all patients continued to have a satisfactory quality of life in terms of reduction of symptoms and with a resumption of sexual activity without dyspareunia.

Conclusion: The treatment with radiofrequency-electroporation synergy is a good option for vulvovaginal atrophy symptoms in a specific setting of breast cancer patient treated with tamoxifen. All the patients increased their level of quality of life without adverse effects during and after the treatment. Long-term studies should be conducted to confirm those preliminary results.

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Este trabalho foi realizado com o patrocínio de: TOP QUALITY

Evaluation of a unique combination of nutrients in the management of hair loss in women (Sponsored by MERZ THERAPEUTICS)

Objectives: The aim of this prospective, open-label, study was to evaluate a unique combination of cystine, B vitamins and minerals, in women with diffuse hair loss, in terms of improvement in hair condition, and product acceptance and safety, following up to 6 months of daily intake.

Introduction: Diffuse hair loss can be triggered by disruption of the normal hair cycle, such as an increased proportion of hairs shifting from the anagen to telogen phase. Moreover, hair loss is associated with deficiencies in several nutrients. This unique combination of cystine, thiamin, pantothenic acid, folic acid, biotin, iron and zinc (Pantovigar® vegan, Merz Therapeutics, Germany) serves to supplement with specific nutrients required in the dietary management of diffuse hair loss in women.

Materials / method: The study included 34 pre- and postmenopausal women aged 30–75 years, with diffuse hair loss (Modified Savin Score I–III). One capsule of the combination of nutrients was to be taken 3 times daily for 6 months. At 3 and 6 months, hair growth rate was assessed using phototrichogram analysis, and participants completed a product acceptance questionnaire. Blood nutrient levels related to diffuse hair loss were monitored at baseline, and at 3 and 6 months. The occurrence of undesired effects was documented throughout the study period.

Results: From baseline to 6 months, a significant increase in anagen (p = 0.012) and decrease in telogen (p = 0.012) hair rates resulted in an increased ratio of anagen/telogen hair rates (p = 0.013), reflecting a proportionate increase in anagen phase terminal hairs. Cumulative hair thickness per area and total hair density remained stable. Most participants agreed with positive hair condition-related statements in the questionnaire. Blood nutrient levels expectedly increased, with ferritin and haematocrit remaining in safe physiological ranges. No serious undesired effects were reported.

Conclusion: Improvement of diffuse hair loss in woman, as shown by the phototrichogram analysis and product acceptance questionnaire results, and confirmed by results of the blood sampling, may be due to the unique combination of cystine, thiamin, pantothenic acid, folic acid, biotin, iron and zinc. Product safety was demonstrated by the absence of serious undesired effects. This specific combination is beneficial in the management of diffuse hair loss in women, and is well-accepted and safe for daily supplementation of nutrients.

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Este trabalho foi realizado com o patrocínio de: Merz Therapeutics GmbH

Broadband light and 1064 nm Nd: YAG: an effective combination - Treatment for skin rejuvenation and facial redness (Sponsored by SCITON)

Objectives: The objective was to demonstrate the effectiveness of combining Broadband light and a sub-millisecond pulsed 1064nm laser for skin rejuvenation and rosacea.

Introduction: Light based devices work effectively by targeting specific chromophores. Broadband light targets melanin and hemoglobin and its infrared emission heats water up to 15mm deep. Sub-millisecond pulsed 1064nm Nd:YAG laser targets small caliber vessels and water.
The use of both together helps improve pigmentation, redness and skin tone due to the effect over melanin, superficial and deep vasculature and collagen synthesis.

Materials / method: Over 1500 patients were treated in last 12 years with combination of Broadband Light (515-590nm, 8-15ms, 12-18J/cm2) and 1064nm pulsed laser (7mm, 0.3ms, 7J/cm2, 3000-5000 shots) for facial rejuvenation and rosacea. The treatment always started with Broadband light first followed by 1064nm laser. Thereafter 1 yearly treatment was provided to prevent pigmentation, recurrence of redness and flushing. Photographs and satisfaction rates of the patients were evaluated during the follow-up period.

Results: Significant improvement in facial redness, pigmentation and flushing as well as an overall improvement in skin tone and texture were observed. Patients reported 98% satisfaction with the results achieved. No adverse events reported.

Conclusion: The combination of Broadband light and 1064nm Nd:YAG in a single session treatment protocol achieves improvement in redness and flushing in rosacea patients as well as pigmentation, tone and texture in photodamaged skin.

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Este trabalho foi realizado com o patrocínio de: SCITON

A customized skin care routine benefits patients with severe rosacea under combination therapy with ivermectin 1% cream and doxycycline 40-mg or ivermectin and placebo (Sponsored by GALDERMA)

Objectives: This multicenter, randomized, investigator-blinded, parallel-group comparison, 12-week, phase 3b/4 study was conducted to evaluate the benefits of a tailored skin care routine comprising a Foaming Wash and a Moisturizing Cream SPF30+ to patients with severe rosacea under combination therapy (ivermectin 1% cream [IVM] + doxycycline 40 mg modified release capsules [DMR]) or monotherapy (IVM + placebo [PBO]).

Introduction: Rosacea is a chronic inflammatory skin disease that primarily affects the central area of the face. It is characterized by erythema, papules, pustules, nodules, and telangiectasia. The purpose of cosmetic care in rosacea is to restore the balance of the skin barrier, while reducing the underlying inflammation, sensitivity, and dehydration. A facial cosmetic care routine composed by a Foaming Wash and a Moisturizing Cream SPF30+, specially formulated with licorice extract, allantoin and caffeine were developed in order to address specific needs of patients with severe rosacea.

Materials / method: Patients were randomized (1:1) to receive 12 weeks of combination therapy: IVM+DMR or monotherapy: IVM+PBO. Eligible patients had severe rosacea (Investigator’s Global Assessment [IGA] score of 4), were ≥18 years old, and had 20 to 70 inflammatory lesions (papules and pustules) and ≤2 nodules on the face. In addition, patients were provided with and instructed to use controlled, rosacea-specific cosmetic care routine composed of a Foaming Face Wash and a Facial Moisturizing Cream. Patient acceptance of the skin care routine was evaluated at 12 weeks by a 4-grade satisfaction scale.

Results: IVM+DMR vs. IVM+PBO displayed superior efficacy in reducing inflammatory lesions and IGA score (p<0.05), and significantly increased the number of patients achieving an IGA score of 0 (100% lesion reduction; p=0.006) at Week 12. Both treatments reduced the Clinician’s Erythema Assessment score, stinging/burning, flushing episodes, Dermatology Life Quality Index score and ocular symptoms, and were well tolerated. Most patients (70% to 90%) with severe rosacea agreed or strongly agreed that the tailored skin care routine was beneficial.

Conclusion: The combination of IVM+DMR was significantly superior to IVM+PBO in terms of percentage reduction in inflammatory lesions from baseline and the proportion of subjects achieving 100% lesion clearance at Week 12.
The study also shows the importance of proper skincare in individuals with rosacea for reduction of discomfort, and the appropriateness of a skin care regimen with a limited number of ingredients and no fragrance for patients with rosacea.

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Este trabalho foi realizado com o patrocínio de: GALDERMA

Innovative application of diathermy in orthodontics: a case report (Sponsored by TOP QUALITY)

Objectives: The study aims to evaluate the use of DIATHERMY technology in orthodontic patients as an adjuvant in tooth movement.

Introduction: In the literature, the numerous scientific controversies concerning the acceleration of the orthodontic movement all have a minimum common denominator: "How is it possible to speed up dental movements?"

Materials / method: 24-year-old Caucasian male. During the first evaluation, the personal and medical history of the patient was collected. [...] This study was conducted at the Specialist Dental Centers of Bari.
Orthodontic multibrackets treatment was performed to realign teeth and improve the bite. The patient underwent banding with lower Synergy brackets and a .015-inch NiTi thermal arch (Figure 1).

Results: The changes in crown movement and translation at t0 and t1 are shown in the DentalMonitoring® software (Dental Monitoring SAS, Paris, France) graphs in Figure 7 and Figure 8.

Conclusion: In this work, DIATHERAPY has suggested to be a tool with the potential to accelerate the orthodontic movement, albeit with little change compared to the control side.
The surgical approach to accelerating orthodontic tooth movement is currently more effective but is more invasive and expensive. Therefore, radiofrequency could be considered a useful, non-invasive and comfortable tool to improve the speed of orthodontic treatment.

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Este trabalho foi realizado com o patrocínio de: TOP QUALITY

How glabellar line severity at baseline can affect efficacy in neurotoxin trials (Sponsored by GALDERMA)

Objectives: To evaluate the duration of response of glabellar line (GL) severity improvement (% responders) after abobotulinumtoxinA (AboBoNT-A) treatment in subjects with different degrees of baseline GL severity.

Introduction: Baseline characteristics in neurotoxin trials can affect perceived clinical efficacy depending on which outcomes are assessed. When GL severity improvement is assessed on a 4-graded scale and a score of none or mild is used as responder definition, subjects who have moderate GLs at baseline must move at least one grade to be considered a treatment success, whereas subjects who start with severe GLs must move at least two grades; a one-grade improvement for those with severe GLs is considered a failure even though the subjects moved the same distance on the scale.

Materials / method: A post-hoc analysis was conducted in a phase II GL study looking at escalating doses of 50, 75, 100 and 125 U (N= 321) of AboBoNT-A to evaluate the outcome (% responders) over time between subjects with different degrees of GL severity at baseline. Within each dose group, statistical comparisons were made between the two baseline severity categories, for each definition of a responder.

Results: Across all doses, 60-73% of subjects had severe GLs at maximum frown at baseline. None-or-mild responder rates were higher at 28 weeks in subjects with a moderate compared to severe baseline GL severity across all doses, suggesting baseline GL severity as a source of bias. Using a ≥1- or 2-grade improvement as the responder definition, efficacy data was more similar for both baseline GL categories within each dose.

Conclusion: A ≥1- or 2-grade improvement may be a better tool to assess clinical efficacy reducing bias due to baseline GL severity differences.

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Este trabalho foi realizado com o patrocínio de: GALDERMA

HSA as a stabilizer in aesthetic injectables (Sponsored by MERZ AESTHETICS)

Objectives: To highlight the safety of HSA use as a stabilizer in aesthetic injectables.

Introduction: Human serum albumin (HSA) is the most abundant protein in plasma and is integral in maintaining osmotic blood pressure, and transporting metal ions, insoluble small molecules, and nutrients. It is often used in pharmaceuticals as a stabilizer (binds to many drugs e.g., botulinum neurotoxin) and is easily broken down by the body into amino acids. It has also been used as an acute volume replacement in ICU, pregnant, and neonatal patients.

Materials / method: Literature on HSA safety was reviewed and summarized.

Results: Observed incidence of adverse events (1998-2000) of HSA distributed worldwide by 10 therapeutic suppliers suggested that serious non-fatal and fatal events are rare. In this study, on average, ~107 units of 40 g of HSA were administered (i.e., large doses). There were no instances of specific antibodies against HSA when used as stabilizer in allergy extracts (n=39). Based on manufacturing process and pathogen inactivation involved, HSA preparations are considered to carry no risk of transmitting infections.

Conclusion: HSA is a demonstrably safe stabilizer for pharmaceuticals with a low risk of pathogenic or pathogenic issues.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Burns and hyperpigmentation post-adult female acne treatment

Objectives: We report a case of a 26-year-old female patient, phototype III, indigenous descent, with acne since she was 13 years old, with a severe complication after EBD. A full recovery was reached after microneedling with drug delivery.

Introduction: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Medical treatments for acne include a variety of topical and oral medications. A variety of light and laser devices has been used for the treatment of acne, including IPL, Radiofrequency, lasers and others.

Materials / method: We treated this patient with one microneedled radiofrequency session, with minimum emission, depth of 1.5 mm (dermis focused) and energy of 1.0, with a robotic device tip 49 and continuous emission through the needle.
During the procedure, the patient did not report pain, only a sensation of heat in the face.
The patient developed grade 1 and 2 burns on the face one day after the procedure and post-inflammatory hyperpigmentation 2 weeks after the procedure. The complication was treated with drug delivery 3 sessions spaced 3 weeks each.

Results: The total time of treatment for hyperpigmentation was 12 weeks, with resolution of at least 90% of the initial condition.

Conclusion: We took advantage of this poster to report possible complications of the use of energy based devices in the treatment of acne in patients with higher phototypes in addition to the use of topical retinoids, as well as the improvement of post-inflammatory hyperpigmentation with a simple, low-cost and effective treatment which can be safely performed in the medical office with low complication rate.

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor.

Awareness of aesthetic and therapeutic crossover usage of botulinum toxin type A (Sponsored by MERZ AESTHETICS)

Objectives: To examine the discrepancy between assumed and actual BoNT/A dosage, and the potential consequences resulting from the lack of dose awareness.

Introduction: Treatment using botulinum toxin A (BoNT/A) is indicated for both aesthetic (Ax) and therapeutic (Tx) purposes, but aesthetic practitioners are often unaware of their patients receiving additional toxin for therapeutic indications. Unbeknownst to their healthcare providers (HCPs), some patients are receiving much higher doses.

Materials / method: A global, web-based survey was conducted to assess the delivery and receipt of botulinum toxin among specialist HCPs and patients, respectively. A total of 398 HCPs made up of specialists in aesthetics, dermatology, plastic surgery, and dentistry, responded to the survey. A consumer survey targeting an equal proportion of BoNT/A Ax-only and Ax-Tx crossover users was completed by 246 patients.

Results: 63% of HCPs did not know if patients were receiving Tx botulinum toxin treatment. Those HCPs who did know estimated that 19% of their patients have received Tx. Meanwhile, almost half of patients surveyed report that they currently receive Tx toxin. 66% of providers observe a requirement for more frequent injections or higher dosing.

Conclusion: With the rising use of BoNT/A in aesthetics, patients are being exposed to far more toxin, potentially over an order of magnitude greater, than their providers are aware. As the total dosage per patient increases, the risk of developing resistance to BoNT/A treatment grows. This can be observed as an increased required frequency or dosage of BoNT/A to achieve the same efficacy, which is an issue commonly reported by HCPs. There is a need for providers to be aware of and track the total dosage for both aesthetic and therapeutic needs, as this may affect the available lifespan of treatment.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Effectiveness and safety of correction of cheek wrinkles using a biostimulatory PLLA injectable implant – Clinical study data up to 24 m (Sponsored by GALDERMA)

Objectives: This abstract summarizes results from a recently completed 12-month, main study (NCT04124692), and a 12-month extension study (NCT04595331). Main study objectives were to evaluate effectiveness and safety of a poly-L-lactic acid injectable implant, PLLA-SCA (Galderma), for correction of cheek wrinkles versus a no-treatment control for up to 12 months. The primary endpoint was ≥1-grade improvement on the Galderma Cheek Wrinkles Scale (GCWS) at rest, in both cheeks, at Month 12. The extension study further assessed the long-term effectiveness and safety until 24 months after start of treatment.

Introduction: These clinical studies were performed to support an expansion of the current indications of Sculptra (PLLA-SCA) in the US. Currently, this product is FDA-approved for use in immune-competent subjects for correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. The studies used the recently FDA-approved method of preparation of PLLA-SCA involving reconstitution in 8 mL of sterile water for injection (SWFI), followed by addition of 1 mL 2% lidocaine, and immediate use after reconstitution.

Materials / method: In the main study, subjects were randomized 2:1 to PLLA-SCA treatment in both cheeks or no treatment (control). PLLA-SCA was injected at up to 4 sessions, approximately 1 month apart. Assessments included cheek wrinkle severity by blinded evaluators using the GCWS, aesthetic improvement, FACE-Q satisfaction with cheeks, exploratory assessments of radiance, skin tightness and jawline contour, and adverse events. In the extension study, formerly untreated controls were offered PLLA-SCA treatment (Group A), and the PLLA-SCA group were followed until Month 24 with no further treatment (Group B).

Results: GCWS responder rate at rest at Month 12 (primary endpoint) was significantly higher for PLLA-SCA, 71.6%, N=97, vs control, 26.1%, N=52, p<0.0001. Most treated subjects also had improved aesthetic appearance (≥93%), radiance, skin tightness, and jawline contour (≥86%) and mean FACE-Q scores (≥38 points increased) at Months 7-12 and maintained similar improvements through Month 24, including 77% GCWS responders at rest within Group B (N=72). Treatment-related adverse events were mainly mild and transient.

Conclusion: Results demonstrated long-lasting effectiveness and safety of PLLA-SCA for correction of cheek wrinkles through 24 months. Effectiveness was supported by high aesthetic improvement, high subject satisfaction with cheek appearance, and improvement in skin quality, including radiance and firmness (tightness), after treatment with PLLA-SCA reconstituted with 8 mL of SWFI.

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Este trabalho foi realizado com o patrocínio de: GALDERMA

Skin movement and volume changes with PLLA-SCA injectable implant: a subgroup analysis of the cheek wrinkle trial (Sponsored by GALDERMA)

Objectives: Effectiveness and safety of correction of cheek wrinkles using Sculptra poly-L-lactic acid (PLLA-SCA) injectable implant was assessed in a 12-month clinical study (NCT04124692). The study’s primary objective was to assess the responder rate of ≥1-grade improvement on the at-rest Galderma Cheek Wrinkle Scale (GCWS) at Month 12 versus a no-treatment control. This abstract presents an exploratory analysis of 3D images, to assess whether the observed treatment effect of PLLA-SCA in this study can be captured and quantified in an objective way.

Introduction: This study was performed to support expansion of the current indications of the PLLA-SCA injectable implant in the US and meet the need for aesthetic treatments to reduce cheek wrinkles and improve skin quality. The study used the recently FDA-approved method of preparation of PLLA-SCA involving reconstitution in 8 mL of sterile water for injection, followed by addition of 1 mL 2% lidocaine, and immediate use after reconstitution. Analysis of 3D images can provide more insight into other effects on skin surface in the treated area after PLLA-SCA treatment, complementing assessment scales.

Materials / method: Subjects were randomized to PLLA-SCA treatment in both cheeks or no treatment (control). Assessments included cheek wrinkle improvement on the GCWS, aesthetic improvement and 3D camera. Canfield software was used to analyze 3D photographs for change from baseline in volume displacement (posterior to anterior, Z-movement) and volume change of both cheeks at Month 9 for the treatment and control group. The subgroup population in this analysis comprised subjects who presented at baseline with severe ratings per GCWS, referred to as GCWS severe subjects.

Results: The primary analysis showed a statistically significant higher GCWS responder rate at rest at Month 12 for PLLA-SCA, 71.6%, vs control, 26.1%, p<0.0001. In the Month-9 subgroup analysis of GCWS severe subjects, mean midface Z-movement tended to show a positive volume shift from posterior to anterior for the PLLA-SCA group (N=46) (0.45 mm Left; 0.34 mm Right) vs. controls (0.25 mm Left; -0.01 Right, N=21). Midface volume and max projection change for the PLLA-SCA group were +4.88 cc/+1.62 mm (Left); +2.84 cc/+1.12 mm (Right) vs. +0.26 cc/+0.34 mm (Left); +0.68 cc/+0.37 mm (Right) for controls.

Conclusion: The primary analysis of the study showed an improvement in cheek wrinkles at Month 12 after PLLA-SCA treatment. Results of the exploratory Canfield analysis of GCWS severe subjects at baseline suggested a clinically meaningful positive volume shift, positive volume change and max projection in the midface at Month 9 for the PLLA-SCA treated subjects complementing the primary results. These exploratory results should be interpreted with caution.

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Deciphering the features of lightfillers with the Teosyal RHA® Range from lab to patient (Sponsored by TEOXANE)

Objectives: 1. Assess the physicochemical features of PNT 1 and how it relates to its specific composition 2. Evaluate the in vitro and ex vivo biological properties of PNT 1
3. Evaluate the clinical performance of PNT 1

Introduction: PNT 1 (Teosyal RHA’s Preserved Network technology), manufactured by Teoxane SA, is a 15 mg/mL mixture of crosslinked and non-crosslinked hyaluronic acid-based soft tissue filler aimed at correcting superficial wrinkles of the face, such as perioral rhytids, circles under the eyes, neck wrinkles, and necklines. PNT 1 is produced with the Preserved Network manufacturing Technology, characterized by a better conservation of high molecular weight HA chains and a low degree of modification.

Materials / method: PNT 1 and competitors were analyzed to evaluate their capacity to maintain their mechanical properties under dynamic stresses (Strength score) or to deform under constant applied force (Stretch score). Their ability to limit swelling was also assessed to evaluate their ability to limit overcorrections. The release of low Mw HA fragments was determined by size exclusion chromatography.
PNT 1 was also assessed for its biological effect on the skin.

Results: Due to its composition PNT 1 possesses mechanical features targeting its indications. Its high malleability in combination with intermediate projection capacity and low water uptake propensity compared to direct competitors makes PNT 1 an adequate candidate for the treatment of the superficial lines, especially in dynamic areas of the face. Preclinical data showed that PNT 1 is a filler that tends to promote collagen I expression and maturation, as well as improve skin elasticity and firmness, without triggering adverse inflammation, thus improving the skin quality.

Conclusion: PNT 1 's physicochemical properties were shown to outperform those of its direct competitors while providing excellent biosafety results. Matching clinical observations, its dynamic and versatile nature optimally accommodate to natural facial expressions and provide more natural-looking outcomes.

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Este trabalho foi realizado com o patrocínio de: TEOXANE

Ready-to-use abobotulinumtoxinA solution vs powder onabotulinumtoxinA for treating glabellar lines: subjects’ and Investigators’ experience (Sponsored by GALDERMA)

Objectives: This open-label, Ph IV, multicenter study (NCT05277337) aimed to investigate subject and investigator experience during treatment of glabellar lines (GLs) with the recently approved ready-to-use (RTU) abobotulinumtoxinA solution (AboBoNT-A solution) and with a powder product, onabotulinumtoxinA (OnaBoNT-A). Additionally, aesthetic improvement, subject satisfaction, and safety after treatment with AboBoNT-A solution were evaluated during a 6-month follow-up period.

Introduction: Powder botulinum toxin type A (BoNT-A) preparations are well established for treatment of GLs. The liquid formulation of AboBoNT-A is the first RTU BoNT-A in Europe approved for this indication. By removing the reconstitution step of powder formulations, the RTU AboBoNT-A solution is expected to increase healthcare professionals’ efficiency and simplify the injection procedure. The clinical development program has shown a rapid onset of effect of AboBoNT-A solution in GLs, starting on Day 1, a duration up to 6 months, and improved psychological well-being after treatment.

Materials / method: Subjects, 18 to <65 years, were randomized 2:1 to 50 U AboBoNT-A solution (N=99; followed up for 6 months) or 20 U powder OnaBoNT-A (N=51; followed up for 1 month). The primary endpoint was time required to prepare AboBoNT-A solution and powder OnaBoNT-A. Other assessments included investigators’ usability experience and subjects’ perception of the treatment procedure. For AboBoNT-A solution, aesthetic improvement in GLs, rated by investigators and subjects, and subjects’ satisfaction were also collected for 6 months after treatment. Adverse events were monitored throughout the study.

Results: Investigators reported less preparation time for the RTU AboBoNT-A solution than powder OnaBoNT-A (mean: 0.55 vs 1.57 min) and all agreed that the RTU solution met their expectations and was easy to use. At most treatment sessions, Investigators preferred an RTU solution over a powder product (81%) and liked proposing a modern and innovative product to patients (87%). Six months post treatment with AboBoNT-A solution, aesthetic improvement remained in ≥76% of subjects and ≥85% were satisfied with their appearance, and reported a natural and refreshed look. Treatments were well tolerated.

Conclusion: Less time was required to prepare AboBoNT-A solution than powder OnaBoNT-A. Investigators generally preferred RTU AboBoNT-A solution and liked proposing a modern and innovative product to their patients. The Investigator- and subject-reported aesthetic improvement in GLs throughout 6 months after treatment, as well as the high subject satisfaction rates at Month 6, supported prior clinical evidence of long-lasting efficacy of AboBoNT-A solution in GLs. Treatment with both products was well tolerated.

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Este trabalho foi realizado com o patrocínio de: GALDERMA

Skin quality - A holistic 360 degree view - Consensus results (Sponsored by MERZ AESTHETICS)

Objectives: Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/ aesthetic physicians was convened.

Materials / method: A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again.

Results: There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person’s chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient.

Conclusion: This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients’ perception for the need for aesthetic treatment.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Dermatological treatment using plant-based makeup as a vehicle

Objectives: The study aims to present an innovative and sustainable plant based vehicle for the skin in makeup form to treat and repair the skin against exposome effects, UVA, UVB radiation, visible light and blue light, DNA protection, antiglycative and collagen booster.

Introduction: Decorative cosmetic as makeup are used for application and coverage of skin defects, resulting in improved appearance as well as psychological effects such as increased self-confidence. Makeup usually contains heavy metals and endocrine disruptors that cause environmental pollution, skin irritation and contact dermatitis and normally can be not use for pregnant and sensitive skins. Pigments from plants in form of makeup are very innovative with strong antioxidant activities because contains flavonoids, tannins, polyphenols, anthocyanins that contains natural photoprotection.

Materials / method: It was developed a foundation in powder using natural pigments
B. excelsa seed powder, D. alata shell powder, O. sativa powder and R.sativus.It was evaluated the safety of the formulation using RIPT (Human Repeat Insult Patch Test) method, cytotoxicity and phototoxicity evaluation in vitro using cell cultures.To evaluate the efficacy of the formulation we used the follow methods:
DNA protection by ultra violet radiation using DNA damages detection.
SPF(Sun Protection Factor) in vivo using methodology ISO 24444.
UVA protective factor using Colipa method.
Collagen synthesis analysis.

Results: According to the results. The plant based foundation in powder is very safety and also can be considered hypoallergenic. By the SPF in vivo, the formulation can provide SPF 30 and UVA 21. The analysis of protection against blue and visible light showed that this foundation is very effective and the product present absorption of 74,1% from 400 nm until 800 nm (visible light) and 80,7% between 400 nm and 500 nm (blue light). The formulation stimulates collagen in 130,38% ± 0,1% in concentration of 1mg/ml. Follow bellow the picture of the formulation.

Conclusion: In conclusion this makeup is a very innovative formulation to treat the skin with safety and efficacy. By the results this new technology can be used to improve the results of the dermatological procedures and protect the skin against exposomes, UVB, UVA, blue and visible light besides to improve collagen proliferation.

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor.

Cosmetic outcomes in patient-centered management of actinic keratosis – Personalising Actinic Keratosis Treatment (PAKT) expert consensus (Sponsored by GALDERMA)

Objectives: The Personalising Actinic Keratosis Treatment (PAKT) expert consensus project aims to define and support optimal, personalised and patient-centred management of actinic keratosis (AK). This abstract aims to:
1. Highlight the impact that poor cosmetic outcomes can have on certain patients undergoing AK treatment
2. Report consensus on factors that can influence cosmetic outcomes in AK
3. Provide practical recommendations on personalising AK treatment where cosmesis is priority

Introduction: AK is a common precancerous skin condition characterised by rough, scaly patches caused by chronic sun exposure, which has both cosmetic consequences and potential for malignant transformation. Cosmetic outcomes influence treatment decisions in AK, given the prominent location of the affected skin regions. Indeed, concern about sequelae such as hyperpigmentation and scarring, particularly with lesion-directed therapies, is a barrier to AK treatment. A patient-centric approach to AK management may improve clinical outcomes, treatment satisfaction and adherence to therapy.

Materials / method: The PAKT panel of 12 dermatologists from Europe (n=10), Canada (n=1) and Australia (n=1) used a modified Delphi approach to develop recommendations to personalise the management of AK via a series of e-surveys. Voting was blinded and consensus was defined as ≥75% voting ‘Agree’/‘Strongly agree’. Consensus statement voting is given in brackets (e.g. 11/12 voted either ‘Agree’/‘Strongly agree’). Some panellists occasionally voted ‘Unable to answer’. Treatment attributes were rated on a 6-point scale (0 ‘very poor’ to 6 ‘excellent’) and open questions prompted detailed feedback.

Results: Patient preference is one of the most important factors to consider when setting treatment goals (8/12), which should be tailored according to the individual patient (12/12). Lesion removal (11/12) and improving skin appearance (9/12) are important goals of AK therapy, but cosmesis can have a substantial psychosocial impact for some patients; factors to identify those for whom cosmesis should be a priority were highlighted. To aid treatment choice, licensed AK therapies were rated for cosmetic outcomes, and pre- and post-treatment adjunctive therapies to improve cosmesis were discussed.

Conclusion: Cosmetic outcomes are an important factor to consider when personalising goals and management strategies for patients with AK. The PAKT group offers recommendations to support shared decision-making where cosmesis is a particular concern to an individual, thus optimising treatment adherence, satisfaction, and outcomes. Recommendations will be used to develop a practical clinical tool to facilitate an ongoing personalised approach to AK management throughout the patient journey.

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Este trabalho foi realizado com o patrocínio de: GALDERMA

Glycerol, a well-tolerated humectant in dermal fillers (Sponsored by MERZ AESTHETICS)

Objectives: The Cohesive Polydensified Matrix (CPM®)-HA20G filler is an injectable resorbable hyaluronic acid (HA) implant indicated for revitalization of early-onset photodamaged facial skin. CPM®-HA20G consists of 20 mg/mL cross-linked sodium hyaluronate and 17.5 mg/mL glycerol. Glycerol is one of the
most effective humectant polyols and is described to lead to a sustained moisturizing effect in the skin. In a previous study CPM®-HA20G contributed to an early onset of skin hydration. In this study, we analyze the effect of glycerol on cells and compare glycerol with other frequently used humectants.

Introduction: Glycerol is a colorless and viscous polyol that occurs endogenously in the human skin. Glycerol diffuses osmotically into the stratum corneum and the underlying epidermis and by acting as a humectant, it pulls and holds water and is thereby protecting the skin from dehydration. To compare glycerol with other frequently used humectants, experiments were performed in which parameters associated with cell stress, cell metabolism and cell proliferation were analyzed.

Materials / method: Primary Normal Human Epidermal Keratinocytes (NHEK) were cultured in growth medium and treated with different humectants (glycerol, sorbitol, or mannitol) at 95-190mM for 24h, 48h or 72h. Cell metabolism was analyzed by Resazurin-assay, glycerol uptake by Glycerol Glo-Assay and cell stress was addressed by monitoring activation of p38 mitogen-activated protein kinase by immunofluorescence (IF)
and Western Blot analysis. Effects on the aquaporin 3 channel (AQP3) were analyzed by IF and qPCR.

Results: Uptake of glycerol by keratinocytes follows a concentration dependent manner. Influx of glycerol does not affect the glycerol permeable AQP3 channel of keratinocytes while mRNA expression and protein expression of AQP3 is increased by sorbitol and mannitol. Both sorbitol and mannitol increase cell stress as indicated by upregulated levels of active/phosphorylated p38 while glycerol
treatment is found to be equivalent to the control condition. Cell viability as well as cell metabolism of keratinocytes remains unchanged by glycerol but is reduced for sorbitol and mannitol treatment.

Conclusion: The current study compared three of the most frequently used humectants in dermal fillers. By specifically addressing the effects related to cell stress induction, glycerol proved to be well-tolerated in regards to: stress-related signaling pathway, cell proliferation and cell metabolism. Therefore, glycerol is proposed to be superior to other tested humectants, sorbitol and mannitol. The current data set
indicates that glycerol is a well-tolerated dermal filler ingredient which has already shown positive effects in hydrating and moisturizing the skin.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Tissue integration of HA-containing dermal fillers: an automated and comprehensive approach to systemically compare dermal fillers (Sponsored by MERZ AESTHETICS)

Objectives: The purpose of this study was to develop an automated method to evaluate and compare different HA containing dermal fillers for their ability to integrate into the dermal tissue. In addition, the analysis will give more insights in the way fillers are integrated into the skin.

Introduction: Hyaluronic acid (HA) based dermal fillers are used for a wide range of aesthetic indications. These dermal fillers differ in their HA content, degree of cross-linking, and cross-linking technologies (such as the CPM® technology) affecting the viscoelastic properties which in turn has a major impact on the performance parameters within human skin. Tissue integration is an important performance parameter of dermal fillers in the skin. Tissue integration is defined as the ability of fillers to homogeneously distribute and evenly integrate within dermal fibers.

Materials / method: The developed algorithm analyzed digitalized histological pictures to automatically identify injection areas and determined a ratio of hyaluronic acid in correlation to entangled dermal fibers. To validate the algorithm, three dermal fillers (CMP®-HA20, CMP®-HA22.5, CMP®-HA26, all Lidocaine) with different viscoelastic properties were injected intradermally (bolus of 0.1 mL) into human ex-vivo skin models(n=5-10) (No massage). The complete skin model was histological cryo-sectioned and stained by a modified H/E and Alcian blue protocol visualizing epidermal/dermal fibers and GAGs/filler.

Results: Based on the histological staining of skin sections, the developed algorithm automatically defines the region of interest (ROI) and analyzes the different structures within the ROI such as hyaluronic acid, entangled tissue fibers, and overlays of both. The semi-quantitative analysis of the algorithm distinguishes between three different dermal fillers in terms of their tissue integration

Conclusion: The developed algorithm can automatically identify areas of filler injection and detect HA and dermal fibers. The tissue integration property of each filler was successfully determined showing significantly different values due to HA content and degree of cross-linkage. The new model will be used for characterization of existing HA-based fillers and will be an important tool to adjust filler properties of
new developments.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Neck rejuvenation in a female patient with pseudoxanthoma elasticum: a case report

Objectives: Pseudoxanthoma Elasticum: to achieve improvement of the texture and elasticity of the skin with a combination rejuvenation treatment of chemical peel, dermal undermining, and PRP.

Introduction: Pseudoxanthoma elasticum (PXE) is a rare autosomal recessive disease characterized by clumped, distorted, and calcified elastic fibers in the connective tissue, - affecting principally the dermis of the skin, media, and intima layer of medium-size arteries and Bruch's membrane of the eye. PXE is caused by mutations in the ABCC6 gene (adenosine triphosphate-binding cassette transporter C6), located in chromosome 16p13.1 leading to the accumulation and deposition of calcium and other minerals in the elastic tissue.
The initial clinical findings of PXE are usually cutaneous.

Materials / method: Case report: A 34-year-old Caucasian woman with PXE complained about the skin appearance of her neck.
A clinical examination of the sides of her neck and cervical skin revealed asymptomatic yellowish papules, coalescing into larger cobblestoned plaques causing skin surface irregularity.
A 3-step rejuvenation protocol was decided for this patient:
1. Application of Jessner’s solution + trichloroacetic acid (TCA) 25% peel.
2. Undermining of the skin
3. PRP mesotherapy

Results: The overall cosmetic result was satisfactory, with improvement in skin texture, irregularity, volume, and distensibility.

Conclusion: This firstly reported combination treatment for cutaneous PXE lesions with Jessner’s solution and TCA 25 % peel combined with dermal undermining and PRP mesotherapy was safe and efficacious and it could also be used as a rejuvenation protocol of the neck for women with no PXE.

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Safety and effectiveness of nasal reshaping with HA through cannula technique: a real-life study

Objectives: Nonsurgical rhinoplasty is one of the fastest-growing cosmetic procedures worldwide. It has become an increasingly popular alternative to surgical procedures, because the effect is visible immediately after the treatment with minimum/no recovery time and patients can return to their normal activities on the same day. The aim of this study was to present the safety and effectiveness of nasal reshaping with hyaluronic acid through cannula technique.

Materials / method: Patient records were retrospectively analysed from 1/12/2021 to 30/11/2022. Twenty-four patients were identified. The majority of patients were females (n=18, 75%). In all cases, hyaluronic acid(HA) 20mg/ml cross-linked with lidocaine 0,3% and was injected with a cannula. The volume range of the HA filler used was 0.7 mL on average. HA was placed deeply, over bony and cartilage tissue, just above the periosteum and/or the perichondrium to avoid vessel cannulation.Patients were asked to answer a validated patient experience questionnaire which has a succinct scale from 0(poor) to 12(excellent).

Results: Twenty-three patients (n=23, 95%) rated their experience as excellent (scored 12/12) and one patient rated as good(10/12) (n=1, 5%). The most common complications were oedema for 4-5 days (n=7, 29.2%), ecchymosis (n=6, 24%) and pain at the point of the injection for 4-5hours post treatment (n=3, 12.5%). No major complications and side effects such as nasal skin necrosis and blindness occurred.

Conclusion: Nasal reshaping through cannula technique is a safe, cost effective, well-tolerated and reproducible technique with no major complications and side effects. This technique could lead to substantial improvement without the complications of more interventional methods. The effect is visible immediately after the treatment without considerable recovery time and with lower cost per treatment compared with rhinoplasty.

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Efficacy and safety of 755 nm picosecond alexandrite laser for the treatment of dermal melanocytosis: a prospective clinical trial (Sponsored by WONTECH)

Objectives: We aimed to evaluate the efficacy and safety of a 755-nm picosecond alexandrite laser for the treatment of overall dermal melanocytosis using objective assessment and included pediatric patients as well.

Introduction: Dermal melanocytosis is associated with significant emotional and psychosocial stress caused by its cosmetic disfigurement. Particularly, NOO and ABNOM is typically seen in the facial area and could affect more burden than others. However, the treatment of this condition used to be challenging. Conventionally, a variety of Q-switched lasers including Q-switched ruby laser, Q-switched alexandrite laser (QSAL), and Q-switched neodymium-doped yttrium aluminum (Nd:YGA) laser, have been used to treat for most patient with dermal melanocytosis.

Materials / method: This prospective, open-label trial comprised 25 Korean subjects with dermal melanocytosis.
All patients underwent 3 treatments at an interval of 2 months with 755-nm, 700-ps PSAL (Picowon®; Wontech, Daejeon, Korea). Before each session, the lesion was gently cleansed and an anesthetic cream (EMLA™; AstraZeneca, Cambridge, UK) was then applied under occlusion for an hour. The initial settings of parameters were 3.0-mm spot size, 3.0 J/cm2 fluence, and 4 Hz frequency and then modified individually to the extents of 10% depending on the therapeutic response.

Results: Clinical responses were evaluated on a five-point physicians’ global assessment scale based on the medical photographs. 54.2% (13/24) and 4.2% (1/24) of subjects were assessed as at least moderate improvement and marked improvement at week 16, respectively. At the final follow-up visits, 50% (12/24) had at least moderated improvement and 16.7% (4/24) had marked improvement (Figure 1-4). Among patients with NOO, 63.6% (7/11) and 18.2% (2/11) were rated as at least moderate improvement and marked improvement at the final visit, respectively.

Conclusion: The 755-nm picosecond alexandrite laser can be an effective and safe treatment option to treat dermal melanocytosis in Asian.

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Este trabalho foi realizado com o patrocínio de: WONTECH

Rheological properties of injectable HA of CPM and NASHA technology

Objectives: For facial wrinkle correction and volumization hyaluronic acid (HA) fillers have become one of the most popular injectable substances. The aim of this study is to compare the rheological properties of two HA fillers designed for facial volume augmentation of different manufacturing technologies to highlight their differences and similarities.

Introduction: Rheological evaluation is of great importance in the selection of HA fillers for specifical clinical needs as the resulting values not only provide information about the physicochemical characteristics, but also allow predictions of how the filler will behave in the tissue after injection. There are differences between HA fillers due to the different manufacturing technologies.

Materials / method: Two crosslinked injectable HA fillers (CPM, Belotero Volume [BEL-VL] and NASHA, Restylane Lyft [RES-L]) were investigated for their elastic modulus G', viscous modulus G", complex shear modulus G*, complex viscosity ƞ*, and their loss factor tan δ. To characterize their rheological properties both HA-fillers are subjected to oscillation measurements. In an exploratory analysis, differences between the independent variables have been assessed via a two-tailed statistical test (Mann-Whitney U test) with a significance level of 5% (p ≤ 0.05).

Results: The elastic and viscous modules as well as the complex viscosity of RES-L are higher than those of BEL-VL. The elastic and viscous modules increase with frequency whereas the complex viscosities decrease with increasing frequency. The values of the loss factors are higher for BEL-VL compared to RES-L. At all three frequencies, the values for the loss factors are similar to each other.

Conclusion: Although RES-L has higher viscoelastic properties than BEL-VL, both are characterized as strong HA-fillers. With its highly cohesive properties, BEL is able to achieve the same clinical effect as RES-L, by offering a smaller injection force. Furthermore, both HA fillers have a tan δ < 1 and are classified as gel-like materials. These physicochemical properties allow their application for subcutaneous to supraperiosteal injections. The differences in the rheological parameters lead to the lower extrusion force of BEL-VL and enables perfect tissue interaction.

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Skin quality booster with glycerol – their viscoelastic skin potential

Objectives: For improving overall skin quality, microinjections with a hyaluronic acid (HA) skin quality booster (SQB) is a common minimally invasive treatment. The aim of this study is to investigate a SQB with the additive glycerol in its viscoelastic skin properties - as skin firmness is an important skin quality attribute, one of the four emergent perceptual categories.

Materials / method: The CPM-HA20G containing 20 mg/ml HA and 17.5 mg/ml glycerol was injected once or thrice, 4 weeks apart, with serial microinjections (each 0.05 ml) into dermal/ immediate subdermal tissue at lower cheek area. Eligible healthy subjects with early signs of facial photodamage, aged 25–45, were enrolled. Biophysical measurements were performed on baseline and follow up visits at 4, 8, 16, 24 and 36 weeks. With Cutometer skin firmness (R0) and skin fatigue (R3) were investigated. With a 22-MHz high frequency ultrasound skin thickness and density were evaluated.

Results: Included were 15 subjects. Five subjects (42±2 years) received the single treat-ment and 10 subjects (34±6 years) the multiple treatment. Both treatments statistically significantly improved skin firmness (p<0.05). In the triple treatment group, significant differences were also observed for skin fatigue (p=0.019) and skin density increasing from 32 to 39 (p=0.017) with skin thickness remaining stable. The improvement of skin firmness (p=0.001) and skin fatigue (p=0.002) was more pronounced in the multiple treatment group than in the single group at week 16.

Conclusion: Skin quality is characterized by four emergent perceptual categories: skin glow, skin firmness, skin surface evenness, and skin tone evenness.
CPM-HA20G microinjection treatment can improve skin quality by significantly improving viscoelastic skin properties and skin density. The multiple treatment group showed a stronger clinical effect in skin firmness and skin fatigue than the single treatment group.

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Autologous follicular stem cell micrograft therapy: a new generation treatment modality for androgenetic alopecia (Sponsored by GLOBAL BIYOMEDIKAL)

Objectives: This study aimed to prospectively evaluate the efficacy and safety of autologous follicular stem cell treatment in 46 patients suffering from androgenetic alopecia.

Introduction: Androgenetic alopecia is hair loss caused by hormonal, and genetic factors (1). There are various treatment options in the treatment of androgenetic alopecia.
Follicular autologous stem cell treatment belongs to the new generation treatment choices in androgenetic alopecia. Stem cells are unique cells that have the ability to differentiate into many cell groups.

Materials / method: Patients over the age of 18 who were clinically diagnosed with androgenetic alopecia applied to our hair diseases unit, were enrolled to the study. Patients having additional
diseases that may cause hair loss, and those who received local or systemic hair loss treatment in the last six months were excluded from the study. A single session of
autologous follicular stem cell treatment was applied to 46 patients included in the study.

Results: Ages of 46 patients that were included in the study ranged from 21 to 53, with a mean age of 36.00 ± 7.630 years. The alopecia severity was the patients were as follows:14 (30.43%) of the patients were stage 3, 26 (56.53%) were stage 4, 6 (13.04%) were stage 5. At the end of 24 weeks, a statistically significant increase was found in hair number, hair density, vellus hair number, vellus hair density and mean hair per unit hair values when compared to pretreatment (p<0.05). There was no significant relationship between the stage of the disease and the treatment response.

Conclusion: This study it has been shown that a single application of autologous follicular stem cell therapy in the treatment of androgenetic alopecia provides a significant increase in hair density and is an effective and safe treatment option for the patients.

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Uncommon management of a common dermatological condition: treatment of Keratosis Pilaris Rubra (KPR) with low fluence Q-switched 595 nm Nd:YAG laser

Objectives: 1. Management of Keratosis Pilaris Rubra (KPR) with low fluence Q-switched 595-nm Nd:YAG laser.

Introduction: Keratosis Pilaris Rubra (KPR) is a commonly encountered but underrecognized condition characterized by hyperkeratotic papules with background of erythema usually located on the cheeks, forehead, chin and eyebrows. Despite being a relatively common condition, the treatment of KPR with topical and oral medications have shown to be ineffective. Reported studies of KPR with laser treatments with fluence ranging at least 5J/cm2 have resulted in cosmetically unacceptable purpura post treatment and to our knowledge, treatment with low fluence Q-switched 595-nm Nd:YAG laser has never been reported.

Materials / method: Case Report

Results: A 40-year-old lady with no known medical illness presented with 4 years history of persistent erythema with pruritus over bilateral cheeks and forehead with follicular hyperkeratotic papules over bilateral arms and bilateral thighs. Blood investigations show raised inflammatory markers with negative autoimmune antibodies screening. The lady tolerated the treatment of low fluence Q-switched 595-nm Nd:YAG laser well with fluence setting of 0.15- 0.30 J/cm2, spot size 5mm, frequency of 2Hz and pulse duration 5-10nS and satisfactory improvement was noted after 5 sessions.

Conclusion: Treatment of KPR with high fluence laser settings has pose as a therapeutic challenge. In light of our positive outcome, we recommend that low fluence Q-switched 595-nm Nd:YAG laser to be considered as an effective and tolerable treatment for the patients.

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Hybrid fractional laser treatment for photorejuvenation (Sponsored by SCITON)

Objectives: The purpose was to demonstrate the effectiveness of hybrid fractional laser for photo rejuvenation with decreased downtime.

Introduction: Individually, non-ablative and ablative dermal remodeling and skin resurfacing are well-established aesthetic procedure to treat photodamaged skin.2 Ablative procedures are considered to be most effective in treatment of photodamaged skin, whereas non-ablative addresses sun damage.
In this investigation we used hybrid fractional laser that delivers both ablative and non-ablative wavelengths simultaneously. Ablative 2940nm targets the epidermis addressing the textural issues and 1470nm targets the dermis stimulating collagen.

Materials / method: Over 30 patients with Fitzpatrick skin type I-IV have been treated so far with the hybrid fractional laser for facial rejuvenation. Each patient received 1 to 2 treatments. Treatment parameters included: 1470nm – depth 400-600um, density 20-40%, and 2940nm – depth 40-100 um, density 15-19%. Topical anesthesia was used prior to start of the treatment.

Results: A significant improvement in skin texture, pores, fine line and wrinkles has been observed. Overall improvement in skin tone has also been noted. Patients have reported satisfaction with the results achieved. No adverse events reported.

Conclusion: The hybrid fractional laser is proven to be safe and efficacious treatment for photodamaged skin with long lasting results and minimal downtime.

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Este trabalho foi realizado com o patrocínio de: SCITON

Where’s my other eyelid crease? Fixing double eyelid asymmetry with modified single-knot continuous buried suture technique

Objectives: Here we describe a simple method to fix uneven eyelid crease using a non-surgical suture technique. This procedure that creates natural looking symmetrical deep eyelid crease without any incision.

Introduction: Traditionally, asymmetrical double eyelids were treated surgically. This requires incisions over the upper eyelid skin muscle complex, and exposure of the levator aponeurosis. This invasive procedure resulted in a longer recovery process. In some cases, the healing process is unpredictable due to the more extensive tissue dissection. This leading to imbalanced crease formation as a result of scarring.

Materials / method: After crease design and simulation of the crease, small holes are pierced over the skin marking using 23G needle. A nylon suture 7/0 with round body needle is passed though in a running manner over from skin, to levator aponeurosis and back to skin in a repeated fashion. Once the 3 of these deep suture loops are made, the suture is tunneled back in the subepidermal plane towards initial suture and tied to itself with 5-7 knots. The knots are then buried deep to the skin/muscle complex. The normal eyelid is also sutured in the same manner.

Results: Symmetrical double eyelid crease in both eyes are created after suturing. Both eyes are treated to ensure equal tension over skin fold to form crease with identical depth and height. Minimal post procedure swelling, that resolves by 2 weeks. Figure 3 and Figure 4 shows the eyelids before and 2 weeks after procedure respectively.

Conclusion: This modified single-knot continuous buried suture technique creates symmetrical double eyelid crease by distributing the force evenly over skin fold. There is no incisions and the recovery is faster compared to surgical treatment

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How useful is the supra sternal notch to nipple distance? A prospective cross-sectional questionnaire survey on anthropometric measurements

Objectives: The aim of this study was to identify the optimum anthropometric measurement between the Suprasternal Notch (SSN) – Nipple distance vs. Mid-Clavicle (MC) – Nipple distance for the aesthetical position of the nipple-areola complex (NAC) on the breast.

Introduction: Several studies have attempted to identify the optimum anthropometric measurement for the aesthetically ideal positioning of the nipple-areolar complex; however, there are no standardized solutions and measurements for planning surgical procedures.

Materials / method: A detailed online survey was sent to 300 board-certified plastic surgeons and residents of plastic surgery departments in German, Austrian and Swiss hospitals. A similar survey was also given to 100 patients who had undergone breast surgery. All participants were asked to rank the attractiveness of a series of women's breasts in images with different NAC position measurements. The images showed breasts from two different measurements and distances: All breasts had equal dimensions, proportions, and same areola size. The results were collected and analyzed descriptively using graphs and statist

Results: Complete datasets were obtained from 203 of 300 board-certified plastic surgeons and residents of plastic surgery departments in German-speaking countries (recall 68%) and from 100 patients. The majority of doctors and patients find a symmetrical breast with a mirrored position of the nipple-areola complex more attractive than a non-symmetrical breast. In cases with minor measure differences such as 0.5cm (SSN vs. MC), there is no relevant difference regarding the breast symmetry. However, at larger measuring distances, the MC to nipple distance is superior for achieving aesthetically appealin

Conclusion: Using the mid-clavicle (MC) to nipple distance seems to be superior for correct nipple positioning than the Suprasternal notch (SSN) to nipple distance and is a valuable preoperative measurement option for a breast symmetry with correct nipple height. Further studies on this topic involving a more general population should be advocated to confirm the improvements in perception with the preoperative measurements using the anatomical landmarks.

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Anatomic evaluation of the normal variants of the arteries of face using color

Objectives: This study aimed to evaluate the normal variations of the facial, angular, transverse facial, supratrochlear, and supraorbital arteries in a sample of normal individuals. we found some different levels of facial artery regarding sex and BMI.

Introduction: Knowledge of normal facial vascular variations could prevent catastrophic complications of cosmetic procedures as well as a guide for surgical planning. Color Doppler ultrasound is safe and noninvasive method for real-time vascular evaluation. This study aimed to evaluate the normal variations of the facial, angular, transverse facial, supratrochlear, and supraorbital arteries in a sample of normal individuals.

Materials / method: Normal individuals referred for dermal filler injection to the
tertiary dermatologic center were selected. Patients who
were smokers or had a history of facial filler injection,
facial surgery, or trauma were excluded from the study.
Facial arteries at three levels as well as angular,
supratrochlear, supraorbital, and transverse facial arteries
were evaluated by an 18 MHz ultrasound linear probe
regarding their distance from facial reference lines and
their depths in various facial regions.

Results: A total number of 86 arteries in 43 individuals were evaluated.The transverse facial artery was absent in 27 (31.39%) assessed individuals. Distance from reference lines at levels 2 and 3 of facial arteries and depth of facial artery at level 2 was significantly different between the left and right side.The comparison of the depths and distances from the reference lines of the assessed arteries between the two sexes revealed only a significantly greater value of facial artery distance in level 1 in males. BMI was also correlated with the depth of the facial artery in levels 2 and 3.

Conclusion: Color Doppler ultrasound could be used to map the
arteries of the face to prevent vascular complications
and safely guide cosmetic procedures.

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Analysis of protein loss as a marker of broad hair shaft damage: evaluation by Lowry and rapid (RPLT) tests.

Objectives: Evaluate the protein loss of the discolored hair shaft by the Lowry and rapid protein loss test (RPLT) methods.

Introduction: Hair is a resistant polymer rich in α-keratin, composed of cystine emission by sulfur binding, which promotes resistance to chemical attack. The loss of protein in the hair causes weakening and breakage of the hair and aesthetic changes in the appearance of the fiber. There are methods that quantify hair protein loss. Lowry's test is traditionally performed, but it is time consuming and difficult to incorporate into outpatient practice. The Rapid Protein Loss Test (RPLT) allows rapid results with scientific validity.

Materials / method: 54 Lowry tests and 54 TRPP tests were performed on virgin straight hair samples that were bleached with hydrogen peroxide (H2O2) and reevaluated (Figure 1), totaling 108 evaluations. Each test used 200mg of chopped hair.

Results: Protein loss using the Lowry test is not detectable with the naked eye, as it presents a subtle color variation, requiring the use of a spectrophotometer In RPLT, the clear colors facilitate the identification of results visually, influencing the absorbance results (Figure 3).
The absorbance variation ratios between bleached and virgin hair for the Lowry and RPLT tests were 2.04 and 2.09, respectively. Despite the ratios being statistically significant, the Lowry test has the disadvantage of not showing a large variation in color intensity (Figure 3). The RPLT test shows clear color variation,

Conclusion: The methods (Lowry and RPLT) showed equivalence regarding the percentage variation of protein loss for virgin and bleached hair samples. RPLT has advantages in terms of practicality and execution time, enabling its use in clinical medical offices, helping to indicate the most appropriate treatments for the damaged fiber, thus being able to use only a colorimetric scale and not requiring robust equipment such as a spectrophotometer or High Performance Liquid Cromatography (HPLC).

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Rapid protein loss test as a guide to hair damage

Objectives: Demonstrate clinical correlation between the hair appearance and rapid protein loss test (RPLT).

Introduction: Chemical treatments lead to hair protein loss.2 Bradford and Lowry assays are the standard methods to quantify protein loss.3 RPLT is an innovative technology, simple to execute. It doen´t require robust equipment, such as the spectrophotometer, to obtain the final results. A colorimetric range ranging from green (low protein loss) to dark purple (intense protein loss) allows for visual assessment (Figure 1).

Materials / method: Six patients who had frizzy and brittle hair after discoloration or coloring processes carried out in the last month were selected. All patients had histories of weekly hydration in beauty salons. Clinical examination identified fragile hair, with breakage in the distal region of the fiber and a frizzy appearance (Figure 2).
RPLT was used as an indicator of hair shaft quality for 24 weeks. The tests were carried out at the beginning of the treatment (day zero - D0) and at weeks 5, 8 and 24. The patients received weekly plant protein replacement with specific serum, according to the test result

Results: With treatment, there was a reduction in the presence of trichorexis nodosa and trichoptilosis in the distal extremities. There was also a decrease in protein loss in RPLT, from purple (intense damage) to green (light damage). (Table 1). The sequenced test correlated with progressive improvement of dermoscopic changes. Tests carried out in the 12th week after the end of treatment indicated some maintenance of the results obtained during the 24 weeks. During the study, patients maintained their hair care routine, with a hairdryer and flat iron, bleaching or coloring every 4 or 6 weeks.

Conclusion: The Rapid Protein Loss Test (RPLT) allows a qualitative assessment of hair shaft damage, useful for dermatologist. Personalized hair shaft protein replacement in an outpatient approach is an innovative therapy for hair aesthetic complaints. It allows dermatological in clinic treatment for damaged hair.

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The influence of oil from the seed of the Peruvian Amazon palm tree (Mauritia flexuosa - Aguaje) on the aesthetic qualities of hair

Objectives: To evaluate the influence of using Aguaje seed oil on combability and hair shine.

Introduction: Aguaje seed oil from the Peruvian Amazon is rich in vitamins (A, C, B1, B2 and B5), minerals (phosphorus, calcium, iodine, iron) carotenoids and tocopherols. Friction is related to the softness and silkiness of the hair, and should be low to allow combing, adhesion between the fibers, minimizing tangling1. Hair shine is related to the organization of cuticular cells, as closed cuticles direct light in a single direction2. Natural products that favor hair aesthetics are a necessity in today's culture.

Materials / method: Water, cosmetic base (without oil) and formulations containing Aguaje seed oil (1.5 and 3.0%) were applied to the hair strands. Gloss tests were carried out using a glossmeter (Figure 1) and combability using a texturometer with two combs (Figure 2).

Results: The combing results demonstrate that the friction on the hair when the formulation with 3.0% of the Aguaje seed oil is applied is statistically smaller when compared with the application of water, the cosmetic base and even the formulation with 1.5% of the oil (Figure 3).
The results of the gloss tests showed that the highest concentration of Aguaje oil (3.0%) positively influences the light reflectance by the fibers. The brightness of the fibers treated with the cosmetic base was superior to those treated with the formulation containing 1.5% Aguaje oil (Figure 4).

Conclusion: The presence of Aguaje seed oil from the Peruvian Amazon positively influences the combability and shine of the hair, and can be used as an important ingredient in hair cosmetic products. At a concentration of 3.0% the results were more effective in terms of combability and shine. Aguaje seed oil acts as a sealing agent for the cuticles, which favors the combability and shine of the hair. It is important to emphasize the need for more studies that can confirm its mechanisms.

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Clinical investigation to evaluate the facial volume restoration and augmentation after HA njection in the face with IPN-26-SENSE (Sponsored by LABORATOIRES VIVACY)

Objectives: The aim of this scientific poster is to describe a post-market study of a class III medical device already present on the market. The study was designed to evaluate the efficacy and safety profile of the product in the augmentation and/or restoration of facial volume.

Introduction: The concerned product is a monophasic gel consisting of cross-linked hyaluronic acid, including lidocaine hydrochloride for the reduction of injection-associated pain. For this purpose, healthy subjects with a clinically evaluated lack of volume in the face received a one session treatment with the product and, if necessary, a touch-up was performed one month later. Subjects were to be followed-up over 18 months after the initial injection.

Materials / method: The study was prospective, uncontrolled, single center and on healthy subjects.
40 women have been selected for this study.
Follow-up was realized at 1 month, 3 month, 6 month, 12 month and 18 month.
The main objectives were to evaluate at each visit:
- Facial Volume Loss Scale (FVLS),
- chin and cheekbone volume variation calculation thanks to 3-dimensional (3D) photographs (LifeVize 3D system),
- chin angle calculation thanks to 3D photographs (LifeVize 3D system),
- subjects' satisfaction evaluated by the FACE-Q questionnaire.

Results: After the procedure, we observed at each timepoint of the study:
- an improvement in the FVLS score analysed by the independent evaluator,
- an improvement in the subjects' satisfaction compared to baseline,
- an increase in the volume variation of the chin and cheekbones,
- an increase in the chin angle.
Regarding the safety profile of the product, all injection site reactions and adverse device effects reported during this study were expected with injectable HA fillers and were already known.

Conclusion: The results of this clinical study confirm the efficacy and the safety profile of this post-market filler in the augmentation and/or restoration of facial volumes.

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Product manufacturing process for PLLA-SCA (Sponsored by GALDERMA)

Objectives: To explain the product manufacturing process of the polymer poly-L lactic acid Sculptra (PLLA-SCA) injectable implant dry powder formulation, for soft tissue augmentation.

Introduction: PLLA-SCA is an injectable implant for aesthetic use in various indications globally. Dry powder PLLA-SCA consists of PLLA particles unique in shape and size, with excipients mannitol and sodium carboxymethylcellulose. PLLA-SCA is manufactured in Italy for Galderma, through a validated, patented process and in accordance with an ISO 13485:2016 certified quality system. It is provided in an air free vial to enhance product protection with a total dry powder weight of 367.5 mg. The manufacturing process is directly correlated to the PLLA-SCA particle’s distinctive properties and characteristics.

Materials / method: The manufacturing of the PLLA-SCA product can be defined by 9 key stages. These stages are growing, fermentation, polymerization, micronization, particle size selection, low heat non residual sterilization, formulation with excipients, aseptic vial filling, freeze drying with hermetic sealing. The manufacturing process includes quality assurance and control steps of all batches of PLLA-SCA to ensure consistent quality and product characteristics.

Results: PLLA-SCA is developed and manufactured without any human- or animal-derived excipients containing only plant-derived ingredients. The final dry powder composition contains 150 mg poly-L lactic acid with unique PLLA-particles both in shape and within a narrow size range (40-63 µm), and 127.5 mg mannitol and 90 mg sodium carboxymethylcellulose as excipients. Each product batch is rigorously quality controlled to ensure high product quality. PLLA-SCA dry powder is reconstituted in sterile water for injection (SWFI).

Conclusion: Key stages in the manufacturing process of PLLA-SCA result in a unique particle shape and size range with a specific product characteristic. This product has been extensively studied as a biostimulatory injectable implant in numerous randomized clinical trials for soft tissue augmentation with natural looking results, high patient satisfaction and an acceptable safety profile. Clinical trial outcomes for PLLA-SCA have for over 20 years repeatedly reported efficacy that can last for more than 2 years.

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Dermatological tattoo complications

Objectives: - Know legal regulations of tattoo ink compositions in the European Union and United States.
- Diagnose tattoo-associated complications.
- Manage tattoo complications.

Introduction: In recent decades, decorative tattoos have gained enormous popularity worldwide, with colorful and large-area motifs in particular. By inserting particles and dyes into the dermis, one obtains a design for a lifetime. Given this developing incidence, the number of reports on tattoo complications has also increased in recent years. The aim of the following work was to summarize the legal regulations of tattoo ink compositions, analyze the heterogeneous spectrum of dermatological tattoo complications, and give a review on their management.

Materials / method: A review of the current literature as well as clinical experience from the university dermatological laser department.

Results: The amendment of the European REACH Regulation in 2022 restricts the use of several dyes and of more than 4000 chemicals. To what extent the legal changes will have an influence on the number and type of undesirable side effects cannot be sufficiently assessed at present. Tattoos can cause a wide range of complications. Most frequently, erosive and ulcerative allergic reactions (37%) and bacterial infections (1 - 5%) have been described. Furthermore, there are increasing reports on viral infections, tattoo-associated sarcoidosis, technical-related complications as well as skin cancer.

Conclusion: Tattoo inks consist of a variety of diverse ingredients. The composition of tattoo inks is currently not sufficiently regulated centrally. Given their continued popularity, tattoos could pose as a significant health risk. Further prospective trials as well as longitudinal observational studies are warranted to assess the extent of tattoo-associated complications.

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Biostimulating fillers and inflammatory pathways: a preclinical investigation (Sponsored by MERZ AESTHETICS)

Objectives: The aim of the study is to characterize the in vitro macrophage response to two biostimulatory fillers, CaHA and PLLA, and evaluate their inflammatory potential.

Introduction: Initial macrophage response to biostimulatory substances is key in determining the subsequent behavior of fibroblasts and the organization of newly synthesized collagen. Though histological studies suggest that calcium hydroxylapatite (CaHA) filler initiates a regenerative healing response with collagen and elastin deposition similar to natural, healthy tissue rather than an inflammatory response with fibrosis, the relative activity of macrophages stimulated by CaHA, as well as how this activity compares to that induced by other biostimulatory fillers, has not been explored.

Materials / method: Primary human macrophages were incubated with 2 dilutions (1:50 and 1:100) of commercially available CaHA or PLLA. After 24 hours incubation, an inflammation array was used to screen for the expression of 40 cytokines by macrophages. Confirmation of array results was done by ELISA.

Results: Four cytokines were significantly upregulated in M1 macrophages incubated with PLLA compared to both unstimulated controls and CaHA: CCL1 (P<0.001), TNFRII (P<0.01), MIP-1α (P<0.05), and IL-8 (P<0.001). In M2 macrophages, MIP-1α (P<0.01) and MIP-1β (P<0.01) were significantly upregulated by PLLA compared to CaHA and unstimulated controls.

Conclusion: Together, these findings indicate that the CaHA mode of action is a non-inflammatory response while PLLA initiates expression of several cytokines known to play a role in inflammation. Our study supports the concept that these two 'biostimulatory' fillers follow distinct pathways and should be considered individually with regard to mechanism of action.

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The MICRO-Lift: A ligaments-based anatomic technique for lower face and neck rejuvenation using bipolar radiofrequency (Sponsored by INMODE)

Objectives: The aim of this paper is to present the results of a new technique for lower face and neck rejuvenation named the MICRO-lift (Minimally Invasive, Combined Radiofrequency, Outpatient lift). This technique is based on a bipolar radiofrequency treatment applied to specific ligamentous areas.

Introduction: Interest in facial and neck rejuvenation have become trends in recent years. The development of new technology together with the increasing interest of the population for less invasive techniques, have made minimally invasive facial rejuvenation techniques gain popularity [1].
On the other hand, a deeper knowledge of the different facial and cervical retaining ligaments has led us to a better understanding of the aging process [2]. The ligaments consist of collagen bands intermingled with elastic fibers that support hundreds of pounds of stress per square inch [3].

Materials / method: Between December of 2019 and September of 2021, all consecutive patients treated with the MICRO-lift by a single surgeon were included in the study.

Results: Sixty-five patients underwent MICRO-lift technique for the lower face and neck. All patients in our series were female. The mean age of the patients was 53,6 ± 10,2 years (range 33–75). The mean amount of energy delivered in the areas of the face was 1,4 ± 0,3 Kj (range 1–2) in MECA, 1,4 ± 0,5 Kj (range 1–2,5) in IECA and 1,3 ± 0,4 Kj (range 1–2) in LECA. The mean amount of energy delivered in the face was 4,1 ± 0,6 Kj (range 3–5,5).

Conclusion: We propose MICRO-lift as a novel tool for minimally invasive face and neck rejuvenation. For carefully selected patients, the MICRO-lift can produce outstanding and satisfying improvements in cervicofacial appearance. To the best of our knowledge, this new approach offers a predictable strategy to achieve the desired aesthetic results, making this procedure more reliable and reproducible for both novel and experienced surgeons with bipolar radiofrequency.

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Injectable dermal filler technique for gluteal augmentation and harmonization (Sponsored by ILIKIA BRASIL)

Objectives: The main objective is to present a description and results of a Gluteal augmentation and harmonization technique using a dermal filler of hyaluronic acid.

Introduction: The demand for gluteal augmentation has increased over the years and a number of techniques are presented to the patients.For patients seeking for non-surgical procedures, dermal filler injection is an effective and instant result option for temporary, with minimal down time procedure for buttock augmentation and harmonization.Here we aim to describe a Gluteal augmentation and harmonization technique using a novel dermal filler composed of reticulated hyaluronic acid. The presented technique can be customized accordingly to the patient body, gluteal shape and patient expectatives.

Materials / method: In the technique, each buttock is divided into 6 areas. Buttock areas marked as B1 to B6, with patient in standing position, where dermal filler should be implanted. The product implanted is the UP Max®, Ilikia. It is a reticulated multiphasic hyaluronic acid based dermal filler, with R2 technology, containing 20mg/mL of hyaluronic acid. A total of 15 mL of product should be planned for implantation to each side. The amount of product injected into each area varies according to the patient's anatomy and desire.

Results: A total of 6 (six) patients were treated from July to December of 2022 in a single session treatment, being one male and five female. The total volume implanted in each patient was 30mL. No major complications occurred. Only mild adverse events were reported, such as edema and ecchymosis. Improved buttocks contour were achieved in all patients. Satisfac- tion was also achieved and reported on the Global Aesthetic Improvement Scale (GAIS) as much improved by both doctor and patients. We also present a follow up of one patient five months after the injection.

Conclusion: We demonstrate a temporary gluteal augmentation and harmo- nization technique showing aes- thetically satisfactory outcomes using a novel multiphasic hyalu- ronic acid based dermal filler with high moldability and volumization feature. The method has wide applicability for different buttocks shapes and presents an easy le- arning curve.

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Este trabalho foi realizado com o patrocínio de: ILIKIA BRASIL

Improvement of chin retrusion in Chinese subjects using HA filler: a randomized, controlled, evaluator-blinded study (Sponsored by GALDERMA)

Objectives: This study evaluated effectiveness and safety of using HA-DEF, a balanced hyaluronic acid (HA) filler in terms of firmness and flexibility, for correction of chin retrusion in Chinese subjects. The primary effectiveness objective was to evaluate improvement on the evaluator-blinded Galderma Chin Retrusion Scale (GCRS) at 6 months vs. a no-treatment control; secondary effectiveness objectives included evaluation of subject satisfaction up to 6 months, and aesthetic improvement and GCRS improvement up to 12 months after treatment.

Introduction: The chin profile is considered an essential part of facial beauty and HA filler injections are used for chin augmentation in Chinese individuals, yet no randomized controlled trial has investigated this. The HA filler used in this study contains lidocaine and is approved for chin augmentation in the US since 2021.

Materials / method: Adults ≥18 years of Chinese origin with mild to moderate chin retrusion were randomized to HA-DEF (n=111) or no treatment (n=37). Injections were administered at Day 1 for the HA-DEF group and 6 months after randomization for the controls, with optional touch-up after 4 weeks for optimal chin augmentation. Both groups were followed for 12 months after the last treatment. Assessments included GCRS improvement from baseline, aesthetic improvement, subject satisfaction, subject diary collection of pre-defined expected events after each treatment and adverse event reporting throughout the study.

Results: At Month 6, a significantly larger subject proportion had improved GCRS scores in the HA-DEF group 81.1% vs. control, 5.4%, p<0.001. At Month 12, GCRS improvement remained in 61.1% for HA-DEF, and aesthetic improvement remained high, >80%. Subject satisfaction, assessed for 6 months, also remained high, with 99% reporting natural-looking results. On average, 2.1 mL of HA-DEF was injected for chin retrusion (n=111) and another 1.4 mL in other areas of the chin for augmentation (n=65) in the group randomized to HA-DEF (initial+touch-up). Adverse events were transient and mostly mild to moderate.

Conclusion: HA-DEF was effective and safe in chin augmentation and correction of chin retrusion, and led to high subject satisfaction. Improved aesthetic appearance was sustained up to 12 months following treatment.

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Subject and physician satisfaction with abobotulinumtoxinA for glabellar line treatment in a real-world study in Chinese subjects (Sponsored by GALDERMA)

Objectives: This abstract presents the first data summary from an ongoing, prospective, non-interventional, multicenter study (NCT05089357) aiming to assess subject and physician satisfaction and long-term experience of abobotulinumtoxinA (AboBoNT-A) treatment of glabellar lines (GLs) in a real-world clinical setting in China. The study will also investigate the effectiveness of AboBoNT-A in treating GLs in subjects of Chinese origin. The primary objective is to evaluate subject satisfaction after the third injection cycle. Data presented herein include the follow-up visit at Week 3 in Cycle 1.

Introduction: The efficacy of AboBoNT-A in aesthetic treatment of GL is well established. However, real-world, long-term treatment experience of AboBoNT-A use in a Chinese population is less documented.

Materials / method: In this study, ~250 Chinese subjects have received one treatment with 50U AboBoNT-A in the GLs, as per the approved label. Two more treatment cycles (3-6 months apart) are planned. Subjects are followed up at 3 weeks (±7 days) and 3 to 6 months after each treatment. Assessments evaluated in this data summary, include secondary outcomes: subject satisfaction, physician satisfaction, subjects’ assessment of GL severity (on a 4-point categorical scale), and physician’s assessment of GL severity (on a validated 4-point Photographic Scale) and adverse events up to 3 weeks after the first treatment.

Results: Three weeks after AboBoNT-A treatment, 96% of subjects (N=241) were very satisfied or satisfied with the aesthetic outcome, 98% felt that they looked natural, 88% felt more attractive and 98% were very satisfied or satisfied with the comfort of the injection. A majority of subjects (89% as reported by subjects, 93% physician-reported) also had ≥1-grade improvement in GL severity at maximum frown at this visit. Physicians were very satisfied/satisfied with the GL appearance and facial expression for ≥98% of subjects. Based on the 3-week data, the AboBoNT-A treatment was well tolerated.

Conclusion: Initial data from this real-world study from China suggested a high level of subject and physician satisfaction with GL appearance at 3 weeks after AboBoNT-A injection in the first treatment cycle. Per physician and subject assessments, AboBoNT-A was effective at improving GL severity at maximum frown within 3 weeks after treatment. The treatment was well tolerated.

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Differentiation of NASHA and OBT HA gels according to firmness and flexibility and the associated clinical significance (Sponsored by GALDERMA)

Objectives: The current study examined firmness (G′) and flexibility (xStrain) data for the full Restylane range of NASHA- and OBT-based hyaluronic acid (HA) gel formulations. The study also aimed to demonstrate the concept of xStrain as a measure of gel flexibility and how it may relate to tissue performance. These data build upon previous studies in this area to provide further evidence of the ways in which the physicochemical properties of HA gel fillers may link to potential clinical outcome.

Introduction: Restylane HA fillers offer a wide range of firmness and flexibility so that aesthetic treatment may be tailored according to individual needs and facial structure to retain natural looking results, even during facial movement/animation. HA gel firmness is expressed as the elastic modulus (G′); flexibility is described according to the xStrain value (the strain value G′/G′′ cross-over point in the amplitude sweep).

Materials / method: HA fillers formulated using NASHA technology and OBT were studied in dynamic mode using a PP25 rheometric measuring system at 25˚C. Firmness was measured using frequency sweep, with G′ evaluated at 0.1 Hz. Flexibility assessments used amplitude sweep measurements between 0.1%–10,000% strain at 1 Hz, with xStrain being the strain value at the cross-over point where G′ and G″ have the same value.

Results: The NASHA- and OBT-based HA gel products showed a wide range of firmness and flexibility. HA-SIL, HA-RES, and HA-LYF demonstrated G′ measurements of 416, 701, and 799 Pa, respectively, while measurements for OBT formulations had G’ values of 70 Pa (HA-REF), 160 Pa (HA-KYS), 171 Pa (HA-VOL), and 271 Pa (HA-DEF). OBT formulations showed xStrain values of 1,442% (HA-REF), 908% (HA-KYS), 930% (HA-VOL) and 761% (HA-DEF). NASHA formulations showed xStrain values of 7% (HA-RES), 19% (HA-SIL) and 17% (HA-LYF).

Conclusion: In this study, the Restylane products demonstrated a wide range in firmness and flexibility. The NASHA products were the firmest within the product range (high G’), which may be of clinical importance in providing tissue lift and projection. The OBT products were flexible (high xStrain) and softer (low to intermediate G’), which may be of clinical importance in dynamic areas of the face. The predicted clinical performance of OBT and NASHA products based on gel firmness and flexibility was supported by existing clinical data.

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Shaving and electrocautery for the treatment of port wine stain - An inexpensive and optimized treatment option to remember

Objectives: To report a case with an inexpensive therapeutic management option, with low side effects, excellent recovery time between sessions and excellent aesthetic results for port-wine stain with nodules related to Sturge-Weber Syndrome (and which can be extended as an option to other nodular hemangiomatous lesions).

Introduction: Sturge-Weber syndrome, also known as encephalotrigeminal angiomatosis, is characterized by the triad of dermal capillary malformation (Port wine stain), in the distribution of the first branch of the trigeminal nerve (V1: ophthalmic), ipsilateral vascular malformation of the central nervous system (leptomeningeal angiomatosis) and vascular malformation of the ocular choroid associated with glaucoma.

Materials / method: Report the case of a female patient, 46 years old, with Sturge-Weber Syndrome associated with a port-wine stain on the left hemiface. The patient reports that she has had a spot since birth, but she reports that at age 23, after her first pregnancy, the spot began to create nodules, first on the nasal dorsum and supralabial region, but which extended to the entire lesion. She had performed CO2 laser sessions with a plastic surgery team with little response. She was referred to the dermatology service for aesthetic evaluation and proposal for shaving and electrocautery sessions.

Results: The patient underwent four sessions of shaving and electrocautery with excellent aesthetic results. The sessions were carried out in a day hospital, without the need for hospitalization and without the need for general anesthesia - they were carried out under local anesthesia. The interval between procedures was, in general, 30 days, with pain management performed with simple anesthetics, healing ointments, without infections and without the need to withdraw from their daily activities.

Conclusion: The shaving method associated with electrocautery for the treatment of verrucous hemangiomas such as port-wine stain related to Sturge-weber syndrome is a cheap therapeutic option, which does not require patient leave during procedure intervals, with low sequelae related to pain and post-session infections and with excellent aesthetic results.

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Case report: granulomas related to cosmetic procedures in the differential diagnosis of skin lesions

Objectives: To report a Granuloma referred to as Basal Cell Carcinoma (BCC). In this sense, aiming at the correct diagnosis, we seek to emphasize the importance of considering granulomas related to aesthetic procedures as differentials in the diagnosis of cutaneous lesions.

Introduction: PDO Sustaining Threads are widely used in face lift procedures whose techniques are minimally invasive and involve the insertion of barbed wires superficially to the musculoaponeurotic system. Such threads stimulate the proliferation of fibroblasts and the expression of TGB-beta, resulting in the local deposition of collagen. This technique has been gaining ground in the market due to the ease of performing the procedure, shorter recovery time and more affordable price when compared to surgical procedures. Some complications of this technique, however, have been reported, such as granulomas.

Materials / method: A 55-year-old woman reports having undergone a non-surgical rhinomodeling procedure with PDO threads nine months ago, at which time she alluded to having served as a model for a clinical course. After nine months of rhinomodelation, he reported poor healing and the appearance of a hardened, pruritic nodule in the same location. Dermatological examination confirmed a pearly hyperemic nodule with arboriform vessels in the distal region of the nasal dorsum on the left side referred for suspected Basal Cell Carcinoma (CBC).

Results: Histopathological examination of the pearly hyperemic papule with arboriform vessels on the left nasal tip was performed, which reported the absence of neoplasms in the sample. At the same time, he pointed out the presence of birefringent material of the foreign body type - surgical thread. Therefore, the diagnosis of Basal Cell Carcinoma (BCC) was discarded and the presence of granuloma related to the PDO thread was verified.

Conclusion: The popularization of PDO thread techniques for aesthetic procedures follows the need to study their repercussions. In this sense, it is necessary to bear in mind that granulomas related to aesthetic procedures are differential diagnoses in cases of cutaneous lesions. In the reported case, the patient, initially with suspected BCC, was submitted to histopathological tests that excluded such diagnosis, verifying the granuloma associated with the aesthetic procedure with PDO threads previously performed.

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The application of Fine-Needle Aspiration Biopsy (FNAB) guided by HFUs on diagnosis of complications after aesthetic procedures

Objectives: To report a case of complication with injection of dermal fillers, and new approaches to investigate its etiology and precise delimitations - such as HIGH-FREQUENCY ULTRASOUND (HFUS) and Fine Needle Aspiration Biopsy (FNAB).

Introduction: Classically, diagnosis in Dermatology are based on clinical and histopathological evaluation. However, high-frequency ultrasound (HFUS) is progressively being introduced into this medical specialty.

Materials / method: 44-year-old female patient evaluated on a Dermatology service, presenting with facial nodules after a cosmetic procedure. 2 years ago, she had dermal fillers injected on nasolabial folds and dark circles. Recently, she had an application of polylatic acid on the lateral portion of her face bilaterally. 15 days after the last procedure, she started with edema on the infrapalpebral region, with the presentation of hardened nodules on the infrapalpebral region, nasolabial folds, labiomentanoian sulcus and malars bilaterally.

Results: HFUS with Doppler was used on the entire face, with 18-22 Mhz linear transducers. An oval image was observed on the infrapalpebral medial region on the left side. It was characterized as slightly hipoechoic and heterogeneous, partially delimited on the hypodermis (1.1 x 0.6 cm), with no evidence of blood. The HFUS guided a FNAB, which confirmed the presence of an hyaluronic acid deposit, associated with a granulomatous reaction. Evaluation of the other lesions observed oval and hypoechoic nodules, with no evidence of anomalous vascular flow on the US, identifying a foreign reaction.

Conclusion: HFUS is effective in analyzing complications without performing invasive procedures. In both nodules, with different collections of material was identified a granulomatous reaction. US guided procedures, such as FNAB, are an excellent alternative in the evaluation of complications, allowing not only the identification of products but also the associated pathogenic process.

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Correction of jawline, jawangle and marionette lines in combination with P(LA/CL)threads and collagen-stimulating dermal filler: an innovative technique

Objectives: This study was aimed to evaluate the efficacy and safety of jawline, jaw angle, and marionette lines correction in combination with poly(lactic acid)/poly(caprolactone) barbed double needles threads and a collagen-stimulating (poly caprolactone based)dermal filler through an innovative technique.

Introduction: Facial aging is a multi factorial process in which considerable changes occur in different structures of the face. Thread lifting and injectables are the most common minimally invasive treatment in related to facial rejuvenation. This study was aimed to evaluate the efficacy and safety of jawline, jaw angle, and marionette lines correction in combination with poly(lactic acid)/poly(caprolactone) barbed double needles threads and a collagen-stimulating(poly caprolactone based) dermal filler through an innovative technique.

Materials / method: In our prospective chart review study, 50 volunteers for lower face correction were included in the study, between October 2019 to February 2020. For the correction,in every side,50 cm bidirectional barbed poly(lactic acid)/poly(caprolactone) thread in double needles form and 1 cc collagen-stimulating(poly caprolactone based) dermal filler, were used through an innovative technique. The efficacy (at 6 and 12 months after the surgery) and safety (1, 6, and 8 weeks after the surgery) were assess by two surgeons independently. Data were analyzed by SPSS ver. 22 for windows (IBM Inc, NY).

Results: 50 patients with Mean±SD age of 53.84±10.79 years old (Range: 42 years) were included. Patients’ level of satisfaction (improved to excellent levels) increased from 74% at 6 months after the surgery to 86% at 12 months after the surgery.The level of satisfaction obtained from surgeons (improved to excellent levels) decreased from 96% to 86% at 6 months and 12 months after the surgery.There were perfect agreements between the surgeon and the independent surgeon to evaluate the surgery efficacy of facial rejuvenation.No side effects were reported after 6 and 8 weeks after surgery.

Conclusion: Regarding the results, due to rare complications, with deep satisfaction, and short downtime, the correction of the lower face in combination with poly(lactic acid)/poly(caprolactone) barbed double needles threads and a collagen-stimulating(poly caprolactone based) dermal filler , through our innovative technique, would be considered as an efficient and safe treatment.

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Althena medical (Sponsored by ALTHENA MEDICAL)

Objectives: Solution for Screw caps hard to unscrew

Introduction: There is only one type of screw cap at present. This standard screw cap contains a rubber inside that wraps
around the tip. In this way the doctor has to apply an initial force for unscrewing, which in some cases can be annoying.

Materials / method: Our screw cap is made with a patented technical solution, which allows the threaded cap not to unscrew during autoclave sterilization, keeps the contents of the syringe sterile for years, and allows the doctor or specialist to easily open the syringe. This result was achieved through a specific study of the shape of the cap, which allows a high static friction between the cap and the luer-lock thread, but applying a very low torque when unscrewing. With this technical solution the rubber in the screw cap does not wrap around the tip, but is pressed against its opening, thus avoiding the entry

Conclusion: The screw cap has been tested during autoclaving many times using various types of drugs and substances from ferrofluid materials, to bone cements, from hyaluronic acids with different densities to saline solutions. All the syringes, 100 pieces for every substance, were then subjected to hermeticity tests with blue methylene, thus demonstrating the absolute tightness of the cap. The same syringes have been subjected to fast aging, up to 5 years, proving also in this case the perfect seal of the cap. Tests with a torque wrench have shown that the necessary force to open one of our syringes is

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Este trabalho foi realizado com o patrocínio de: ALTHENA MEDICAL

Photobiodynamic therapy: a new alternative for the treatment of melasma (Sponsored by SKYMEDIC)

Objectives: To evaluate the effect on the improvement of melasma of a multimodal photobiodynamic therapy that combines the topical application of antioxidant molecules, tyrosinase inhibitors, melanogenesis blockers, antioxidants, and anti-inflammatory molecules, with UV-free photomodulation based on HDD light ( I.o.530± 10 nm) and colloidal
gold as photoactivator.

Introduction: Melasma is a common acquired disorder of facial hyperpigmentation with frequent recurrence after treatment.
Treatments used up to now are either associated with toxicity, or have shown unsatisfactory or short-lasting results.

Materials / method: The presence of defined brown spots of variable extension (melasma) and red areas (vascular alterations) on the
face of the patients was evaluated before and after 6 weeks after finishing treatment. For this, Wood's lamp, VISIA
system and 3D Digital Photography were used. The treatment was applied in 4 phases (peeling, photodynamic
serum, HDD light and depigmenting mask) under medical supervision.

Results: 28 volunteer patients, diagnosed with melasma, of Latino origin with a predominance of phototype III on the Fitz
patrick scale participated in this study. 86% of the patients, in addition to melasma, exhibited red areas, indicative
of vascular alteration. 75% of the patients had been previously treated in the last two years with other treatment
modalities and were repeaters. The 3D digital photographs showed that all the patients improved in the resolution
of the spots after the treatment.

Conclusion: The results of this work are preliminary. However, they showed for the first time, that the treatment of melasma with
multimodal photobiodynamic therapy was effective and it didn’t cause any discomfort or immflamatory complications
after its application, in any of the patients, although it is necessary to evaluate the effect in these patients later in time.

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Evaluation of artificial sea water damage on the bleached and dyed hair fiber

Objectives: To evaluate the damage caused by artificial sea water, in virgin hair fiber, bleached hair and colored hair with 3 different levels of blonde (8.0; 10.0 and 12.0) with the evaluations: color, combing force and loss protein albumin equivalente.

Introduction: Hair is basically composed of a protein, the keratin. It is constantly damaged by: ambiental factors, chemical treatments, types if water and thermic accessories. The discoloration and coloring processes are related to hair fiber damage and cause: weakening, loss of aesthetic characteristics or even hair loss due to breakage and interferes with the hair structure making them more sensitive and fragile.

Materials / method: It was used a straight brown virgin lock; bleached and toned locks with the respective blonde levels. They were divided into 5 groups: virgin (Control), Discolored and with Coloring 8.0 (T1), 10.0 (T2) and 12.0 (T3) and were immersed for 3 h/day (4 days). After each submission, they were rinsed with warm water and dried. In sequence, the locks were applied with conditioner, washed off and dry at 23.0°C. Artificial sea water: mixture of ready-made sea salts and distilled water. Analyses:Color. dE* represents the total color differen-ce. Dry combing. The total work required to dry comb the lock.

Results: Dry Combing (Fig. 1), after the submission of artificial sea water, there was an increase in the force in all hair’s groups (virgin, bleached and colored). The blonde level 12.0 (T3) had the highest strength compared to the virgin. The Color showed little change of the locks after submission in artificial sea water. Protein loss. Fig. 2 showed a difference between the Blue group x Orange less than 5% in all groups. The artificial seawater does not able to damage the hair fiber in relation to the loss of hair proteins.

Conclusion: The greatest damage caused to the hair fiber was the discoloration process: dye 8.0 the most color alteration and 12.0 the highest strength comb force. The conditioning process reduced the combing force. The artificial seawater does not was able to damage the hair fiber (loss of hair proteins), by keeping the cortex and cuticule preserved. The salts present in the artificial seawater increased the force used (J) to comb the locks in the groups. The force to comb the locks decreased notoriously in the group with the conditioning wash after the artificial seawater.

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Methodologies to evaluate the properties of the hair fiber and guide clinical treatment

Objectives: Scientific methods that can evaluate the characteristics of the layers of the hair shaft, such as the cuticles and the joint interpretation of the results was the objective of this work that intend to aim the clinic treatment.

Introduction: When exposed to various chemical treatments, the hair suffers damage to its structure and alters the characteristics of color, brightness, breaking strength, elasticity, combability, among others. Among the factors to be considered to select the most appropriate method, we consider the cortex and cuticle layer of the hair shaft such as important points to be evaluated. Protect these layers prevent damage to the structure of hair fiber.

Materials / method: Strands of standard straight and wavy hair were subjected to a process straightening and discoloration. The evaluations were carried out in a comparative way with the untreated, virgin lock (CT).

Color - Diffuse reflectance spectrophotometry  specific equation, dE*  total color difference.

Shine - Polarized camera  imaging system that mimics the eye  calculates the brightness amplitude by a luster equation.

Dry combing - Standardized equipment  the total work required to dry combing the locks before and after the chemical treatments.

Results: Color - Straight and wavy hair that was bleached (DD) showed variation in parameter dE* 64.06±1.0 and 59.90±0.35; respectively, Figure 1. Comparing the results, there were statistically significant differences in dE*.

Shine - The straight and wavy control locks (CT) had a statistical variation of 33.6±0.66 and 27.32 ±1.38 au. brightness, respectively. DD and TUC showed reduced Luster for all hair type.

Dry combing - The same treatment had a similar behavior, Figure 2. There was a decrease in total work after treatment in wavy hair with TIO and GUA, and for GUA greater force was needed.

Conclusion: The color, shine and combing tests showed similar perceptions and behaviors following the pattern of the different types of damage caused by the treatment. The discolored samples (DD) and those dyed ultra-light blonde (TUC) or platinum had more damage to the cuticles, with greater dE* (color variation), less shine and greater force when combing. The TLC, TIO and GUA samples exhibited minor changes when compared to the CT samples. It was found that all procedures applied to the locks could cause damage, reflecting the need to use hair products that can minimize the problem.

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Role of ultrasound in the diagnosis and management of the complications of common non-surgical midface rejuvenation methods: a case study

Objectives: 1- Diagnosis and treatment of the complications of filler injection superficial to SMAS for mid-face rejuvenation with ultrasound guidance;
2- Focus on mid-face deep structural age-related changes;
3- Ultrasound-assisted augmentation of supportive mid-face structures by injecting filler in sub-SMAS;
4- Comparison of the results of supra and sub-SMAS filler injection for mid-face rejuvenation;
5- Considering the role of ultrasound in the management of filler complications and sub-SMAS injection for mid-face rejuvenation.

Introduction: Aging process involves all anatomical layers. One of the prominent issues in mid-face aging is losing anterior maxillary projection. While traditional non-surgical mid-face rejuvenation methods usually focus on the filler injection superior to superficial musculoaponeurotic system (supra-SMAS), deep to SMAS (sub-SMAS) injection has been given priority in recent ones (1).
We compare the outcomes of supra and sub-SMAS hyaluronic acid (HA) filler injection for mid-face rejuvenation and correction of nasolabial folds (NLFs) in a case managed with ultrasound.

Materials / method: A 52-year-old woman was treated with supra-SMAS injection of 4cc HA filler for the improvement of her NLFs. Two months later, she came to us with chief complaint of droopy lip corners (Fig1.1). We studied her mid-face with ultrasound and found migrated filler on superficial nasolabial fat pads (Fig1.A,B). Ultrasound-guided filler removal by hyaluronidase injection corrected her lip ptosis (Fig1.2). Then, we assessed the depth of the pyriform spaces with ultrasound (Fig1.C) and chose an appropriate needle to inject HA filler in these spaces to compensate lost projection.

Results: The results of the sub-SMAS injection in deep pyriform spaces are available in Fig1.3. We can compare the effectiveness of supra and sub-SMAS filler injection for mid-face rejuvenation in Fig1 (1 and 3).

Conclusion: In this case, superficial migrated filler acted as an obstacle on the contracture of lip elevator muscles and led to lip ptosis (2). Ultrasound enabled us to find and remove this obstacle.
With the usage of ultrasound, we could measure the exact depth of recessed pyriform spaces and select appropriate devices (in this case, needles with 25 mm length). Ultrasound-guided augmentation of these spaces not only resulted in the improvement of anterior maxillary projection and having a natural youthful appearance but also avoided vascular complications.

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Positive results of striae distensae treatment with HA mechanically stabilized lift formulation complexes: a case report

Objectives: To report a two months follow up assessment of therapy by injection of HA mechanically stabilized lift formulation complexes (HLC) in an adult female with striae distensae (SD) on the legs.

On HLC the main ingredient is HA stabilized with specific active ingredient’s formulation composed by amino acids (arginine, proline, valine, glycine, lysine) and vitamins (riboflavin, biotin, tocopherol, sodium ascorbyl phosphate). The combination of the ingredients activities can result into reparation of the skin alteration in SD. The evaluation of the positive impact is described in this case.

Introduction: Striae distensae (SD) or "stretchmarks", are a form of scarring on the skin with an off-colour hue, they are caused by tearing of the dermis, which over time may diminish, but will not disappear completely. They are the result of the rapid stretching of the skin associated with rapid growth or rapid weight changes.
In most cases may also be influenced by hormonal changes associated with: puberty, pregnancy, bodybuilding or hormone replacement therapy. HA mechanically stabilized lift formulation complexes (HLC) can be a different way of therapy to improve, prevent and manage striae.

Materials / method: A 35 years old female with striae distensae on the legs area, was selected for HLC procedure in our clinic. The affected area presented superficial white SD with no ladder rungs and non-palpable depression, that correspond to a stage 2A on the Deprez-Adato classification. Three treatment sessions biweekly were suggested as protocol, a control session was done 2 weeks after last treatment. Three millilitres HLC were used per session. The injectable method was intradermal papula technique with a 4mm 33G needle. Contraindications, such as active infection of the skin were not present.

Results: Skin structure improvement can be seen by visual assessment and clinical imaging. Brightness of skin with the shown SD was significantly higher before than after the treatment cycle. Overall improvement of the dermo-epidermal layer can be seen as less reflective texture and reduction of the “shine-through” aspect. Elevation of the dermal-epidermal junction maybe functionally related to the positive effect of the HA to the collagen fiber alignment. Overall, the skin seems more firm and more elastic as revealing changes of the dermal thickness and elasticity of stratum corneum.

Conclusion: This report demonstrates that injectable treatment with HLC is beneficial reducing and improving the appearance of SD.
This outcome suggests that the HA together with the active ingredients present in the HLC formulation, it can be helpful in prevention and improving skin changes associated with SD.

These data need to be corroborated, but suggest that HLC has a therapeutic and preventive benefit in the handling of SD. The molecular mechanisms underlying the observed effect needs to be further investigated.

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Effect of exosome liposome hybrid extracellular vesicles in wound healing

Objectives: 1:Isolation of cord blood plasma exosome
2:Liposome preparation with sonication method
3:Characterization of exosome, liposome and hybrosome
4:Investigation the wound healing effect of hybrosomes in in vitro model

Introduction: Wound healing is the main physiological process consisting of hemostasis, inflammation, cell proliferation, migration, and tissue remodeling steps. Recent studies showed that body fluids and plasma applications for tissue engineering continues to attract interest among regenerative medicine. It has been identified that umbilical cord blood is an essential source of extracellular vesicles carrying messenger molecules called exosomes. They promotes angiogenesis and speeds up wound healing. Currently, liposome hybridization utilizing to modify and upgrade the cargo carrying capacity of exosomes.

Materials / method: In this study, as a first step the cord blood of female calf giving birth was collected. Cord blood plasma separated from the unwanted blood components by centrifugation. Exosome isolation was conducted with Exo-spinTM Buffer. Hybrosome vesicles were prepared via probe-sonication. Nanoparticle tracking assay, flow cytometry analysis, cell proliferation tests, wound healing tests, immunohistochemistry analyses, anti-inflammation tests, RT-PCRi, and cellular uptake studies were carried out in in vitro to characterize the novel hybrid exosomes and determine their efficacy on wound healing.

Results: NTA study shows that UCBP exosome, liposome, and hybrosome had size ranges of 106, 191, and 139 nm.The presence of the CD63 and CD81 biomarker proteins of exosome, liposome and hybrosome was examined by labelling with CD63, and CD81 antibodies.Cell proliferation utilized with WST-1 assay and 100 ug/ml selected as active dosage.Cellular uptake performed with 100 µg/mL PKH67-labeled exosome, liposome and hybrosomes for 48 h. Scratch assay confirmed the wound healing and cell migration effect of hybrosome. Hybrosomes had an effect on pulling inflammation back and increase COL, MMP & laminin genes

Conclusion: In this study, a new approach named “hybrosome” was developed by hybridizing calf umbilical cord blood plasma derived exosomes and liposomes for the first time to control and modify the performance of calf umbilical cord blood exosome nanocarriers by fusing membranes of exosomes and liposomes. Considering the experimental observations, hybrosome technology is a promising new generation bioengineering approach in the field of regenerative medicine and wound treatments.

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Clinical trials of exosome liposome hybrid extracellular vesicles

Objectives: Formulation and evaluation of anti-aging and wound healing effects of a topical cream containing Hybrosome. Three different clinical studies have been designed for the active substance obtained with the Hybrosome technology. A stable dermatological formulation having Hybrosome as a main ingredient, was formulated and applied to human skin and compared with controlled base formulation and retinol, and the results were examined. Different parameters related to skin aging such as TEWL, wrinkle area and melanin level were evaluated.

Introduction: Skin provides protection against the external environment. It supports fluid balance, regulates body temperature, and protects the body from the harmful effects of sunshine, microorganisms, and chemicals. The skin structure is broadly composed of three layers: epidermis, dermis and hypodermis. Due to internal and external factors, the collagen and elastic fibers in the dermal tissue of the skin are altered or disrupted, which results in the development of wrinkles and skin sagging as the loss of skin elasticity is one of the primary causes of skin aging.

Materials / method: The aim of the test was to define the direct influence of the tested product on reduction of wrinkle wrinkle area on the measurement zone by using Primos 3D Lite. The test has been conducted using special measuring device manufactured by LMI Technologies GmbH. Instrumental study has been carried out on 108 subjects. The measurements have been performed at the site of application –before product application (D0), after 28 days (D28) and after 56 days (D56) of regular use.

Results: Hybrosome creams are compared with Retinol, Hybrosome creams cause more elasticity and decrease wrinkle area than retinol.When different concentrations of hybrosome creams were compared, it was observed that there was no statistically significant difference between the two concentrations.Clinical Trail II results shows that Recure is better in wrinkle area and TEWL reduces and lightens the skin more than retinol.Significant reduction of forehead, crow’s feet, and recovery of wrinkle area upon treatment with hybrosome cream once a day after 28 and 56 days in Clinicial Trail III.

Conclusion: it has been seen that cream formulation with Hybrosome molecule, obtained with exosome liposome hybridization technology, reduces the wrinkle area, increases the elasticity, as well as gives better results in wrinkle area and TEWL recovery against the gold standard retinol. The recovery of the forehead and crow's feet wrinkle areas as well as the melanin level results of hybrosome improved in direct proportion to the usage, according to findings of 28 and 56-day blind tests.it supports wound healing in diabetic non-healing wounds and Finger put amputation cases and effective in alopecia.

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Consensus on the use of HA fillers from the cohesive polydensified matrix range: best practice in specific facial indications (Sponsored by MERZ AESTHETICS)

Objectives: The mail objective of this Consensus Meeting was to define best practice of the use of the CPM-HA portfolio in various facial indications based on (rheological) characteristics and specific techniques based on avoidance of complications.

Introduction: As the treatment indications for the Cohesive Polydensified Matrix® hyaluronic
acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.

Materials / method: An international panel of experts in the field of aesthetic medicine convened to
develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.

Results: Consensus members considered treatment indications in the upper, middle and
lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including their newest addition.

Conclusion: The recommendations in this consensus document are provided to assist
clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.

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Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Successful cosmetic treatment in a patient with connective tissue disorder with CaHA filler - Case report

Objectives: We aim to report a case of good response after a CaHA filler treatment to improve skin quality in a patient with stable scleroderma.

Introduction: Cosmetic treatments in patients with connective tissue disorders (CTD), such as scleroderma, is controversial since there is a theoretical risk of re-triggering the disease by immune activation. Despite this concern, recent studies have demonstrated that dermal fillers seem to be safe in this patient population. Among the different types of fillers, the choice for patients with CTD should be based on low potential to generate inflammation. Several in vivo, microscopy and ultrastructural studies have shown that CaHA fillers stimulate fibroblasts collagenesis with minimal inflammatory response.

Materials / method: A 72-year-old woman presented in 2021 due to aging skin. She was diagnosed with scleroderma in 2013. Upon presentation, her disease was stable for 5 years and she was in use of prednisone and mycophenolate. On medical examination, it was observed loss of facial contour and thinning of the skin. After informed consent was obtained, three separate sessions of CaHA injections were performed, with 3 months and one-year intervals between them. A cannula was positioned in the sub-dermal plane and the filler was distributed in a fan technique.to cover areas of the cheeks, mandibular line and chin.

Results: The result observed was an improvement in skin quality and facial contour, which was noticeable up to 1 year following the applications. The patient did not experience any adverse effects.

Conclusion: CaHA fillers are apparently possible alternatives for aesthetic treatments in patients with CTD, despite the theoretical risk of disease reactivation. Further studies are needed to compare more precisely the properties of the different fillers available on the market, regarding their mechanism of collagen induction, amount of collagen produced, durability and safeness in CTD population.

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Clinical results on a novel Autologous Micrografting Technology (AMT) in androgenetic alopecia patients (Sponsored by REGENERA ACTIVA SL)

Objectives: Presenting clinical results on a novel Autologous Micrografting Technology (AMT) used in 16 Androgenetic Alopecia patients in a 6-month follow-up study.

Introduction: Androgenetic Alopecia (AGA) is still one of the most relevant aesthetic-related conditions people suffer all over the world, having a great impact on mental health. Little has progressed in the pharmaceutical industry since the commercialization of minoxidil and finasteride, having alternative therapies like Platelet-Rich Plasma (PRP) taking the lead on AGA treatment innovation. However, doctors and patients still require new alternative and innovative therapies. Autologous Micrografting Technology (AMT) is a single-session minimally invasive autologous treatment based on progenitor.

Materials / method: Clinical evaluation, global photography assessment, and trichoscopy were performed before and once every 3 months after treatment. Trichoscopy evaluation was performed with FotoFinder Leviacam using a standard TrichoLAB trichoscopy report.

Results: Results show a statistically significant improvement of hair diameter mean in the frontal area at months 3 and 6 compared to month 0.

Conclusion: AMT technology as monotherapy can increase hair thickness and improve scalp coverage, posing a novel effective therapy for AGA patients. The combination of the tissue-specific growth factors expressed by AMT’s progenitor cells with those unspecific factors present in PRP treatments may pose an innovative approach for AGA, stimulating angiogenesis through different pathways that could rescue hair follicles before total miniaturization.

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Este trabalho foi realizado com o patrocínio de: REGENERA ACTIVA SL

Efficacy and safety of monopolar RF for Treatment of lower facial laxity in Asian patients (Sponsored by WONTECH)

Objectives: This study aims to evaluate the efficacy and safety of MRF for treating lower facial laxity in Asians.

Introduction: The face transforms throughout time. The alterations occur at every anatomic level due to a dynamic interaction between extrinsic and intrinsic factors and the activities of the facial musculature. Gradual deterioration of these layers manifests clinically as excessive skin laxity. Lower face wrinkles and excessive skin laxity make people look ‘‘older.’’ Over time, the designs of RF devices have advanced so that they can now tighten and contour the skin and body effectively.

Materials / method: This prospective, cohort, evaluator-blinded study enrolled 30 volunteers with Fitzpatrick Skin Types Ⅲ-Ⅳ and mild-to-moderate skin laxity. Subjects received a single MRF treatment.
The study used a monopolar radiofrequency device (Oligio; Won Tech Co., Ltd., Seongnam, Gyeonggi, Korea) with a frequency of 6.78 MHz. The system generates deep-tissue heating (40-60℃). Contact cooling from a cryogen spray on the inner surface of the treatment tip occurs simultaneously before, during, and after each energy pulse.

Results: The dermatologists’ assessments of improvement in lower facial laxity using the 6-point scale are summarized in Fig. 1. Immediately after treatment, 65% of the patients showed a 1–25% improvement, and 33.33% showed a 26–50% improvement. Some patients became worse (5%) or had no change (26.67%) relative to baseline. Steady improvements were observed at the 1-, 3-, and 6-month follow-ups (P<0.01; Table 2). At the 1-month follow-up, 86.67% of patients showed improvement, with 1–25%, 26–50%, and 51–75% improvements in 61.67%, 16.67%, and 8.33% of the patients, respectively.

Conclusion: Our prospective clinical trial demonstrated that the new-generation MRF device we investigated is effective and safe for lower facial laxity in Asian skin. MRF treatment appears to give mild-to-moderate improvement, with statistically significant improvement over time. Additionally, the newer technologies of the latest MRF devices offer improved levels of safety that prevent complications. Appropriate patient selection, a proper setting, and suitable treatment protocols are mandatory to achieve optimal clinical outcomes.

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Este trabalho foi realizado com o patrocínio de: WONTECH

A topical antioxidant serum containing silymarin reduces sebum peroxidation and improves facial acne

Objectives: This study evaluated the ability of a serum containing 0.5% silymarin, 15% vitamin C, 0.5% ferulic acid, and 0.5% salicylic acid to help reduce sebum peroxidation and improve facial acne when used over time.

Introduction: Research suggests a connection between acne vulgaris and cutaneous lipid peroxidation. Since there is evidence that certain antioxidants can help reduce lipid peroxidation, an opportunity exists for topical antioxidant treatment to help intervene in this pathogenesis.

Materials / method: Research suggests a connection between acne vulgaris and cutaneous lipid peroxidation. Since there is evidence that certain antioxidants can help reduce lipid peroxidation, an opportunity exists for topical antioxidant treatment to help intervene in this pathogenesis.

Results: After 4 weeks of treatment, subjects showed statistically significant improvement in skin clarity, skin tone evenness, and PIH which continued to improve through week 12. Global lesion count showed a modest decreasing trend at week 4, but significant improvement by week 8 and week 12. Overall sebum levels showed reduction as early as week 1. Furthermore, analysis of the collected sebum samples showed reduction in squalene peroxide at both week 4 and week 12.

Conclusion: This efficacy study demonstrated that a topical serum containing 0.5% silymarin, 15% vitamin C, 0.5% ferulic acid, and 0.5% salicylic acid was effective in reducing facial acne and improving associated skin attributes such as clarity, tone evenness, and pigmentation. While some skin benefits are seen rather quickly, the strongest improvement in lesional acne is observed with continued usage. This suggests that the fundamental stabilization of lipid peroxidation may be an important underlying strategy for daily management of oily, acne-prone skin while also improving overall skin appearance.

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor.

Comparative clinical and histomorphological evaluation of the injectable CPM-HA 20 and CaHA combination (Sponsored by MERZ AESTHETICS)

Objectives: This article highlights the clinical advantage of the combined injection of CPM-HA20 and CaHA. Combination of CPM-HA20 and standard CaHA had a greater expected remodeling effect on one’s skin compared to combined injection of CPM-HA20 and diluted CaHA.

Introduction: Aging is a result of the interplay of changes occurring in all facial anatomical layers. To target these, multilayer, combined intervention is required to relax, volumize, resurface, and re-drape facial skin. No single technology, filler, or neuromodulator can achieve all the results desired in treating the aging face. CPM-HA20 and CaHA being dermal fillers are Ministry of Health of the RF approved. Combined aesthetic interventions have widespread application in clinical practice, but results are infrequently reported. Expert consensus supports a combination approach using multiple modalities

Materials / method: An open-label, prospective study enrolled 14 female volunteers, 35–45 years of age with BMI < 21, and randomly assigned subjects to groups injected with CPM-HA20 all over the face and periauricular area at the first Visit (D01) and followed subdermal diluted (Group I) or standard (Group II) CaHA at the second stage (M01). Data included Merz Aesthetics Scales™ scores by independent experts, Global Aesthetic Improvement Scale (GAIS) scores by subjects and investigators, evaluation of skin elasticity, type I/ III collagen, and elastic fibers, assessed at Stage 2 (M01) and Stage 3 (M06). Mild stai

Results: The results of this study demonstrate that the injections of CPM-HA20 and CaHA supply clinical and histomorphological improvement. According to our results, the injections of CPM-HA20 and standard CaHA had a relatively greater remodeling effect on one’s skin compared to the injections of CPM-HA20 and diluted CaHA.

Conclusion: Evaluation according to a Merz scale and patient satisfaction evaluation based on the GAIS Scale showed no difference between groups.
Combined injection of CPM-HA20 and CaHA had a greater remodeling effect on the dermis over baseline, confirmed by intense type I - III collagen accumulation in the dermis (p<0,05) and intense angiogenesis. Injection of CPM-HA20 and standard CaHA had a greater remodeling effect on skin compared to the combination with diluted CaHA, confirmed by intense type I – III collagen accumulation in the dermis (р<0,05) and intense angiogenesis (p<0,05).

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Não

Você possui relação financeira com alguma entidade que possa competir com os medicamentos, materiais ou instrumentos abordados no seu estudo?
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Você detém ou pediu a registro de patente para algum dos instrumentos, medicamentos ou materiais abordados no seu estudo?
Não

Este trabalho foi realizado com o patrocínio de: MERZ AESTHETICS

Palestrantes	Título da apresentação	Resumo	Número
Dr Sevasti AFANTENOU	Combined treatment of phototherapy, chemical peeling and topical combination of adapalene/benzoyl peroxide in patients with papulopustular acne	Visualizar	123124
Dr Akriti AGRAWAL	No-Laboratory Epidermal Cell Paste (NLEP) technique - A novel modification of non-cultured epidermal cell suspension	Visualizar	122458
Dr Cleiton Jose BELLE KUNZLER	Technical evaluation and in-vitro studies of different CaHA-containing dermal fillers: considering the impact of particle characteristics on biostimulation (Sponsored by MERZ AESTHETICS)	Visualizar	122889
Dr Stefano BERARDI	The treatment for vulvovaginal atrophy symptoms in breast cancer patients under tamoxifen therapy: is the RF-electroporation synergy a good option? (Sponsored by TOP QUALITY)	Visualizar	122918
Dr Birgit BLESSMANN GURK	Evaluation of a unique combination of nutrients in the management of hair loss in women (Sponsored by MERZ THERAPEUTICS)	Visualizar	123223
Dr Antonio CAMPO VOEGELI	Broadband light and 1064 nm Nd: YAG: an effective combination - Treatment for skin rejuvenation and facial redness (Sponsored by SCITON)	Visualizar	122907
Dr Rajeev CHAVDA	A customized skin care routine benefits patients with severe rosacea under combination therapy with ivermectin 1% cream and doxycycline 40-mg or ivermectin and placebo (Sponsored by GALDERMA)	Visualizar	123122
Dr Nunzio CIRULLI	Innovative application of diathermy in orthodontics: a case report (Sponsored by TOP QUALITY)	Visualizar	123364
Sarah COQUIS KNEZEK	How glabellar line severity at baseline can affect efficacy in neurotoxin trials (Sponsored by GALDERMA)	Visualizar	122884
Andy CURRY	HSA as a stabilizer in aesthetic injectables (Sponsored by MERZ AESTHETICS)	Visualizar	123149
Dr Fernanda DACACHE JUNQUEIRA	Burns and hyperpigmentation post-adult female acne treatment	Visualizar	122935
Dr Carina DAUGHTRY	Awareness of aesthetic and therapeutic crossover usage of botulinum toxin type A (Sponsored by MERZ AESTHETICS)	Visualizar	122757
Dr Sabrina FABI	Effectiveness and safety of correction of cheek wrinkles using a biostimulatory PLLA injectable implant – Clinical study data up to 24 m (Sponsored by GALDERMA)	Visualizar	123101
Dr Sabrina FABI	Skin movement and volume changes with PLLA-SCA injectable implant: a subgroup analysis of the cheek wrinkle trial (Sponsored by GALDERMA)	Visualizar	123222
Dr Jimmy FAIVRE	Deciphering the features of lightfillers with the Teosyal RHA® Range from lab to patient (Sponsored by TEOXANE)	Visualizar	123435
Prof Peter Arne GERBER	Ready-to-use abobotulinumtoxinA solution vs powder onabotulinumtoxinA for treating glabellar lines: subjects’ and Investigators’ experience (Sponsored by GALDERMA)	Visualizar	123157
Dr Kate GOLDIE	Skin quality - A holistic 360 degree view - Consensus results (Sponsored by MERZ AESTHETICS)	Visualizar	123206
Dr Joyce Santos Quenca GUILLEN	Dermatological treatment using plant-based makeup as a vehicle	Visualizar	122898
Prof Merete HAEDERSDAL	Cosmetic outcomes in patient-centered management of actinic keratosis – Personalising Actinic Keratosis Treatment (PAKT) expert consensus (Sponsored by GALDERMA)	Visualizar	122079
Thomas HENGL	Glycerol, a well-tolerated humectant in dermal fillers (Sponsored by MERZ AESTHETICS)	Visualizar	122983
Thomas HENGL	Tissue integration of HA-containing dermal fillers: an automated and comprehensive approach to systemically compare dermal fillers (Sponsored by MERZ AESTHETICS)	Visualizar	122985
Dr Kanella KALAPOTHAKOU	Neck rejuvenation in a female patient with pseudoxanthoma elasticum: a case report	Visualizar	123295
Dr Aikaterini Anni KARAISKOU	Safety and effectiveness of nasal reshaping with HA through cannula technique: a real-life study	Visualizar	123086
Dr Won Serk KIM	Efficacy and safety of 755 nm picosecond alexandrite laser for the treatment of dermal melanocytosis: a prospective clinical trial (Sponsored by WONTECH)	Visualizar	123439
Dr Linda KLEINE BOERGER	Rheological properties of injectable HA of CPM and NASHA technology	Visualizar	123107
Dr Linda KLEINE BOERGER	Skin quality booster with glycerol – their viscoelastic skin potential	Visualizar	123119
Prof Zekayi KUTLUBAY	Autologous follicular stem cell micrograft therapy: a new generation treatment modality for androgenetic alopecia (Sponsored by GLOBAL BIYOMEDIKAL)	Visualizar	123432
Dr Yean Chen LAI	Uncommon management of a common dermatological condition: treatment of Keratosis Pilaris Rubra (KPR) with low fluence Q-switched 595 nm Nd:YAG laser	Visualizar	121630
Dr Arnaud LAMBERT	Hybrid fractional laser treatment for photorejuvenation (Sponsored by SCITON)	Visualizar	122908
Dr Alicia Kwei Huan LIW	Where’s my other eyelid crease? Fixing double eyelid asymmetry with modified single-knot continuous buried suture technique	Visualizar	123285
Dr Rafael LOUCAS	How useful is the supra sternal notch to nipple distance? A prospective cross-sectional questionnaire survey on anthropometric measurements	Visualizar	123236
Dr Stephen LYNCH	A topical antioxidant serum containing silymarin reduces sebum peroxidation and improves facial acne (Sponsored by SKINCEUTICALS)		123362
Dr Hamidreza MAHMOUDI	Anatomic evaluation of the normal variants of the arteries of face using color	Visualizar	123181
Dr Tercio MARTINS	Analysis of protein loss as a marker of broad hair shaft damage: evaluation by Lowry and rapid (RPLT) tests.	Visualizar	123153
Dr Tercio MARTINS	Rapid protein loss test as a guide to hair damage	Visualizar	123216
Dr Tercio MARTINS	The influence of oil from the seed of the Peruvian Amazon palm tree (Mauritia flexuosa - Aguaje) on the aesthetic qualities of hair	Visualizar	123264
Prof Alain Ali MOJALLAL	Clinical investigation to evaluate the facial volume restoration and augmentation after HA njection in the face with IPN-26-SENSE (Sponsored by LABORATOIRES VIVACY)	Visualizar	123225
Peter MORGAN	Product manufacturing process for PLLA-SCA (Sponsored by GALDERMA)	Visualizar	123221
Dr Lynhda NGUYEN	Dermatological tattoo complications	Visualizar	123288
Dr Bartosch NOWAG	Biostimulating fillers and inflammatory pathways: a preclinical investigation (Sponsored by MERZ AESTHETICS)	Visualizar	123102
Dr Jesus OLIVAS MENAYO	The MICRO-Lift: A ligaments-based anatomic technique for lower face and neck rejuvenation using bipolar radiofrequency (Sponsored by INMODE)	Visualizar	124237
Dr Renato PAZZINI	Injectable dermal filler technique for gluteal augmentation and harmonization (Sponsored by ILIKIA BRASIL)	Visualizar	123253
Inna PRYGOVA	Improvement of chin retrusion in Chinese subjects using HA filler: a randomized, controlled, evaluator-blinded study (Sponsored by GALDERMA)	Visualizar	122882
Inna PRYGOVA	Subject and physician satisfaction with abobotulinumtoxinA for glabellar line treatment in a real-world study in Chinese subjects (Sponsored by GALDERMA)	Visualizar	123142
Inna PRYGOVA	Differentiation of NASHA and OBT HA gels according to firmness and flexibility and the associated clinical significance (Sponsored by GALDERMA)	Visualizar	123207
Dr Fernanda RAMOS PAES E LIMA	Shaving and electrocautery for the treatment of port wine stain - An inexpensive and optimized treatment option to remember	Visualizar	123269
Dr Fernanda RAMOS PAES E LIMA	Case report: granulomas related to cosmetic procedures in the differential diagnosis of skin lesions	Visualizar	123293
Dr Fernanda RAMOS PAES E LIMA	The application of Fine-Needle Aspiration Biopsy (FNAB) guided by HFUs on diagnosis of complications after aesthetic procedures	Visualizar	123297
Dr Samad REZAEE KHIABANLOO	Correction of jawline, jawangle and marionette lines in combination with P(LA/CL)threads and collagen-stimulating dermal filler: an innovative technique	Visualizar	121141
Alfredo RICCI	Althena medical (Sponsored by ALTHENA MEDICAL)	Visualizar	122910
Dr Zulay RIVERA PINEDA	Photobiodynamic therapy: a new alternative for the treatment of melasma (Sponsored by SKYMEDIC)	Visualizar	122909
Dr Maria Valeria ROBLES VELASCO	Evaluation of artificial sea water damage on the bleached and dyed hair fiber	Visualizar	122893
Dr Claudineia Aparecida SALES DE OLIVEIRA PINTO	Methodologies to evaluate the properties of the hair fiber and guide clinical treatment	Visualizar	122921
Dr Pantea SHEKARRIZ	Role of ultrasound in the diagnosis and management of the complications of common non-surgical midface rejuvenation methods: a case study	Visualizar	122050
Dr Gabriel SIQUIER DAMETO	Positive results of striae distensae treatment with HA mechanically stabilized lift formulation complexes: a case report	Visualizar	122988
Ray SONG	Daeyang Medical (Sponsored by DAEYANG MEDICAL)		123363
Dr Tunc TIRYAKI	Effect of exosome liposome hybrid extracellular vesicles in wound healing	Visualizar	122905
Dr Tunc TIRYAKI	Clinical trials of exosome liposome hybrid extracellular vesicles	Visualizar	122906
Dr Jani VAN LOGHEM	Consensus on the use of HA fillers from the cohesive polydensified matrix range: best practice in specific facial indications (Sponsored by MERZ AESTHETICS)	Visualizar	122648
Dr Rossana VASCONCELOS	Successful cosmetic treatment in a patient with connective tissue disorder with CaHA filler - Case report	Visualizar	122025
Dr Colombina VINCENZI	Clinical results on a novel Autologous Micrografting Technology (AMT) in androgenetic alopecia patients (Sponsored by REGENERA ACTIVA SL)	Visualizar	123254
Prof Rungsima WANITPHAKDEEDECHA	Efficacy and safety of monopolar RF for Treatment of lower facial laxity in Asian patients (Sponsored by WONTECH)	Visualizar	123438
Dr Stacy WHITE	A topical antioxidant serum containing silymarin reduces sebum peroxidation and improves facial acne	Visualizar	123210
Prof Yana YUTSKOVSKAYA	Comparative clinical and histomorphological evaluation of the injectable CPM-HA 20 and CaHA combination (Sponsored by MERZ AESTHETICS)	Visualizar	123226

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IMCAS World Congress 2023
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