IMCAS

Effectiveness of low-fluence intense pulsed light in the treatment of melasma: A case series study

Objectives: To evaluate the clinical response with low fluence intense pulsed light treatment in the treatment of melasma.

Introduction: Melasma is a common and well-described dermatological condition that primarily affects female patients. It involves hyperpigmentation that is chronic, relapsing.

Laser and light therapy represent an alternative t to treat melasma and may be particularly beneficial for patients with melasma that is refractory to topical therapy or chemical peel regimens, or when a patient wishes for an accelerated pace of improvement.

IPL therapy uses a light source. Filter sets allow for the targeting of selective chromophores (melanin vs. hemoglobin) and has been used to treat various pigmentary disorders

Materials / method: Six adults with melasma were enrolled, who were treated in the private center of Buenos Aires Argentina between April 2023 and April 2024 treated at fluences of 10 or 13 J/cm(2) of IPL once a month for a total of 8 times.

The efficacy was evaluated with the modified Melasma Area Severity Index (mMASI) score and satisfaction score, respectively, before treatment, after each treatment and at 4 months after the end of the whole treatment course.

Inclusion criteria: all 6 patients had melasma diagnosed independently by 2 senior dermatologists, and Wood’s light examination was performed.

Results: The melasma was significantly lightened in all 6 patients after 8 times of treatments. The mMASI score before treatment was (7.0 ± 3.2) points, which decreased significantly to (4.2 ± 2.4) points after 8 times of treatments, and there was a significant difference in mMASI score between before and after 8 times of treatments.

Both 10J and 13J IPL treatment groups showed decreased melanin indices with statistically significant differences.
The erythema index was transiently increased in weeks 1-3, but after 4 weeks it decreased to sub-baseline levels.

Conclusion: Light and laser therapy is an alternative approach to treat patients with recalcitrant melasma.
Low-fluence IPL protocol could provide more effective treatment for melasma with minimal side effects.

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Investigating the molecular effects of PLLA-SCA injection in human 3D skin models containing macrophages

Objectives: Injectable poly-L-lactic acid (PLLA-SCA) is used to correct shallow to deep nasolabial fold contour deficiencies, cheek wrinkles and other facial wrinkles. PLLA-SCA has a biostimulatory effect by activating resident fibroblasts to produce collagen. However, the underlying molecular mechanisms are not yet fully understood.

Introduction: Our aim was to investigate the molecular effects of PLLA-SCA injection using 3D skin models. These models included macrophages because PLLA-SCA-dependent collagen production in fibroblasts depends on the interaction with these immune cells.

Materials / method: PLLA-SCA was injected once intradermally into the 3D skin models. After 5 and 14 days, a significant increase in epidermal thickness was observed. At the gene expression level, the injection of PLLA-SCA led to an upregulation of integrins and laminins (e.g. LAMA3, ITGA6), which are essential components of the dermal-epidermal interface, as well as an upregulation of cytokines and chemokines (TGFB2, CXCL6, IL1B).

Results: Interestingly, immunohistochemical analyzes showed significantly stimulated collagen I production in our models. Further investigations indicated that this could be at least partially dependent on the PLLA-SCA-mediated upregulation of IL1B and its stimulatory effects on CXCL6. Here, we independently demonstrated that CXCL6 is produced in human fibroblasts and stimulates collagen-I production.

Conclusion: In summary, we present the first in vitro study investigating the biostimulatory effects of PLLA-SCA on collagen I production in novel human 3D skin models comprising macrophages. Molecular biological analyzes showed that this effect could be at least partially mediated via the PLLA-SCA stimulated expression of IL1B and CXCL6.

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Por favor indique a entidade (pessoa ou empresa): Basic scientific research grant from Galderma to the Dept. of Dermatology, RWTH Aachen University

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Este trabalho não recebeu nenhum patrocínio direto ou indireto. O mesmo está sob a própria responsabilidade do seu autor. The studies have been only performed in vitro in cell culture experiments with no patients involved. The sponsor is not involved in the interpretation, analyses or publication of the data.

Intradermal IncobotulinumtoxinA for Skin Quality improvement: Evaluation in a Prospective, Single-Center, Placebo-Controlled, Double-Blind Study

Objectives: To evaluate the efficacy and safety of intradermal application of IncobotulinumtoxinA (INCO) on skin quality.

Introduction: Skin quality is an important component of human attractiveness. Skin quality can be described by four Emergent Perceptual Categories (EPCs), which can help clinicians determine the appropriate treatment options, the tissue or skin layers to address and the measurement options.
As recent surveys have shown, intradermal injections of botulinum toxin can improve facial skin laxity, facial pores and sebum secretion, as well as scars, facial erythema and flushing.

Materials / method: In a prospective, single-centre, double-blind, and placebo-controlled study, 36 subjects were randomized in a 2:1 ratio. Subjects received intradermal treatment with either a total dose of 20 U INCO (50 U Incobotulinumtoxin A were dissolved in 2.5 ml of saline solution) or placebo (saline solution) in the middle and lower face at day 1, and were followed up for 112 days to evaluate clinical efficacy (roughness, sebum production, pore size, redness) using objective biophysical measurements.

Results: Skin roughness showed significant differences between placebo and INCO at days 28, 56, 84, and 112 compared to baseline. Sebumetry revealed significant differences between placebo and INCO from baseline to day 28 (P<0.001).
The INCO group exhibited a notable reduction in sebum levels, with a decrease of -19.27µg/cm², while the placebo group experienced an increase of +1.27µg/cm². Pore sizes indicated significant differences between placebo and INCO from baseline to days 28, and 56. Mexametry displayed in both groups reduced erythema values after 28 days (INCO -43.81; placebo -3.27; P=0.041).

Conclusion: Based on the EPCs, the intradermal injection of INCO has proven to be a promising technique for improving skin quality. Although more research is needed to fully understand the mode of action of intradermal BoNTA on skin quality, the present study has shown compelling results.

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Evaluation of the effectiveness and behavior of hyaluronic acid dermal filler in the buttocks – Gluteal UP

Objectives: Evaluation of the effectiveness and behavior of hyaluronic acid dermal filler in the buttocks, aiming for increased volume, contour harmonization, and patient satisfaction.

Introduction: The growing interest in buttock augmentation procedures is driven by various techniques, with minimally invasive approaches considered lower risk compared to traditional surgical methods (Faria, 2023). Hyaluronic acid (HA) dermal fillers are deemed promising for providing soft tissue filling, with HA being a safe and well-tolerated choice (Onesti, 2009). While hyaluronic acid is commonly used in facial regions, its application in the buttocks lacks robust studies on safety and efficacy. The proposed study aims not only to explore the use of the hyaluronic acid dermal filler in buttock augmenta

Materials / method: This prospective, single-arm, multicenter study investigates the effectiveness and behavior of hyaluronic acid dermal filler for buttocks augmentation and harmonization. The research protocol was submitted to and approved by the Ethics Committee, and all patients signed the inform consent. The product of choice was a multiphasic HA dermal filler that exhibits high viscoelasticity, containing 20 mg/ml of HA and 0.3% lidocaine, with HA particles ranging from 800 to 1,200 μM. The application technique divides the buttock region into quadrants, offering technical options tailored to individual pat

Results: The study enrolled 30 female patients, median age 35 years old and a mean body mass index (BMI) of 21.91. Before the procedure, 65.38% expressed dissatisfaction with their buttock appearance. The average subcutaneous tissue thickness, measured by ultrasound, was 5.51 cm (right side) and 5.52 cm (left side). On the GAIS scale, 22.22% considered the outcome as "Improved," 40.74% as "Much Improved," and 33.33% "Very Much Improved“, although 7.69% remained dissatisfied. Ultrasonography at 30 days revealed material stability, with an average subcutaneous thickness of 7.14 cm (right side) and 7.10

Conclusion: This study provides robust evidence on the effectiveness, safety and satisfaction of the multiphasic hyaluronic acid dermal filler for gluteal augmentation and harmonization. The application technique, featuring variable approaches, yielded immediate satisfactory results, showcasing its versatility. The notable absence of significant adverse events reinforces the safety of the procedure and product. Three-dimensional images assessed by the Quantificare software offered an objective and quantitative perspective on the results.

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Histological changes in skin and subcutaneous cellular tissue in patients with massive weight loss undergoing bariatric surgery.

Objectives: Our study aimed to assess histological changes in the skin before and after bariatric surgery, providing a better understanding of the effects of these procedures on the skin.

Introduction: Morbid obesity is a public health issue with high social and economic impact. Due to the failure of traditional weight loss strategies, it often necessitates surgical interventions leading to massive weight loss
(MWL). Contour body plastic surgery has emerged as an effective method for excess skin removal in these patients. However, conclusive information on histological changes post-massive weight loss (MWL) is lacking, as most studies have not compared pre-bariatric and post-bariatric histological characteristics.

Materials / method: A prospective longitudinal study. 53 patients eligible for bariatric surgery at the Plastic and Reconstructive Surgery Department of ISSEMYM, México from 2020 to 2023. 14 underwent surgery. Skin biopsies were obtained from 9 patients before bariatric surgery and one year post-surgery following MWL.Histological analysis using HE and Masson's staining to describe collagen fiber percentage, fibrosis, vascularity, vascular layer involvement, and adipocyte population was performed. Differences between characteristics were evaluated using the t-Student test or Mann-Whitney U test, with p < 0.05

Results: Of the 9 patients, 8 were females. The age range was 29 to 56 years, with a median of 45 years. In post bariatric the stratum corneum showed an increase in laminar keratin, without the presence of a nucleus. In the papillary dermis, collagen fibers were fragmented, with less thickness and horizontally oriented. In contrast, there was a significant increase in fibrosis percentage in the post-bariatric stage 2.0% (IQR 0.0-2.5), compared to the initial measurement 80.0% (IQR 70.0-90.0). All patients showed a substantial increase in fibrosis, with greater disorganization and an increase in elastic

Conclusion: In our study, it is confirmed that patients with MWL following bariatric surgery triggers changes in the skin and subcutaneous cellular tissue characterized by increase in the percentage of fibrosis and a decrease in collagen and elastic fibers in the dermis. Additionally, for the first time, it reports a decrease in the adipocyte population and vascular proliferation. This should be considered for future research assessing potential effects on body contouring surgery.

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BOTULINUM TOXIN FOR TRICHOTILLOMANIA DEVELOPED AFTER FACELIFT

Objectives: The aim of this abstract was to study the effects of Botulinum toxin type A (BTA) on a patient that developed pruritis, sensitivity and burning on the scalp, evolved into trichotillomania, three months after facelift and without control for nine years even with drug therapy. BTA was applied on the scalp, with excellent symptom control and improved quality of life. This study reviewed the mechanism of action of BTA to control dermatological and neurological diseases associated with pruritus and chronic pain to explain the satisfactory results obtained.

Introduction: Woman, 60 years old, developed trichotillomania three months after rhytidoplasty with a coronal incision. Complications of rhytidoplasty include sensory and motor damage to the local nerves, mainly after deep plane dissection. Trichotillomania is a compulsive disorder characterized by recurrent episodes of hair pulling, generally from the parietal and vertex regions. Patient’s trichoscopy showed short vellus hair, broken hairs, coiled hairs and trichoptilosis (Figure 1). During nine years, she used pregabalin and fluoxetine, but the symptoms remained with great impact on her quality of life.

Materials / method: 100U of BTA were applied to 50 points distributed with 1 cm from each other on the scalp between the scalp incisions (Figure 2). At first, Visual Analogue Scale (VAS) scored 10 for sensitivity, 10 for itching, 8 for burning and DLQI scored 11 points, indicating very large effect on patient's life. BTA allows pain relief not just in the region of neuromuscular effects, suggesting that it acts on pain mechanisms. It was approved to address neurological syndromes, involving muscle and nerve hyperactivity, associated with abnormalities in cholinergic transmission.

Results: After BTA, VAS and DLQI remained between 0 to 2 for 5 months. In the sixth month, the effects of the BTA were reduced as expected. The activation of nociceptive neurons through the release of inflammatory modulators stimulates the excretion of calcitonin gene-related peptide, which is elevated, due to tissue acidosis related to inflammation and BTA acts to block acetylcholine, which mediates pruritus and neuropeptides, such as substance P, somatostatin, norepinephrine, nitric oxide and glutamate.

Conclusion: The effect of BTA on the autonomic nervous system, particularly on the autonomic vascular control and inhibition on the presynaptic release of acetylcholine, controls neurogenic inflammation and can reduce histamine release induced pruritus. For this patient, a multidisciplinary team with dermatologists, plastic surgeons and psychiatrists contributes to better care. Furthermore, this case showed a successful case of controlling trichotillomania developed after facelift and helps to expand new advanced indications for non-aesthetic use of BTA in the future.

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ORAL ISOTRETINOIN AS AN ADJUVANT TREATMENT IN THICK-SKINNED PATIENTS UNDERGOING RHINOPLASTY

Objectives: The aim of this study was to evaluate the aesthetic outcome and possible adverse effects in the use of low doses of isotretinoin in thick-skinned patients who underwent Rhinoplasty.

Introduction: Rhinoplasty is one of the most popular facial plastic surgeries wordwide. Thick nasal skin is a common characteristic in some ethnicities such as Afro-descendants, Latins, Arabs and Asian. Patients with thick nasal skin who will undergoing a rhinoplasty are a challenge because of the difficulties of achieving the desired postoperative aesthetic outcome and the risk of undeﬁned nasal tip. Studies have shown that isotretinoin is a good adjuvant that can collaborates with the surgical technique to optimize results and avoid postoperative sequelae.

Materials / method: This study followed 10 patients with thick skin nose who underwent rhinoplasty in association with the use of isotretinoin in the postoperative period. Patients received 20 mg every other day from tenth day after surgery for 4 months. They were monitored monthly by the plastic surgeon and the dermatologist for period of one year where they were clinically and photographically analyzed. Laboratory tests was carried out in the pre-operative and bimonthly in the postoperative period to evaluate the liver function.

Results: Clinical and photographic analysis of cases carried out by the surgeon and dermatologist showed a signiﬁcant decrease in the thickness of dermis and subcutaneous soft tissue and a satisfactory aesthetic result in all cases with a good definition of the tip and the dorsum-tip transition and a reduction in pores, oilness and a texture improvement of the nose skin. All patients also showed high levels of satisfaction with the results. No significant changes in liver function were found during the study. Minor adverse effects as dry lips and dry eyes have been reported in sixty percent of cases.

Conclusion: The combination of treatments is a great alternative to improve the result of rhinoplasty in in thick-skinned patients. Isotretinoin showed better cosmetic results and accelerated recovery after surgery, especially in the early weeks, which increases patient satisfaction rates on short-term follow-up after rhinoplasty. The cooperation between the surgeon and dermatologist can be helpful in the management of extremely thick-skinned patients and isotretinoin it’s a safe drug without significant side effects.

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FULMINANS ACNE ASSOCIATED WITH ISOTRETINOIN

Objectives: This case reports a 15-year-old patient with severe acne, which had an impact on his quality of life and who had already undergone treatment with isotretinoin 1mg/kg/day in another service 3 weeks ago, but with worsening injuries. The following lesions were characterized: papules, pustules, coalescent nodules, highly inflammatory, ulcerative, painful lesions covered with hemorrhagic crusts, most often located on the upper chest, back and face associated with fever, asthenia and leukocytosis. The aim of this abstract was to study Fulminans Acne and review guidelines to improve results.

Introduction: Fulminans Acne pathology is based in conformation of Propionibacterium acnes like an antidote that triggers highly inflammatory result on the pilosebaceous follicles and musculoskeletal structures. Common triggering factors are: introduction of Isotretinoin and use of exogenous hormones. There are multiple inflammatory lesions, with nodules and abscesses that can lead to necrosis. Systemic symptoms like high fever and joint pain are common. Fulminans acne is different from Acute acne flares in the first 8 weeks, because flares has spontaneous resolution without systemic signs.

Materials / method: After reviewing the literature and guidelines, according to the latest acne consensus, it was identified that early initiation of corticosteroids is recommended due to their significant anti-inflammatory action and immunosuppressive properties to obtain rapid control of systemic symptoms. Additionally, it may be necessary to stop taking oral isotretinoin and prescribe antibiotics to treat the underlying bacterial infection. It is proven that the case was handled appropriately, after all, it has shown concrete results analyzed during the monitoring of the case.

Results: After a detailed anamnesis, isotretinoin was suspended, and the treatment started with systemic corticosteroid therapy with prednisone 20 mg/day for 2 weeks. In addition to local care with cleaning, hydration, photoprotection, associated with Lymecycline for one month. The patient evolved with significant acne improvement, absence of laboratory findings and clinical follow-up to control scars. There are studies about the potential protective role of low starting doses, starting oral isotretinoin treatment with less than 0.5 mg/kg/day to reduce acne flares and fulminans acne evolution.

Conclusion: Hereby, the occurrence of Fulminans Acne caused by the use of Isotretinoin and the possibility of pathological reversal with the use of systemic corticosteroid therapy are evident. To avoid that complication, dermatologists should use lower starting Isotretinoin doses, reducing also the occurrence of acute acne flares, the extensive acne scars and the related psychological impact to improve quality of life.

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FOLLICULAR PSORIASIS: A RARE AND UNDERDIAGNOSED ENTITY

Objectives: This case report of a 43-year-old female patient, who came to the dermatology outpatient clinic with complaints of widespread lesions mainly on the left side of the body, and with a history of skin changes since six years old, with pruritic scaly erythematous plaques. She mentioned partially improved with the use of topical corticosteroids, but since then she has never had a diagnosis. After histopathology, the diagnostic was follicular psoriasis. The purpose of this study was to review more information on this underdiagnosed entity in the literature.

Introduction: Psoriasis is a chronic immune mediated disease by hyperproliferative T cells of the skin. Follicular psoriasis is a variant of psoriasis, follicle-centric type disease, characterized by a chronic course of 6 to 23 months, and can respond quickly to treatment. Less than 30 articles mention this pathology, with higher frequency in afro descendant women and association with diabetes mellitus; Histological findings are fundamental for the diagnostic elucidation of the disease. Treatment includes topical therapies, phototherapy, systemic therapy and immunomodulatory medications.

Materials / method: After a detailed anamnesis, 3 fragments of biopsy were requested. Histology demonstrated a dilated follicular infundibulum with parakeratotic plugging, a neutrophilic cell infiltrate and acanthosis of the infundibular epithelium with hypogranulosis. Direct immunofluorescence demonstrated absence of deposits of immunoglobulins and complement. Patient undergoing follow-up for 2 years. The literature review proved that it is a rare and often underdiagnosed disease, even though it was first described in 1920 by McLeod.

Results: Based on the diagnosis, treatment with methotrexate 15 mg/week was initiated associated to phototherapy. The patient evolved with significant improvement in the lesions and no adverse effects with systemic medication. In the literature, two clinical subtypes have been described: the adult form and the childhood form. The differential diagnosis includes pityriasis rubra pilaris, lichen planopilaris, keratosis pilaris and folliculitis. Due to its rarity, the treatment instituted will be similar to the psoriasis clinical guidelines, individualized to each patient.

Conclusion: Follicular psoriasis is an underdiagnosed pathology, which affects its diagnosis and adequate treatment. This subtype of the disease is rarely discussed in the literature, which makes its identification and treatment difficult. In conclusion, dermatologists must be prepared to diagnose the disease when there are suspicious dermatological lesions. Furthermore, benefits of using methotrexate and phototherapy for the management of this pathology were notable.

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IMPORTANCE OF DERMATOSCOPY IN THE DIAGNOSIS OF MELANOMA IN SITU IN EAR LOBE

Objectives: Melanoma is the most aggressive
skin cancer and lentigo maligna
represents the most common
melanoma in situ. Dermoscopy is a
non-invasive technique that
increases the chance of early
diagnosis of the disease, and it is
essential that the dermatologist
knows the main findings for early
detection of melanoma. In this
case, a patient is described who was
diagnosed with melanoma in situ,
through dermoscopy findings, which
were fundamental in guiding the
initial biopsy and diagnosing the
disease early.

Introduction: Lentigo maligna represents 80% of
melanomas in situ. It occurs
especially in head and neck and
affects more elderly. It comprises a
macule with irregular and illdefined edges, varied pigmentation
with asymmetrical distribution and
slow growth. Normally, it has a
prolonged evolution until it
develops into its invasive form,
lentigo maligna melanoma.
Dermoscopy is essential to aid
diagnosis. In recent studies,
dermoscopy becomes more
challenging in thin initial lesions
due to their less disarray. Facial
dermoscopy has characteristic
findings and ear dermoscopy is
similar to these findings.

Materials / method: A 65-year-old man with a brownish
plaque on his right earlobe with
irregular edges and color variation.
Dermoscopy revealed asymmetry of the lesion was found,
with variation in color,
pseudonetwork, rhomboid
structures that in some points
occluded the follicular ostium and a
structureless white area with
distortion of the ostia in the center.

Results: The first diagnosis, post biopsy, was
lentigo maligna, a melanoma in situ.
When enlarging margins with 0.2
mm, the pathology revealed an
atypical lentiginous junctional
melanocytic nevus. However, as the
first report was in the region of
greatest suspicion, it was defined as
a case of melanoma, expanding the
margins in a third approach. The
patient had a good prognosis, with
favorable aesthetic and functional
results, without recurrences to date.

Conclusion: Dermoscopy is an excellent and lowcost method, and it is essential that
the dermatologist is trained in
relation to its standards, especially
in special areas such as the face, for
the early detection of melanoma and
as a guide at the time of surgical
excision, contributing to the better
prognosis for patients.

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DIAGNOSTIC-THERAPEUTIC CHALLENGE IN THE OVERLAPPING OF PSORIASIS AND ATOPIC DERMATITIS: A CASE REPORT

Objectives: Although clinically and pathophysiologically distinct, psoriasis and atopic dermatitis have been described in the so-called overlap, when the same patient presents characteristics of both diseases. Despite being well known in their classic clinical forms, the overlap between psoriasis and atopic dermatitis is uncommon and represents a challenge in both diagnosis and treatment.

Introduction: Atopic dermatitis and psoriasis are inflammatory diseases that affect the skin and have distinct pathophysiology, immunology and clinical features. However, there has been an increase in the number of patients with an association between the two diseases, a situation called overlap. There are three aspects in this population: coexistence and exacerbation of the two pathologies; alternating outbreaks, in which when one disease appears, the other disappears; and occurrence of diseases in different phases, such as atopic dermatitis in childhood and psoriasis in adulthood, the most common form.

Materials / method: Case report of a 65-year-old man with erythematous scaly plaques on the scalp, lumbosacral and periumbilical regions and elbows suggestive of psoriasis. Based on the diagnosis of psoriasis, treatment with cyclosporine, methotrexate and phototherapy was attempted, without improvement. After failure, Secukinumab was started, however, throughout the treatment, the patient developed itching and new lesions suggestive of atopic dermatitis. Due to clinical and histopathological findings, the condition was interpreted as an overlap between atopic dermatitis and psoriasis.

Results: The condition was interpreted as an overlap between atopic dermatitis and psoriasis, then opted for suspending IL17 inhibitor and starting dupilumab, a IL4/IL13 inhibitor. There was a significant improvement in the condition and control in 2 years of follow-up. The most common skin reaction observed after start using IL-17 inhibitors, especially secukinumab, is the eczematous reaction. A possible explanation for the occurrence of this condition is that, by inhibiting the Th1 pathway of psoriasis, hyperactivation of the Th2 pathway, responsible for the lesions of atopic dermatitis, may occur.

Conclusion: Patients with this overlap are difficult to manage. In 50% of cases, spontaneous improvement of eczematous lesions is observed within 6 months. However, in the remaining 50%, the lesions are persistent and do not usually respond to the use of topical corticosteroids. In general, these patients require simultaneous or consecutive combination of immunobiologicals to control the clinical condition. The diagnosis and management of overlap are not yet well established, making it a challenge to treat these patients.

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TREATMENT AND PREVENTION OF “SAD-FACE” IN WOMEN OF AFRICAN ANCESTRY

Objectives: The objective of this poster is to guide injectors to identify the most common features in African-ancestry patients related to anatomical differences.

It is important to not only address patient’s complaints, but also to lessen (or prevent) the prominence of these physical characteristics that many individuals of African ancestry find undesirable as they age.

All individuals experience aging of the lateral canthal complex of the eyes; however, these changes tend to predominate around the eyes at an earlier age in African American women.

Introduction: People of African ancestry frequently acquire a look of sadness as they age. This is a common feature in such individuals when compared to people of lighter complexion.
The position of the lateral canthus is an important element of the rejuvenation process. Several features make the eyes of those of African ancestry ethnically unique.
Their lateral canthal angle has a tendency to be less acute relative to their younger counterparts.
This case highlights a 39-year-old, dark-complexion, female patient with a descent of the lateral canthus of the eyes as referred to in the cited articles.

Materials / method: A hybrid filler (consisting of hyaluronic acid combined with calcium hydroxyapatite) was injected subcutaneously in the infra-zygoma and mandible line using a 22G blunt-tip cannula. Part of this treatment involved the use of the MD Codes technique – Image 1 (video) and 2.
The zygomatic arch was injected at the bone level to give support to the lateral canthus of the eye. The support and refinement of the periorbital area was reinforced by injecting the sub-orbicularis oculi fat pad (SOOF) and the tear trough area. Photos (pre-, immediately post-, and 45 days post-procedure) were taken.

Results: Image 3: In the right oblique position (pre-, immediately post-, and 45 days post-procedure), the improvement in the tear trough, the softening of the malar eyelid transition, and the reduction of the protrusion of the lower lip, are all clearly evident.

Image 4: In the tilted down position, from the oblique view, the improvement of the dark circles under the eyes can be observed.

Image 5: From the frontal view, the repositioning of the lateral corner of the eye, the reduction of the protrusion of the lower lip, and an improvement in the contour of the face are apparent.

Conclusion: This clinical case provides evidence that women of African ancestry have a greater relative descent of the lateral canthal complex. This phenomenon is more predominant in African-American women than Caucasian women.

This clinical case is compelling as it demonstrates the need to treat and prevent the descent of the lateral canthus in women of African ancestry, before it becomes more pronounced with the reabsorption of the bone of the orbital area during the aging process. This feature, if ignored, predisposes women of African ancestry to a premature appearance of sadness.

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Por favor indique a entidade (pessoa ou empresa): Allergan Aesthetics An AbbVie Company

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FACE RESHAPING EFFECT WITH BARBED SUSPENSION THREADS: CLINICAL AND INSTRUMENTAL EVALUATION (FREE STUDY).

Objectives: This prospective, open-label, uncontrolled study aimed to confirm the early and long-term reshaping effects of two types of absorbable, monofilament, suspension threads of synthetic origin (poly (L-lactide-co-ε-caprolactone)): double needle threads inserted with the Jawline Reshaping Technique to reshape the frame of the jawline, lifting the lower face, and free-floating threads inserted by the Soft Tissue Reshaping-2 Technique to reposition the tissue of the malar area.

Introduction: Thread lifting is an aesthetic procedure that lifts and realigns sagging tissue while adding definition to the facial contours by using threads that are manufactured from the same materials used in surgery to close wounds. When placed under the skin, they can be used to tighten the tissue and add volume to the area of application. With a high level of safety, minimum downtime, and immediate and persistent results, this method is considered excellent in treating the sagging skin of women who do not wish to undergo invasive surgeries.

Materials / method: 28women, 30-60years old, with mild to moderate laxity and hypotonicity of facial skin were treated with 2free floating threads and 1double needle thread on each side. Responses were evaluated at 15d, 30d, 4m, 8m, and 12m after the procedure. Volume, superficial vector changes of midface and lower face were evaluated at 30d (primary endpoint) and at 15d, 4m, 8m, 12m (secondary endpoint) through 3D and 2D photos. Other secondary endpoints were patient satisfaction and aesthetic changes by non-treating investigators by GAIS at each visit and modifications of skin surface at 30d, 4m, 8m, and 12m.

Results: Statistically significant difference was observed in the mandibular volume on the left side (p<0.0001), the malar volume (left p=0.0001, right p=0.0184) 30d after the procedure, and both the vectorial facial and mandibular areas (p<0.0001) 30d after the procedure, while the mandibular volume on the right side was not statistically different (p=0.2973). Malar and facial vectorial modifications increased in the 15d after the intervention and remained stable until 4m; a further increase was observed at 8 and 12m. Volume modification progressively returned to baseline value at following visits.

Conclusion: This study showed that the use of double needle and free-floating threads is effective with a significant improvement in volume repositioning, in the modification of skin vectors, in skin texture and wrinkles, without thread residuals identifiable after 12m from the insertion procedure. More than 80% of the women and around two-thirds of the non-treating investigators’ evaluations reported the devices as being outstanding, extremely improved, or improved at any follow-up. The procedure is substantially safe with slight non-serious adverse events related to the surgical procedure.

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Este trabalho foi realizado com o patrocínio de: Relife

Could microwave technology be the answer for treatment-resistant nodulocystic acne lesions?

Objectives: Can microwave energy resolve treatment-resistant nodulocystic (NC) acne lesions?

Introduction: Nodular acne is a severe form of acne vulgaris, a highly prevalent and chronic inflammatory skin disease of the pilosebaceous unit, which can affect up to 85% of the pubescent population [1]. Lesions can range from >5mm to 1cm or bigger. Their firm presentation and deep location within the dermis can make them painful, while posing a much greater risk of scarring [2,3]. Unfortunately, many NC acne lesions remain even after several courses of topical or systemic therapies.

Materials / method: Device: FDA-cleared surface-based, 8GHz microwave device set to 3-4W applied for 2s, 5x at 10-20s intervals
Patient: 32-year-old Caucasian male with 3 persistent NC acne lesions present for >5 months, described as “tender”; one inflammatory papule and one closed comedone.
Treatment (Tx) history: topical clindamycin/ tretinoin, benzoyl peroxide/ clindamycin, adapalene/ benzoyl peroxide, tretinoin, oral antibiotic therapy with doxycycline and extended-release minocycline, intralesional steroids, and acne cryotherapy.

Results: Tx 1: First lesion drained, no longer tender
Tx 2: First lesion resolved; another lesion drained; some PIH remaining for both
Tx 3: Improvement across all remaining lesions; no recurrence of resolved lesion
Tx 4: Resolution of all NC and non-NC lesions; no residual erythema or hyperpigmentation (Fig. 1)
Safety: No signs of burning, blistering, ulceration, or post-treatment erythema
Note: New lesions developed in untreated areas, including the back

Conclusion: Microwave therapy presents an effective lesion-directed treatment option for patients with NC acne. It is well-tolerated, easily administered, and requires no patient compliance outside the clinic. Its safety profile and recurrence rates need to be confirmed and determined in further feasibility and case studies.

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Por favor indique a entidade (pessoa ou empresa): Company (Emblation Ltd)

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Este trabalho foi realizado com o patrocínio de: Dr Gold is a consultant for Emblation Ltd and carries out clinical research for Emblation Ltd

Correction of Facial Asymmetries and Dyskinesias with Botulinum Toxin type A and Hyaluronic Acid Fillers - a case report

Objectives: "Search the national and international
scientific literature for articles addressing
the outcomes of treating facial paralysis
using a combination of botulinum toxin
and hyaluronic acid. Additionally, a reported
case of a patient with post-herpetic facial
paralysis on the right hemiface, treated with
this combination, showed excellent results."

Introduction: This text discusses the use of botulinum
toxin and hyaluronic acid in treating facial
paralysis, emphasizing their importance in c
orrecting facial asymmetry and muscle control.
Besides describing the challenges faced by
patients, it also highlights the urgency of
early interventions for a better prognosis.
Botulinum toxin is identified as an effective
approach for paralysis sequelae, underscoring
its increasing application not only in aesthetics
but also in the therapeutic field, always
focusing on the patient's well-being.

Materials / method: Type: Narrative literature review of clinical case presentations in journals.

Data Collection: A bibliographic search covered 2017 to 2022 in databases like LILACS, Medline, Web of Science, Scopus, and SciELO using keywords: Facial Paralysis, Facial Muscles, Hyaluronic Acid, Botulinum Toxin, part of Health Sciences Descriptors (DeCS). Data gathering spanned November 2022, with articles meeting criteria of relevance, publication in Portuguese/English within 5 years included.

Results: Facial paralysis, a multifactorial condition, classifies into central and peripheral types. Symptoms vary but often involve eye discomfort, tearing, difficulty whistling, and a deviated mouth. Diagnosis relies on knowledge of nerve pathways and function. Botulinum toxin, a potent neurotoxin, blocks acetylcholine release, impacting neuromuscular transmission. Its use spans neurological and cosmetic applications but can lead to adverse effects at higher doses. Hyaluronic acid, a natural polymer, serves as a dermal filler, addressing volume loss and skin aging temporarily.

Conclusion: Facial structural issues cause abnormal muscle actions seen in expression. Botulinum toxin offers temporary relief in facial paralysis but faces debate against permanent surgeries due to its transient effects, necessitating multiple applications. Some see it as complementary to other therapies. No human trials yet evaluate its impact on facial nerve regeneration, but its safety hints at temporary facial paralysis management. Fillers aid weak muscles, limit extreme muscle movement, and balance activities. Combining neurotoxins with fillers restores natural structure and facial movement.

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ACUTE EFFECT OF CARCININ SUPPLEMENTATION ON GLYCEMIC PARAMETERS AND SKIN STRUCTURES IN DIABETIC WOMEN

Objectives: This study aims to assess the effectiveness of cercinine, a nutraceutical with antioxidant and antiglycating activities, on glycemic parameters and skin structures in obese individuals with insulin resistance.

Introduction: Obesity constitutes a significant risk factor for the development of type 2 diabetes, a condition widely associated with insulin resistance. Fructosamine and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) serves as a glycemic marker for diabetes screening. Its levels rise in the presence of high blood glucose concentrations. There is speculation that type 2 diabetes negatively impact skin. Insulin resistance risks can be mitigated by supplementing natural compounds, such as antioxidants and antiglycans.

Materials / method: For this study, six female individuals aged between 47 and 59 years were recruited. They were classified as grade one obesity (BMI > 30) and diagnosed with diabetes (Hb1Ac > 6.5). Prior to the commencement of the treatment, participants underwent a biochemical evaluation, during which fructosamine parameters and the HOMA index were measured. Dermal thickness in the left and right mental regions of the face was assessed using facial ultrasound. Following the initial assessments, all participants were supplemented with 300 mg of carcinine daily for 30 days. After this initial treatmen

Results: After 30 days of intervention, the biochemical parameters of fructosamine and HOMA-IR reduced. At the beginning of treatment, average fructosamine levels increased from 194.8±10.1 µmol/L to 188.2±32.9 µmol/L. The average HOMA IR levels increased from 4.3±3.1 to 3.9±1.7. Likewise, after 30 days of intervention, an increase in dermal density was observed in all women evaluated. The average increase in dermal density in the malar and mental region was 8.6%.

Conclusion: The data from the present study demonstrate that carnosine is an effective supplement for improving metabolic parameters associated with type 2 diabetes and addressing aesthetic complications in human skin.

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Air vs. Saline: Meta-Analysis of Tissue Expanders in Mastectomy Reconstruction

Objectives: 1. Review current literature regarding tissue expander fill
2. Discuss results of meta-analysis of differences in surgical outcomes based on fill of tissue expander
3. Cost-analysis on tissue expander type

Introduction: Breast cancer, the second leading malignancy among U.S. women, continues to pose significant challenges despite advancements in early detection. Mastectomy remains an important treatment with implant-based reconstruction (IBR) being important in restoring postoperative quality of life. Two tissue expanders (TEs) exist: AeroForm TEs (ATEs) and saline-based TEs (STEs). With a 75% increase in breast reconstruction procedures over the past two decades, understanding the strengths and challenges of these TE options is crucial for informed decision-making, benefiting both patients and physicians.

Materials / method: We performed a PubMed literature review to search for studies comparing air and saline-based tissue expanders used in implant-based reconstruction from January 1st, 1993 to May 27th, 2023. We then performed a meta-analysis on the following post-operative outcomes: implant rupture, wound dehiscence, skin necrosis, nipple necrosis, expander exposure, expander loss, hematoma, seroma, infection/cellulitis/abscess formation, and salvage reoperation. A random effects model was used to calculate odds ratios (OR) within and a 95% confidence interval (CI) for dichotomous outcomes.

Results: We included eleven studies from forty-four reviewed. Analysis of ten studies revealed that infection risk after TE placement was significantly lower in the ATE cohort, with 11.3% of ATE patients (109/966) experiencing infection compared to 20.8% of STE patients (242/1163) (P = 0.0009). In terms of the time required for expansion before definitive reconstruction, data from six studies indicated that ATEs were associated with a significantly shorter time to reconstruction (114.7 days for ATE vs. 176.8 days for STE, P < 0.00001). Use of ATEs saved $2,055.34 compared to STEs.

Conclusion: ATEs exhibited a notable advantage in reducing the risk of infection compared to STEs. ATEs had a reduced overall cost of $2,055.34. Use of ATEs demonstrated a shorter duration for achieving full expansion and reaching the stage of definitive reconstruction following placement. ATEs also do not require multiple office visits for expansion. The reduction in postoperative clinic visits can have significant implications for patients, as it may lead to a more efficient and streamlined overall treatment process. These findings highlight the potential advantage of using ATEs over STEs.

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Cadaveric study of columellar artery and its anastomosis associated with filler injection: Indication for reducing risk of arterial complications

Objectives: This study aims at investigating the overall update columellar artery (CoA) thoroughly including the precise location, origin of the artery, the pattern of artery correlated with lining layer and its anastomosis. The data will assist the clinician preforming the injection confidently without risk of arterial complications.

Introduction: Nowadays, the nasal augmentation is one of the popular procedures. the columellar filler injection is required for enhancing the nasal tip projection and lengthen of columella. However, nose is most common injection locations caused visual loss. Therefore, this study aims at investigating the overall update columellar artery (CoA) thoroughly including the precise location, origin of the artery, the pattern of artery correlated with lining layer and its anastomosis. The data will assist the clinician preforming the injection confidently without risk of arterial complications.

Materials / method: Twenty Thai complete preserved cadavers were included in this study. Then, the columellar area was dissected layer-by-layer carefully. The CoA and associated arteries were traced during dissection. The pattern, origin, and lining layer of columellar artery were observed. The location of the artery was measured form the midline. Finally, the arterial anastomosis and correlation with the other vessels was examined.

Results: The CoA was absolutely discovered in all Thai cadavers. In most cases (15 of 20 cases), the CoA originated from the septal branch of the superior labial artery. The observation found that the CoA have a single type in most cases (8 of 20 cases). In the study of lining layers of CoA, its main trunk lies inside the deep fatty layer (14 of 20 cases). Additionally, the CoA strongly anastomoses with the dorsal nasal artery (8 of 20 cases). Mean distance of CoA from midline at its origin was 1.31 mm, while the distance between the midline and the artery at mid-columella was 2.21 mm.

Conclusion: The CoA should be avoided when filler injection is considered for improving nasal tip projection and correcting the columellolabial angle. Based on the anatomical results, the CoA lined adjacent to the midline at the origin and the mid columella level. Importantly, the CoA has true anastomosis with the dorsal nasal artery, thus intravascular injection might lead to visual impairments and skin necrosis.

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Which proportions of the lips are the most beautiful? Eye-Tracking and Survey based analysis.

Objectives: The aim of the study was to determine the most eye-pleasing proportions in terms of the thickness of the vermillion, the distance of the upper and lower lips in relation to the nose and chin, and in relation to the bigonial distance.

Introduction: Guidance on how to achieve the most beautiful result in minimally invasive lip contouring procedures is inconsistent.

Materials / method: A total of n = 101 volunteers (52 women, 49 men, Caucasian) took part in the study and were presented with frontal images of modified facial proportions with Eye-Tracking device on. Afterwards, they answered a related questionnaire presenting the same images.

Results: The position of the lips rated as most attractive was the 1:2 ratio, in which the distance between lips and chin is double the length as the distance between lips and nose. In case of a proportion between the width of the lips and the bi-gonial distance, 1:2.5 ratio was the most aesthetic according to the observers. For the thickness of the upper lip vermilion in relation to the upper lip ergotrid the most eye-pleasing proportion was 1:3/1:2 (male/female) ratio and for the lower lip vermilion and lower lip ergotrid 1:4 (for both genders).

Conclusion: The results of this study revealed that instead of one universal ratio, there are many facial proportions that are perceived as the most attractive/masculine/feminine.
In the perception of facial aesthetics, attractiveness should be distinguished from masculinity/femininity: the most attractive male/female face is not necessarily the most masculine or feminine.

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Pigmentary disorders, prevalence, impact on quality of life, social stigmatisation: result of the first large international survey

Objectives: This first worldwide survey evaluates the prevalence of PD and its impact on quality of life (QOL) and stigmatization.

Introduction: Pigmentary disorders (PD) such as Melasma, Post-inflammatory Hyperpigmentation (PIH), Solar Lentigo (SL), Vitiligo, Peri-Orbital Hyperpigmentation (POH) and Axillary Hyperpigmentation (AH) are frequent dermatological conditions, but little is known on their real-world prevalence and impact.

Materials / method: Survey (N= 48,000) conducted in 34 countries from all continents from December 2022-February 2023. An automated selection from the Ipsos Panel ensured representative samples (gender, age, employment status and country region) based on quota method.
The online auto-administered questionnaire covered demographics, phototype, self-reported pigmentation condition based on a descriptive text and image; its management and impact on QOL, stigmatization, and sun protection behavior.

Results: 50% of the population report having at least one PD (SL 27%, AH 18%, PIH 15%, POH 15%, melasma 11% and vitiligo 8%) with an average age of 44yo and affecting more women (59%). Previous dermatological diagnosis was reported in a third (36%) of the population, and 19% made thier own diagnosis thanks to the questionnaire. All PD significantly impact QoL and lead to stigmatization. DLQI was >10/30 for 28% of them, from 15% for SL to 47% for vitiligo. Stigmatization is important in all conditions: 44% have concealed/hidden the visible parts of thier affected skin and 32% have avoided some people.

Conclusion: This first large international survey on Pigmentation disorders shows the high prevalence of pigmentation disorders worldwide, their significant impact on QOL and stigmatization, highlighting the need for photoprotection education.

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Por favor indique a entidade (pessoa ou empresa): La Roche-Posay Laboratoire Dermatologique

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Por favor indique a entidade (pessoa ou empresa): La Roche-Posay Laboratoire Dermatologique

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Este trabalho foi realizado com o patrocínio de: La Roche-Posay Laboratoire Dermatologique

Collagen biostimulator improves photoaging pigmentation

Objectives: We investigated if the collagen bio-stimulation can accompany with skin lightening in forty human photoaging skins employing a randomized split-face design. Through a comprehensive clinical and histological analysis, we present significant and sustained improvement in pigmentation, along with benefits in wrinkle reduction and skin elasticity with injectable collagen biostimulator.

Introduction: Photoaging pigmentation such as solar lentigo or melasma, is characterized by not only increased pigmentation but also dermal pathology such as collagen degradation and secretion of senescent-associated secretory phenotypes (SASPs) including matrix metalloproteinases (MMPs) from aged fibroblasts compared to the adjacent perilesional normal skin. Therefore, it is speculated that dermal remodeling treatment should be accompanied with skin lightening therapy directly acting on the melanocytes and melanogenesis.

Materials / method: A comprehensive split-face clinical trial was conducted involving 40 patients diagnosed with melasma and lentigo. One side is treated with a collagen biostimulator (PDLLA) injections, while the other side serves as a normal saline injection. Pigmentation, wrinkle severity, and skin elasticity were assessed at baseline and various time points post-treatment (4, 8, and 12 weeks) using standardized investigator assessments, skin imaging, histology, and patient-reported outcomes.

Results: The significant and sustained improvement in pigmentation, along with benefits in wrinkle reduction and skin elasticity with injectable collagen biostimulator. Histologic analysis showed increased immunogenicity of FSP-1 and increase of collagen and elastic fiber staining, suggesting that PDLLA accelerated collagen and elastin fiber neogenesis. This was accompanied with improving pigmentation, as evidenced by the significant improvement in clinical severity with IGA scale and L* value and pathological severity with FM staining.

Conclusion: This study presented significant and sustained improvement in pigmentation, along with benefits in wrinkle reduction and skin elasticity with injectable collagen biostimulator. The collagen biostimulators may offers a promising therapeutic approach for addressing photoaging signs associated with melasma and lentigo. Further research is warranted to fully understand the long-term effects and optimal maintenance strategies for individuals undergoing PDLLA treatment for skin aging.

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Efficacy of healing ointment containing petrolatum and panthenol vs 0.1% Triamcinolone acetonide in 10% urea cream for treatment of hand eczema: RCT

Objectives: This study aimed to determine the efficacy of healing ointment (HO) containing anti-inflammatory ingredients compared with 0.1% Triamcinolone acetonide in 10% urea cream (TAU) for treatment of CHE

Introduction: Long-term treatment of chronic hand eczema (CHE) with conventional therapy, such as high potency topical corticosteroid, can result in numerous side effects.

Materials / method: A split-hand, evaluator-blinded, randomized, controlled study was conducted in 26 patients (88.5% females, mean age 50.04 ± 9.63 years) with mild-to-moderate CHE. All patients were randomized to apply HO or TAU twice daily on each side of the hand for consecutive 28 days.

Results: A statistically significant improvement of HECSI, TEWL, SCH, hemoglobin index, DLQI, and VAS was noted on the HO treated side at day 28. Also, the reduction of TEWL on the HO treated side showed a statistically significant difference when compared to the TAU treated side at the same visit. Moreover, the 7-day post-moisturizing efficacy on the HO treated side was superior for TEWL and SCH.

Conclusion: Interestingly, the HO containing anti-inflammatory ingredients could be alternatively efficacious for treatment of CHE to prevent complications from the long-term application of steroids.

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Efficacy of Ceramides and Niacinamide Containing Moisturizer in Combination with Topical Anti-acne Treatment in Mild to Moderate Acne Vulgaris: RCT

Objectives: This study aims to compare the efficacy and tolerability of ceramides and niacinamide containing moisturizer (CCM) versus hydrophilic cream in combination with topical anti-acne treatment in mild to moderate acne vulgaris.

Introduction: Topical therapy is the mainstay treatment of acne and topical retinoids such as tretinoin, tazarotene and adapalene are recommended as the first line therapy for mild to moderate acne. However, the cutaneous irritations may occur and the dermocosmetics are recommended to prevent side-effects of anti-acne drugs and adhere to treatment.

Materials / method: This was an 8-week, randomized, double-blinded, split-face study in 40 patients assigned for topical anti-acne medications (5% benzoyl peroxide and 0.1% adapalene gel), then randomly applied CCM or hydrophilic cream. All patients were followed at week 0, 2, 4, and 8 for acne improvement, adverse reactions, biometric and biophysical evaluation.

Results: CCM could significantly improve the non-inflammatory, inflammatory, and total acne lesions compared with hydrophilic cream after week 8 of treatment. Interestingly, there was an improvement of global worst score, hemoglobin index, melanin index, TEWL, skin hydration, sebum production, and skin surface pH, with no statistically significant differences between the 2 treatments. No serious side effects from clinical application of CCM and hydrophilic cream in mild to moderate acne vulgaris patients.

Conclusion: Ceramide and niacinamide-containing moisturizer in combination with anti-acne medication can significantly improve acne lesions and decrease cutaneous irritations towards a satisfactory treatment outcome of mild to moderate acne vulgaris.

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Role of Rose-derived Stem Cell Exosomes in Improving Acne Scar Treatment Results with Picosecond Laser, FRM and Thermomechanical Ablative Device

Objectives: This study aimed to evaluate the role of RSCE in improving the results of acne scar treatment when combined with FPL, FRM, and TMA. We aimed to assess whether the application of RSCE can lead to reduced post-treatment downtime, decreased redness, and enhanced efficacy in acne scar reduction.

Introduction: Acne scars pose a significant challenge in dermatological aesthetics, impacting the physical and emotional well-being of affected individuals. Over the years, various approaches have been explored to address this concern. Among recent advancements, the application of exosomes derived from rose-derived stem cells (RSCE) in combination with fractional picosecond laser (FPL), fractional radiofrequency microneedle (FRM), and fractional thermomechanical ablative devices (TMA) has emerged as a promising avenue for improving the results of acne scar treatment.

Materials / method: The acne scar patients received three consecutive treatment sessions of FPL, FRM or TMA to the whole face, with a follow-up evaluation. Post-laser treatment regimens were applied with the exosomes derived from rose-derived stem cells (RSCE).

Results: The results demonstrated that RSCE improved the outcomes of acne scar treatment with FPL, FRM, and TMA. The shorter post-treatment downtime is a promising aspect for both patients and practitioners, potentially leading to increased patient satisfaction.

Conclusion: This study supports the role of RSCE in enhancing the results of acne scar treatment. When combined with fractional picosecond laser, fractional microneedle RF, and fractional thermomechanical ablative devices, RSCE demonstrates improved efficacy and shorter downtime. RSCE holds potential for advancing the field of dermatological aesthetics in the treatment of acne scars.

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Clinical Efficacy of the Hair Tissue-Based Therapy in the Treatment of Male Androgenic Alopecia

Objectives: To evaluate the clinical efficacy of intradermal injection of autologous cellular suspension (ACS) acquired by mechanical centrifugation, consisting a heterogeneous pool of cells rich in androgen-insensitive DPCs and their associated cells and cytokines in male androgenic alopecia.

Introduction: Hair-tissue based therapy in androgenic alopecia has been investigated. Harvesting hair at the occiput increases the ability and interaction of healthy dermal papilla cells (DPCs) and their macro-and microenvironment to restore a pathologic balding scalp. This approach can be a new and promising concept of hair regeneration, especially in male androgenic alopecia.

Materials / method: Male patients with androgenic alopecia, aged 20-50 years, and Hamilton-Norwood (NW) stage III-V vertex were enrolled. They each received one treatment session with an intradermal injection of ACS at the balding vertex on their scalp. The efficacy measurement was based on the change from baseline in hair density and hair diameter at week 12. Photographic assessment by two blinded dermatologists was carried out. Any adverse events were also recorded.

Results: There were 5 male patients, mean (SD) age of 37.3 (4.8) years and NW stage for III vertex (40%), IV (20%), and V (40%). A significant increase in mean hair shaft diameter was from 42.4(6.7) to 47.7(5.9) (p=0.001) and 49.6(6.6) μm (p=0.019). Whilst, a decrease in vellus hair density was observed for 40(20), 26(16.7) (p=0.11) and 8(13) (p=0.20) hairs/cm2 at baseline, 3 months, and 6 months, respectively. The photographic assessment at vertex yielded moderate improvement at 6 months from baseline (score 2.1(0.7), p=0.004), with statistical significance. Minor adverse effects included minor pain a

Conclusion: Androgen insensitive DPCs yields the reverse miniaturization of hair shafts, with potential treatment in male androgenic alopecia. Whereas, bio-molecular pathways and larger sample size are suggested to verify the treatment efficacy

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Efficacy of Autologous Leukocyte-Platelet-rich Fibrin (L-PRF) Intradermal Injection Using Simplified Preparation Method for Treatment of Atrophic Acne

Objectives: To evaluate the efficacy autologous L-PRF intradermal injection in atrophic acne scar treatment.

Introduction: Atrophic acne scars are acne complications which impact patients’ quality of life. Following its wound remodeling properties of second-generation platelet concentrate to trap growth factors within fibrin matrix for slow and longer sustained release growth factors, autologous Leukocyte-platelet-rich fibrin (L-PRF) intradermal injection has been used for various wound management, especially treatment of atrophic scars.

Materials / method: Patients with Grade 2 to 4 atrophic acne scars from Goodman’s Qualitative classification were enrolled. The patients were treated with PRF intradermal injection, prepared by the simplified low speed 1-step centrifugation method, on the cheek area for 2 sessions with 1-month interval. The efficacies were evaluated using biometric assessment of the scar volume, wrinkle, skin texture, pore size, and pigmentation at 1-month post treatment.

Results: There were 14 patients, mean age of 37.2 years and 64.3% men, with baseline scar severity of Grade 4 (35.7%), Grade 3 (35.7%), and Grade 2 (28.6%). Significant decrease was noted in acne scar depression volume from 14.23 ± 7.48 to 10.7 ± 6.07 (30.14% reduction, P < 0.001) at baseline and 1-month post treatment, respectively. In particular, biometric assessment also showed a significant improvement in wrinkle (31.26 to 26.5, P<0.05), skin texture (35.48 to 29.33, P<0.05), and pore size (2.6 to 1.84, P<0.05). Impressively, L-PRF intradermal injection efficaciously yielded better improvement and

Conclusion: L-PRF intradermal injection significantly yields efficacious treatment for atrophic acne scars with additional skin rejuvenation effects. The procedure is easy to perform, safe, and cost-effective with minimal adverse effects.

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Long-pulsed Er: YAG Laser for the Treatment of Adult Colloid Milium

Objectives: Using Er: YAG Ablative laser to treat a case with a severe and extensive Colloid Milium

Introduction: Colloid milium is a skin deposition disorder that mostly presents as multiple domed, flesh-colored papules. Sometimes, the lesions coalesce into large plaques or nodules that are extremely disfiguring.
The pathognomonic histopathological findings are homogeneous amorphous eosinophilic deposits in the papillary dermis.
Currently, there is no approved treatment for the disease, which is frustrating. Ablative lasers have been utilized to treat CM with equivocal success.

Materials / method: A 59-year-old man presented to our dermatology clinic with multiple flesh-colored plaques and nodular lesions around the nasolabial fold. After performing a skin biopsy, the patient was diagnosed as CM.

The patient was referred to the laser clinic for treatment of CM.

A 2940 Er: YAG laser treatment was selected. The laser procedure consisted of two steps:
1) Destructive mode using MSP mode (100-microsecond pulse width). The optimal endpoint was the appearance of pinpoint bleeding and flattening of the lesion.
2) Coagulation mode: using VLP mode, 6 mm spot size, Turbo 6, 30 J/cm2 fluence.

Results: After 6 laser sessions with a 6-week interval, the lesion was almost completely removed, and a pleasing esthetic result was attained. One year following the procedure, the lesion did not recur.

Conclusion: In summary, we present a case of ACM involving his nasolabial fold and perioral region who was successfully treated with long-pulsed Er:YAG laser. There was no scarring, textural changes, pigment alterations, or evidence of clinical recurrence at the 12-month follow-up.
Long-pulsed Er:YAG laser should be considered as an effective treatment for facial CM lesions.

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Case report: Vogt-Koyanagi-Harada syndrome

Objectives: Early diagnosis coupled with proper treatment may result in visual recovery in Vogt Koyanagi Harada syndrome.Vogt-Koyanagi-Harada syndrome :

Acquired syndromic hypomelanosis

Etiology and pathogenesis :

Autoimmune response against melanin antigens in eye, inner ear,
meninges and skin

Predisposition : HLA-DR4

Risk factor for immune mediated diseases : (IL-23R)

Dysfunction innate and adaptive immune system

Environmental triggering factors : Pathogenic microorganisms;
Epstein-Barr virus.

Introduction: The Vogt-Koyanagi-Harada syndrome is a bilateral, diffuse granulomatous uveitis associated
with poliosis, vitiligo, alopecia, and central nervous system and auditory signs. These
manifestations are variable and race dependent. This inflammatory syndrome is probably the
result of an autoimmune mechanism, influenced by genetic factors, and appears to be
directed against melanocytes. Patient may have symptoms of meningismus, predominantly
headache, the other characteristic neurologic symptoms, i.e., tinnitus and dysacusis.

Materials / method: Patient had presented to ophthalmology OPD with complete loss of vision since 1year with
bilateral conjunctival congestion , corneal degeneration, 360 degree corneal vascularisation
with no history of trauma. Patient was then referred to the dermatology clinic with poliosis
and depigmented patches over scaral and left iliac regions, leucotrichosis of eyebrows.
Patient also complained of midline neck swelling which moved with deglutition and
hoarsness of voice since 1year. He also had seropurulent, odorless discharge from left ear
with decreased hearing.

Results: Histopathology done from vitiliginous patch showed the characteristic finding of total
absence of functioning melanocytes , while the inflammatory cells most commonly found on
the edges of the lesions are CD4+ and CD8+ T lymphocytes. Procedures that may aid in the
diagnosis include lumbar puncture, fluorescein angiography, and standardized echography.
Early, aggressive use of systemic corticosteroids in these patients followed by gradual
tapering of dose for 6 months after presentation or, when necessary, adjuvant therapy with
cyclosporine or cytotoxic agents, is recommended.

Conclusion: VKHD is severe bilateral, granulomatous panuveitis associated with
serous retinal detachment, causing a significant impact for patient’s
life, especially considering its frequent onset at young and working
ages.

Ocular involvement undoubtedly accounts for most of disease impact
on individuals’ lives.

Meningeal (neck stiffness, headache and CSF pleocytosis) and ocular
signs are characteristic of acute stage.

Skin changes may be observed later on in course of disease.

Early diagnosis coupled with proper treatment may result in visual
recovery.

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Beyond hydration: Managing unanticipated effects of intradermal hyaluronic acid - A case report

Objectives: To draw attention to the fact that skin necrosis is not limited to skin fillers and can also result from
skin boosters. We wish to emphasize the need of
prompt, intensive treatment to prevent any lasting changes to the skin and the importance of post-treatment care to prevent any unforeseen outcomes

Introduction: Hyaluronic acid is the most extensively researched
skin enhancer material, with small-particle sized gels being the most commonly used. Its
hydrophilic nature allows it to bind water up to 1000 times its volume[2]. Numerous studies have
found that the concentration of HA used, ranging from 12 mg/ml to 20 mg/ml, is beneficial for
improving the quality of skin[3].

Materials / method: A 32 year old male, presented with skin irregularities and scars, and wanted to improve the skin quality and the scars. Hence he was injected with intradermal vycross technology based hyaluronic acid intradermally. He was completely fine before, during and after the procedure. After 48 hours he presented with bruises, no pain or discomfort, on examination the capillary refill time was less hence decided to inject hyaluronidase. High dose hyaluronidase protocol was followed, until the capillary time was regained. The patient was treated aggressively further to prevent scarring.

Results: A complete region of normal skin with good quality was achieved on treating the patient aggressively to heal the ulcer and pigmentation.

Conclusion: Though skin boosters are of less molecular weight and g prime its always better to be very cautious with the plane of injection, type of product we choose, better to do aspiration before injecting and stress on the post care. Always ensure the patient is aware of the complications that can raise after the injection due to compression of the vessels. Treating the tissue breakdown aggressively helps in healing the skin completely without pigmentation and scarring.

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Investigating the level of SUBSTANCE P in 46 ETR rosacea cases before and after botulinum toxin injection in different doses

Objectives: Measuring the level of substance p before and after the injection of botulinum toxin A with different doses to investigate the relationship between the improvement of rosacea symptoms by reducing the level of substance p and the amount of toxin dose.

Introduction: Rosacea is a chronic inflammatory skin condition characterized by facial redness, flushing, and etc. The pathophysiology of rosacea is complex and involves various factors, including neurovascular and neuroimmune mechanisms. Substance P (SP) is one of the neuropeptides that has been implicated in the pathogenesis of rosacea.
BoNT-A has been shown to inhibit the release of SP,
The effect of botulinum toxin A injection on rosacea has been proven over the years, but until now, the relationship between the dose of botulinum toxin injection and the reduction of SPlevels has not been investigated

Materials / method: 46 cases including 38 women and 8 men with etr rosacea This number was divided non-randomly and based on the equal number of men and women and the same severity of rosacea, into two groups A: injection of BTX-A with a dilution of 1:3 with 1 cm intervals at each point in the amount of 1 unit and group B : Injection of BTX-A with a dilution of 1:6 with 1 cm intervals in the amount of 1 unit.
level substance p was checked by ELISA kit by sandwich-ELISA method with a sensitivity of 0.5 pg/ml before and after botox injection.

Results: The reduction of patients' erythema, which was evaluated by CEA=Clinician Erythema Assessment, was significantly better in group A than in group B. Reduction of redness in female is better than male, but it is not significant.
The amount of reduction of substance p in group A compared to group B was significantly better in both male and female. The response rate to BTX-A in female is better than male, but it is not significant.

Conclusion: For the first time, we showed the relationship between the dose of Butulinum toxin A injection and the reduction of erythema in patients with rosacea through the examination of Substance P, and we also showed that the reduction of Substance P has a direct relationship with the rate of reduction of erythema.

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An innovative protocol in the treatment of enlarged open pores: Investigation low concentrations Hyaluronidase in 72 cases with enlarged open pores

Objectives: A comprehensive investigation was conducted on a cohort of 72 female individuals presenting with grade 2 open pores, characterized by a diameter ranging from 0.3 to 0.6 mm. The objective of this study was to assess the impact of low concentration of hyaluronidase injection on the size of these open pores through meticulous measurement before and after the administration of said injection.

Introduction: the causes of open pores can be multifactorial and may vary among individuals. The interplay of these factors can contribute to the appearance and size of open pores.
Decreased skin elasticity around the pores can lead to pore enlargement . Skin aging and decreased collagen production can affect skin elasticity and contribute to pore size.
In this study, we endeavor to explore the effects of hyaluronidase on open pores by examining its impact on the extracellular matrix, marking the first attempt to investigate this phenomenon."

Materials / method: Seventy-two female participants, ranging in age from 21 to 56 years, presenting with grade 2 open pores measuring between 0.3 to 0.6 mm , without any history of aesthetic procedures were recruited for this study. Following local anesthesia administration, normal saline was injected in the cheek areas on the right side of the face. On the Left side, low concentrations of Hyaluronidase were injected. Both side injected in intradermal depth. Participants were evaluated at intervals of 2 weeks, 3 w and 12 m to assess changes in open pore size compared to baseline measurements.

Results: During the first visit (second week), improvements were observed on both sides; however, a significant reduction in the number and dimensions of open pores was noted specifically on the left side (hyaluronidase). By the 12th week, no significant differences were observed on the right side (normal saline) compared to baseline conditions. Conversely, the left side exhibited a substantial decrease compared to baseline levels, although it did not differ significantly from the first visit. No significant differences were observed at the third visit or at the conclusion of one year for either side.

Conclusion: This study represents a pioneering investigation into the impact of hyaluronidase on enlarged open pores, drawing upon evidence from tissue engineering and previous research. The findings demonstrate its effective and significant effects. We recommend that further studies be conducted to elucidate more precise injection intervals and explore the long-term effects of hyaluronidase.

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Exploring the Alignment of Non-Surgical Aesthetic Procedures with Social Necessities: A Comprehensive Three-Year Study on the Influence of Aesthetic

Objectives: What proportion of regularly and commonly performed aesthetic procedures contributes to the enhancement of adaptability and the promotion of efficient, effective social communication and quality of life ?"

Introduction: Interpersonal intentions and promoting social engagement are of utmost importance for several significant reasons like Establishing Meaningful Connections, Enhancing Communication, Encouraging Collaboration , Strengthening Empathy and Compassion , Enhancing Personal Growth and Cultivating Social Norms and Values.
Face features can have a profound impact on interpersonal intentions and promote social engagement due to the vital role of nonverbal communication in social interactions through smiling , eyes , skin texture , etc.

Materials / method: Data collection was conducted from November 2019 to November 2022 across nine non-surgical aesthetic clinics. The information gathered pertained to the volume of non-surgical procedures, the age and gender of the clientele, and the total number of participants involved. During the final consultation related to each procedure, the FASQol questionnaire was systematically administered to the individuals in question.

Results: A total of 28,709 clients who did not undergo surgery conducted 86,543 aesthetic procedures. Out of these individuals, 22,349 identified as female and 6,360 identified as male. The clients' average age was reported to be 34 years, with a range spanning from 16 to 69 years.
The frequency of Aesthetic procedures and their importance and impact on the quality of life are shown in figures 1 to 8.

Conclusion: This extensive research, conducted for the first time, with a significant quantity of data, scrutinizes the effectiveness of non-surgical aesthetic treatments in augmenting the quality of life for individuals. The findings yield valuable insights into the role and importance of non-surgical aesthetic procedures for physicians, patients, and industry manufacturers. The knowledge derived from these findings can guide medical professionals to develop a more precise understanding of their clinic's marketing dimensions.

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Efficacy of Tranexamic Acid Injections for the Treatment of Melasma Subtypes: Evaluating Concentration and Penetration - A Meta-Analysis

Objectives: 1. To analyze the correlation between different TXA concentrations and their efficacy in melasma subtype management, with a focus on determining the most effective concentrations.

2. Investigate the impact of various TXA penetration techniques in treating different melasma subtypes and determine which methods yield optimal results.

3. Assess the efficacy of TXA injections in treating distinct melasma subtypes (epidermal, dermal, mixed-type, and indeterminate), considering the unique characteristics and challenges presented by each subtype.

Introduction: Melasma is a common and often distressing skin condition characterized by the development of brownish, symmetrical facial hyperpigmentation. These subtypes include epidermal melasma, dermal melasma, mixed-type melasma, and indeterminate melasma. Tranexamic Acid (TXA), an antifibrinolytic agent, has gained recognition as a potential therapeutic solution for melasma. Moreover, TXA can be administered via intradermal injections, which enable targeted delivery to the affected areas.

Materials / method: Random-effects model meta-analysis utilizing the DerSimonian and Laird technique was conducted, which is based on the inverse variance method. The findings will be illustrated using forest plots. The heterogeneity of the comparisons was assessed using the Chi-square test (Cochran's Q), with a statistical significance level of p = 0.005 (p < 0.005) rejects the null hypothesis of homogeneity). We employed the I^2 statistic to determine the proportion of total heterogeneity beyond chance: less than 25% heterogeneity is considered low, 25% to 50% is moderate, and more than 50% is high. RevMan vers

Results: A total of 15 randomized controlled trials were included. We observed varying degrees of efficacy based on Tranexamic Acid concentration. Notably, the low concentration (2%) exhibited a melasma improvement rate of 40% (95% CI: 35%–45%), the moderate concentration (4%) showed 55% improvement (95% CI: 50%–60%), and the high concentration (6%) demonstrated a significant improvement rate of 70% (95% CI: 65%–75%). Subgroup analysis focusing on penetration depth revealed distinct responses, with deep penetration yielding a melasma improvement rate of 75% (95% CI: 70%–80%).

Conclusion: While Tranexamic Acid Injections show promise as a therapeutic option for melasma, comprehensive investigations into concentration optimization and penetration mechanisms are essential. Future research endeavors should focus on refining protocols, exploring novel delivery methods, and addressing the existing gaps in the current literature to establish TA injections as a safe and effective modality for melasma management.

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Anatomical and ultrasonography-based investigation for vascular localization of the temporal region

Objectives: The purpose of this study was to investigate the vascular topography and localization on the temporal region related to the facial landmarks to propose the safety guideline using conventional cadaveric dissection and ultrasonographic investigation in a healthy volunteer.

Introduction: Temporal augmentation is one of the most popular cosmetic procedures for correcting the excessive depression of temple. However, the serious complications due to vascular compromise have been reported. Color Doppler ultrasound could grant a precise knowledge of the location and relationship of vessels with neighboring tissue even the filler material placement. These could minimize the possibility of vascular injury and also provide appropriate guidance to the clinician. Nevertheless, few studies have investigated about the vascular topography and localization of temporal region.

Materials / method: This study was approved by the Institutional Review Board of the Faculty of Medicine Vajira Hospital, Navamindrahiraj University (IRB No. 162/65E, COA No. 008/2023). Two investigating methods were utilized consisting of conventional dissection in twenty embalmed cadavers and color Doppler ultrasonographic investigation in twenty healthy volunteers to identify vascular distribution at the temporal region correlate to anatomical reference.

Results: This study found that at the V0 level, the inferior branch of descending frontal branch of superficial temporal artery (Inf-dFBrSTA) and middle temporal vein traveled near a gun shot injection point for temporal augmentation about 20% of the cases with the vertical distances of 15.8 and 12.6 mm from the H-line, respectively. After the Inf-dFBrSTA traveled with a short distance from FBrSTA, it adhered tightly to bony surface of lateral orbital rim to to grant the anastomosis with any branches of ophthalmic artery.

Conclusion: A color Doppler ultrasonographic examination prior to the injection is highly recommended performing to gain the actual vascular distribution and topography for conducting an appropriate injection technique in order to minimize the opportunity of severe complications.

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Por favor indique a entidade (pessoa ou empresa): Overseas academic presentation scholarship from the Faculty of Medicine Vajira Hospital, Navamindrahiraj University.

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Este trabalho foi realizado com o patrocínio de: Overseas academic presentation scholarship from the Faculty of Medicine Vajira Hospital, Navamindrahiraj University.

COMPLETE FACIAL REJUVENATION: INTEGRATING PHENOL CROTON, FILLERS, AND BOTULINUM TOXIN

Objectives: To present a clinical case in which a 47-year-old patient underwent complete rejuvenation with a combination of 0.8% croton phenol peeling according to Hetter's formula, associated with botulinum toxin and hyaluronic acid fillers.

Introduction: The use of phenol croton peel, once popular with the Baker formula, faced limitations due to extended recovery periods and a heightened risk of hypochromia. However, modern advancements, particularly the Hetter formula using 0.2% to 1.6% croton oil, have replaced the need for 2% croton oil. This contemporary approach combines the Croton phenol peel with fillers and botulinum toxin, enabling dermatologists to achieve effective and comprehensive facial rejuvenation with reduced risks and improved outcomes.

Materials / method: A 47-year-old patient with no comorbidities sought treatment for general facial aging, including static and dynamic wrinkles, xerotic skin, photodamage, temporal sinking, nasolabial fold and labio mental changes, lip flattening, loss of lip definition, and barcode wrinkles. Initially, a botulinum toxin procedure on the entire face targeted dynamic wrinkles, followed 15 days later by a full-face phenol croton peel using 0.8% croton based on Hetter's formula. After six months, following recovery from the peel's effects, the patient received 11 hyaluronic acid syringes for ongoing treatment.

Results: The patient underwent comprehensive facial rejuvenation: botulinum toxin addressed dynamic wrinkles, deep peeling tackled static wrinkles, and hyaluronic acid fillers restored lost volume caused by bone reduction and fat pad loss. This clinical case highlights a practical therapeutic combination suitable for a Dermatologist's daily practice, offering long-lasting results that bring satisfaction to the patient and the doctor.

Conclusion: In conclusion, this clinical case underscores the efficacy of a comprehensive treatment approach integrating 0.8% croton phenol peeling as per Hetter's formula, coupled with botulinum toxin and hyaluronic acid fillers. Addressing multiple facets of facial aging in a 47-year-old patient, this method effectively targeted static and dynamic wrinkles, skin texture irregularities, and volume loss attributed to structural changes.

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Association of the perioral phenol-croton peel technique with hyaluronic acid filler in lip rejuvenation

Objectives: This case report aims to demonstrate a new technique for lip rejuvenation,
based on the association of perioral phenol-croton peel with lip filler with hyaluronic acid, which
allows treating all components of lip aging And providing highly satisfactory results for the patient.

Introduction: The aging of the lips leads to loss of volume, reduction in contour and formation of fixed rhytids in the perioral region. Treating this area is an important challenge due to the different components associated with its aging process. In this sense, phenol-croton peel allows effective treatment of deep rhytids in the perioral region, while hyaluronic acid fillers can be used to restore the contour, lost volume and restructure the lips.

Materials / method: The perioral area was marked using a white skin pencil. A 1% Hetter formula was applied thoroughly with a first pass using a wooden applicator with the wet tip wrapped in cotton, followed by 5-10 multi-direction passes without adding any extra solution. No analgesia is needed, as phenol itself works as an anesthetic
drug. After the healing process the lips was filled with hyaluronic acid using a 22 gauge cannula (image 1)

Results: This case report aims to demonstrate a new technique for lip rejuvenation, with long lasting results and providing highly satisfactory results for the patient.

Conclusion: The association of perioral phenol-croton peel with lip filler with hyaluronic acid is a new technique for lip rejuvenation, which allows treating all components of lip aging .

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The efficacy of erbium YAG laser alone and in combination with stromal vascular fraction and platelet-rich plasma in the treatment of striae distensae

Objectives: To investigate and compare the efficacy of the combination of Erbium YAG (Er:YAG) laser and stromal vascular fraction (SVF), the combination of Er:YAG laser and platelet-rich plasma (PRP) and Er:YAG laser alone in the treatment of striae distensae.

Introduction: There is no definitive solution for the treatment of striae distensae (SD), and the effectiveness of each treatment method remains controversial. In this study we decided to investigate and compare the efficacy of the combination of Erbium YAG (Er:YAG) laser and stromal vascular fraction (SVF), the combination of Er:YAG laser and platelet-rich plasma (PRP) and Er:YAG laser alone in the treatment of SD.

Materials / method: In 12 participating patients with at least three lesions, each lesion was treated with an Er:YAG laser. Subsequently, SVF was randomly injected for the first lesion, PRP for the second lesion, and normal saline as placebo for the third lesion. The treatment duration was one session, and the efficacy of the treatment was assessed 3 months later using the following items: evaluation of biometric parameters including corneometery, erythema, melanin, tewametery, color, cutometery, complete, epidermal, and dermal thickness, complete, epidermal, and dermal density.

Results: The mean age of the patients studied (10 women and 2 men) was 39.16 ± 4.66 years. In the SVF group, the mean indicators of thickness and density increased significantly (P<0.05). In the PRP group, the mean values of cutometer R5, complete, epidermal, and dermal thickness, complete and dermal density increased significantly (P<0.05). Finally, the mean changes of complete thickness, dermal thickness, complete density, epidermal density, and dermal density were significantly higher in the SVF group than in the other two groups (P: 0.001).

Conclusion: The results of the present study showed that the combination of Er:YAG laser and SVF injection could be considered an effective and safe treatment method in the treatment of SD.

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EVALUATION OF THE BENEFIT OF COMBINING A DERMOCOSMETIC PROTOCOL WITH A FRACTIONATED RADIOFREQUENCY PROCEDURE WITH MICRONEEDLES

Objectives: Fractional radiofrequency with microneedles is a volumetric dermal remodeling system, which induces collagen formation.
To evaluate the efficacy of a corrective serum (15% pure vitamin C, ferulic acid and vitamin E) in reducing the unwanted effects of the aesthetic procedure (redness, edema), 24 hours after the procedure (evaluation of half of the face: left side control, right side application of the serum).
To assess the improvement of the signs of aging by combining the aesthetic procedure with a dermo-cosmetic protocol: cleanser, corrective serum (15% vitamin C, vitamin E and ferulic acid)

Materials / method: 10 women, between 40-70 years old, phototypes II to IV. Application of the dermocosmetic routine 7 days before the procedure. Clinical evaluation of dehydration and lack of luminosity at V-7 and V0. Procedure and application of corrective serum on mid-face. Clinical evaluation of edema, erythema, burning sensation and pruritus, V0 and 24 h, on both halves of the face: clinical scores (VAS: Visual Analog Scale) and photographs (VISIA).
Dermocosmetic protocol 60 days. Evaluation of signs of aging by EVA scale at V0, V30 and V60, and VISIA photographs.

Results: The dermo-cosmetic protocol applied one week before the aesthetic procedure significantly reduces dehydration by 42% and lack of radiance by 15%.
Significant reduction of the side effects of the aesthetic procedure 24 hours after the intervention in the right half (with serum), compared to the left half (control): reduction of edema 17%, erythema 25%, pruritus 18%, burning sensation 17%.
Evaluation of the combined procedure: at V30 there is a significant reduction of all signs of aging: 59% decrease in dehydration, 15% flaccidity, 27% hyperpigmentation, 15% wrinkles, 45% lack of luminosity.

Conclusion: The combined application of a cosmetic protocol together with an aesthetic procedure improves the quality of the skin, prepares it before the intervention, reduces the side effects of the procedure, enhances and maintains the results on the signs of aging after 60 days.

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Filler induced skin allergy

Objectives: Post filler injection complications vary and can be categorized based on their timing in relation to the filler injection as early events (occurring up to several days post treatment) or delayed events (occurring weeks to years post treatment).

Introduction: Fillers have become an important treatment for patients wanting noninvasive rejuvenation. The American Society of Plastic Surgeons (ASPS) reported that approximatel 4,9 million dermal filler procedures were performed by plastic surgeons and other board-certified physicians in 2022 which is 70% increase in comparison with the prepandemic 2019. As the field of soft tissue augmentation is becoming increasingly popular, reports of adverse events have also risen.

Materials / method: We present a case of a 46 year old patient with a skin rash at the site of the filler injection on her face. The day after she was injected with a filler in her nasolabial folds, she developed a pruritic, erythematous urticarial plaques at the site of injection. The pruritus was mild, but persistant. During the day the skin became intensively dry and developed small papulas on the urticarial plaques.

Results: She was treated with metilprednisolon 32 mg p.o. for 3 days, followed by tempering of the dose for another 5 days. After a 2 week follow up, there was a complete resolution of the symptoms. She was also treated with antihistamines for 10 days. As soon as the treatment was initiaded, the skin changes improved with complete resolution. As this was her first filler injection and reaction, 4 months later she was injected with a filler from another brand in her temporal fossa, and developed again the same reaction at the site of injection. She was then treated with the same therapy.

Conclusion: HA molecules in all fillers are the same polysaccharide molecules that compose a major part of our skin. Therefore, HA molecule itself is not usually considered an immunogen. As suggested by Bitterman-Deutsch et al, however, in some conditions, glycosaminoglycans, such as HA, could directly trigger a specific immune response without the primary phase of inflammation, like a “superantigen”. Other components that are added to stabilize HA molecules in soft tissue fillers (eg, crosslinkers, conserving) may also be immunogenic.

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EFFICACY OF PHYTOTHERAPY-BASED LIPOLYTIC INJECTION FOR TREATMENT OF LOWER EYELID BAGS: A CROSS SECTIONAL STUDY

Objectives: General objective
1. To assess the effectiveness (infraorbital subcutaneous fat volume reduction, patient satisfaction, frequency of adverse reactions, and time of recovery) of active lipolytic solutions with phytotherapeutic action for treating lower eyelid bags.

Specific objectives
1. To determine the average dose of the lipolytic solution with phytotherapeutic action for treating lower eyelid bags
2. To measure the level of patient satisfaction after treatment
3. To describe the presence and duration of the most frequent adverse reactions after treatment application.

Introduction: Eyelid bags and signs of facial aging have a prominent place in aesthetic medicine. In addition to aesthetics, they have functional and psychological implications. Today we live in an image-based society, therefore, the treatment of eyelid bags has increased and effective alternatives are being sought. Phytotherapy offers a promising and natural solution. Using plant extracts with anti-inflammatory and revitalizing properties, this approach aims to diminish visible symptoms and enhance overall skin health. Phytotherapy raises questions about the connection between nature and aesthetic health.

Materials / method: A cross-sectional study was conducted from May to November 2022 in one private clinic in Mexico City. Participants were fully informed about the study, its sessions, benefits, and ethical aspects. Sequential photographs were taken to visually document periorbital changes over time. At the same time, we assessed patient satisfaction in witnessing their facial transformation. The lipolytic solution with phytotherapeutic properties was injected into the three main lower eyelid bags (0.30 cc each). A 15-minute observational follow-up was performed to evaluate adverse reactions.

Results: The lipolytic solution was found to have good efficacy in terms of infraorbital subcutaneous fat volume reduction according to sequential photography, and in terms of patient satisfaction, 84.6% reported high satisfaction. Of these, 64.5% experienced discomfort at the injection site and 50% reported edema. Recovery varied: 65.4% recovered in 1-2 days, 23.1% in 3-6 days, and 11.5% took 7 or more days.

Conclusion: Here, we showed that phytotherapy-based lipolytic injection for treatment of lower eyelid bags has promising and even higher results than other studies for infraorbital subcutaneous fat volume reduction. The aesthetic appearance was improved and there were no significant adverse reactions. Therefore, this is a feasible option for patients seeking to improve the appearance of eyelid bags without the need for costly and invasive surgical procedures. Further research is recommended to better understand the mechanisms of action and to validate long-term efficacy, opening Dermatology's New Horizons

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Longevity of non-surgical Hyaluronic Acid filler-based revision rhinoplasty

Objectives: We aimed to assess long-term longevity of the gradual revision NSR in a case by imaging methods (simple photography and ultrasound study).

Introduction: HA fillers are being used for tissue augmentation in primary NSR. In addition, these fillers can be a replacement of the lost tissues during revision NSR, similar the grafts used for open surgery. Many people prefer to conduct a revision NSR instead of an open secondary rhinoplasty but there are concerns regarding the longevity of revision NSR as it is counted as a temporary aesthetic procedure. Given the mentioned issues, we studied longevity of a revision NSR by serial physical investigations and imaging methods.

Materials / method: A 43-year-old female patient presented to our aesthetic clinic 15 years after primary rhinoplasty for the correction of her nose deformity. She did not mention functional problems. We started her treatment by injecting 1.65cc of HA filler in two sessions during the 1st year of the treatment period. In the 2nd year, 0.98cc of the same filler was injected and the results were satisfactory. She presented 1 year later and visual investigation and study of the photographs showed good longevity of the filler. At this step, we injected only 0.27cc filler that resulted in a favorable nose shape.

Results: The ultrasound study also showed the total injected filler in the proper place without considerable absorption. In the follow up, one year after the last injection and 4 years after the start of treatment, the nose shape was unchanged and the patient did not need any complementary treatment.

Conclusion: We investigated the results of the gradual revision NSR in a patient during a 4-year period. The volume needed for the correction was decreasing every year and the injected fillers were not absorbed significantly. The results of this study, in line with other relevant reports, show that gradual revision NSR can be with satisfactory long-lasting results. This case declares that gradual NSR treatment could be considered as an option for the treatment of nasal deformities secondary to primary rhinoplasty.

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SURPRISING OUTCOME IN THE TREATMENT OF LICHEN PLANOPILARIS USGING DERMABRASION

Objectives: The aim of this study is to highlight the treatment of lichen planus pigmentosus, a condition commonly observed in patients with Frontal Fibrosing Alopecia, through the use of dermabrasion, a procedure involving the removal of facial pigmentation. It is important to emphasize the stability of the condition with minimal recurrence after 12 months of treatment, coupled with patient satisfaction. Due to the scarcity of case reports using this technique, further studies are necessary to define the role of
dermabrasion in the treatment of Lichen Planus Pigmentosus.

Introduction: Lichen Planus Pigmentosus is a chronic, recurrent, and challenging-to-treat condition. It presents as brownish or grayish-brown, reticular macules that can be asymptomatic or pruritic, predominantly affecting sun-exposed areas such as the temples, forehead, and neck. Current proposed therapies include the use of topical corticosteroids, calcineurin inhibitors, intense pulsed light, and Nd: YAG laser. However, there is insufficient data in the literature. We describe a female patient, white, 74 years old, with Frontal Fibrosing Alopecia and Lichen Planus Pigmentosus on the forehead for 5 years.

Materials / method: We report a case of a 74-year-old female patient with systemic arterial hypertension using enalapril, hydrochlorothiazide, aspirin, and simvastatin. She reported prior treatments with facial lightening agents for one year without improvement. In addition to a detailed medical history, clinical dermatological examination, and dermatoscopy, a skin biopsy was performed on the frontal and scalp regions for diagnostic confirmation. Manual dermabrasion was chosen for the forehead region after anesthesia, combining infraorbital block and infiltration of lidocaine solution.

Results: The patient was evaluated one month after the surgical procedure and demonstrated improvement in local hyperchromia with satisfaction regarding cosmetic results. Topical use of 4% hydroquinone combined with 1% glycolic acid, a medication the
patient had been using before dermabrasion, was maintained with good progress. Six years after the surgical intervention, the patient remains satisfied with her appearance.

Conclusion: Therapeutic modalities for Lichen Planus Pigmentosus are still limited, with few reports in the literature regarding long-term results. It is a challenging disease with high recurrence rates, significantly impacting the quality of life of affected patients.
The case presentation aims to highlight a potential therapeutic approach for the removal of facial pigmentation associated with Lichen Planus Pigmentosus. However, further refinement is needed regarding the definition of the role of dermabrasion, clinical indications, and post-surgical follow-up.

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TOPICAL IMIQUIMOD ALONE IN THE EFFECTIVE TREATMENT OF NAIL CHROMOBLASTOMYCOSIS

Objectives: Chromoblastomycosis is a chronic infectious dermatosis, classified as a subcutaneous mycosis of implantation.It is caused by the traumatic inoculation of dematiaceous fungi. Clinically,it presents in a polymorphic, oligosymptomatic form and can take months to develop.The most prevalent clinical expression is the verrucous form, which can spread through contiguity,lymphatically, or hematogenously.It especially affects the lower limbs, with only one case described in the literature of nail involvement.In this article, we present a case of nail chromoblastomycosis treated with topical imiquimode.

Introduction: The treatment of chromoblastomycosis is not yet consensual. It is associated with low cure rates and high recurrence rates. Imiquimod is an immune response modifier with antiviral, antitumor, and immunoregulatory action. It is approved by the Food and Drug Administration in the USA for the treatment of certain skin tumors, but is studied off-label for the treatment of various other infectious and non-infectious cutaneous diseases.

Materials / method: We used a review of medical records and histopathological examinations for case reporting. This is the case of a 46-year-old
white male patient with a history of lesions in finger, periungal and upper limbs for 1 year. The patient underwent histological
examination of nail skin confirming chromoblastomycosis, followed by the initiation of treatment with topical 5% imiquimod five times a week for 2 years. After 6 months there was a significant local inflammatory reaction with erythema.

Results: In 2011, a multicenter study investigated the underlying mechanisms of susceptibility and chronicity of chromoblastomycosis.In 2014, this group published cases of chromomycosis treated with topical imiquimod with promising results, demonstrating that it could modify the response to conventional antifungal treatment, including in cases where antifungals did not respond.This led us to question, being the first case of chromomycosis treated exclusively with topical imiquimod, demonstrating the efficacy of this medication in the antifungal response, through the modification of the immune response.

Conclusion: The treatment success demonstrated in this case, as well as in other previously published cases, supports the action of imiquimod as an effective and promising therapeutic antifungal response modulator in the treatment of chromoblastomycosis.
However, further studies with a larger number of patients are necessary to confirm the efficacy of this treatment observed here.

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HAIR TRANSPLANT AS A SAFE AND SATISFACTORY METHOD IN A PATIENT WITH CONGENITAL HIGH FOREHEAD - A CASE REPORT

Objectives: The objective is to highlight this technique as a safer alternative
with fewer side effects than frontoplasty surgery and emphasizes the need for more publications to enhance the technique among surgeons, given the increasing demand for this method among Western women.There is a considerable number of reports on this technique applied to male pattern baldness, and there is a growing number of case reports involving Asian female patients.

Introduction: As an alternative to invasive methods such as frontoplasty, Hair
Transplantation has become popular, with lower surgical risk, shorter recovery time, and absence of scars.References describing techniques specifically for Western female patients are still scarce. We describe the case of a patient with congenital
high forehead who sought our service to improve self-esteem and enhance her facial contour.

Materials / method: 34-year-old female patient with no comorbidities, denying the use of continuous medications and previous treatments to improve
facial contour due to congenital high forehead. Scalp pathologies
were excluded. The design was created by our team of dermatologists who performed the transplant. A total of 1200 follicles were extracted using the (FUE) technique, sparing the patient from a scar in the donor area, and implanted in the recipient area.

Results: Patient demonstrated complete satisfaction with the applied scales. There were no complications after surgery, and no revision surgery was required.Ten months post-surgery, the patient noted satisfactory growth in the donor area and a natural
appearance in the recipient area.The patient denies alopecia and
loss of transplanted hair. As this procedure was performed on a
scalp without previous pathologies, the results are expected to be more lasting and satisfactory.

Conclusion: There are still few reports in the literature on Hair Transplants aimed at correcting genetically high hairlines in Western women. There are substantial differences between genders and ethnicities, and creating a natural hairline involves careful attention to detail in both the frontal edge and the area immediately behind it, in the frontotemporal angles, the temporal
hairline, and its components. Sharing successful cases can encourage the improvement of the technique among surgeons and spare patients from more risky invasive surgeries.

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PHOTOTHERAPY AS A SAFE AND SATISFACTORY METHOD IN PATIENTS WITH PITYRIASIS LICHENOIDES - CASE REPORT

Objectives: The objective of this presentation is to record the successful therapeutic management of a patient with Pityriasis lichenoides, a rare disease in medical practice. Therefore, recording your cases is necessary for the training and expansion of medical learning, especially with regard to the effectiveness of treatment, especially with the use of phototherapy. Recording your cases is necessary for the training and expansion of medical learning, especially with regard to the effectiveness of the main therapies used, such as phototherapy, which will be described in this report.

Introduction: Pityriasis lichenoids is a rare inflammatory disease with unknown etiology, but it is speculated to be an inflammatory reaction triggered by certain infectious agents, an inflammatory response secondary to T-cell dyscrasia, or immune complex-mediated hypersensitivity. It manifests as varied and widespread papulosquamous lesions on the trunk and flexural areas of the extremities, which can occasionally have systemic repercussions. A comprehensive understanding of these clinical aspects is crucial for accurate diagnosis and effective management of this multifaceted condition.

Materials / method: Male patient, Caucasian, 57 years old,without comorbidities.In 2023, he sought the dermatology service,complaining of redness all over his body that started 1 week before the appointment.Two weeks before presentation, he had flu-like symptoms and took anti-flu medication and promethazine, after which he developed diffuse erythroderma without itching or other symptoms.He also mentioned the use of cephalexin before the consultation, with worsening of skin manifestations.The patient underwent oral corticosteroid therapy with little improvement,so he opted for phototherapy,achieving improvement.

Results: A punch biopsy of a representative area revealed a focal lichenoid component and parakeratosis crust, confirming pityriasis lichenoids. As a therapeutic proposal, he used oral corticosteroids with little response and subsequent phototherapy sessions. In 12 weeks, 19 sessions of UVB-narrow band were performed and the patient already showed significant improvement, with cessation of crusty scaly plaques and regression of erythroderma.

Conclusion: The treatment of pityriasis lichenoides is still uncertain and there is no therapeutic standard,mainly due to its unknown etiology.Medications include corticosteroids,antibiotics, antivirals,methotrexate,and immunoglobulins.Options such as narrowband ultraviolet B(UVB) phototherapy are used to suppress the disease due to their anti-inflammatory effect and immunosuppressant,preventing progression to lymphoma cutaneous T-cell therapy.Phototherapy is also useful in prevention of relapses.Sharing cases expands the range of data and allows for a better understanding of the disease and it management

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Hyaluronic acid mechanically stabilized hair formulation complex, a new medical approach for alopecia areata barbae. Case Report

Objectives: To report a two months follow up assessment of therapy by injection of hyaluronic acid mechanically stabilized hair formulation complex in two adult males patients with alopecia areata barbae.

Introduction: There is no known curative therapy to date and currently treatment options rely on corticosteroids, immunosuppressive drugs like ciclosporin or anti-inflammatory drugs like sulfasalazine. Newer therapies like the JAK Inhibitors show promising results in the therapy of alopecia areata. However, all those treatments have a limited success rate with often unsatisfactory results. Relapses occur frequently once the treatment is discontinued and can affect up of to 25% of the successfully treated patients. It is, therefore, crucial to explore additional therapeutic options.

Materials / method: Two male patients, both aged 30 with frequent recurrence of alopecia areata barbae symptoms, not adequately controlled with topical treatments were selected for hyaluronic acid mechanically stabilized hair formulation complex procedure. Six treatment sessions biweekly were suggested as protocol, a control session was done two weeks after the last treatment. Three milliliters of the formulation were used per session. The injectable method was intradermal micropapula technique. Contraindications, such as active infection of the skin or treatment with immunosuppressants, were not present.

Results: After 3 cycles, hair growth starts again, hair regrowth approx. 4-6 weeks after start of treatment; frequently, regrowing hairs are depigmented. Spontaneous regrowth usually occurs in the center of the bald spot and spreads to the periphery. Often thin, completely downy hairs appear first, which are gradually replaced by longer often still unpigmented hairs, which later begin to color normally (as seen on both patients).

Conclusion: This report demonstrates that injectable treatment with hyaluronic acid mechanically stabilized hair formulation complex is beneficial in alopecia areata barbae (AB). This outcome suggests that the HA together with the active ingredients present in the formulation, may help to reduce the symptoms of AB. These data need to be corroborated, but suggest that it has a therapeutic and preventive benefit in the handling of AB. The molecular mechanisms underlying the observed effect needs to be further investigated.

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Autologous Micrografting Technology (AMT) for Androgenetic Alopecia: Demonstrating Efficacy through Data

Objectives: To showcase the effectiveness of Autologous Micrografting Technology (AMT) in treating Androgenetic Alopecia (AGA). Through the presentation of two distinct cases, we seek to highlight the substantial improvements observed in hair count, density, and thickness following AMT interventions, supported by complementary treatments such as mesotherapy. The results are supported not only by macroscopic analysis, but also with trichoscopic data.

Introduction: AGA, a common hair loss problem, lacks consistent solutions. Autologous Micrografting Technology (AMT) shows promise by utilizing the body's regenerative potential. AMT involves converting scalp biopsies into micrografts for injection into affected areas, stimulating hair growth. Two cases illustrate AMT's role in treating AGA, supported by additional interventions and trichoscopic evidence.

Materials / method: 1. Involves a 50 y.o. male patient with AGA. Trichoscopy identified increased thin hairs, reduced hair shaft density, and diffuse hair thinning. The patient underwent AMT followed by three sessions of mesotherapy over 3 months. Follow-ups at 3 and 6 months revealed a significant enhancement in hair count, density, and follicular unit increase, corroborated by trichoscan results.
2. Features a 35 y.o. male patient with AGA. Despite prior attempts with minoxidil and PRP, the patient experienced persistent hair loss and thinning.

Results: 1. Demonstrated an improvement in hair count, density (before AMT 238 N/cm², after AMT 253 N/cm² in the frontal area), and cumulative thickness (from 11.2 to 12.1 mm/cm²). Trichoscan analysis showcased a decrease in thin hair count, an increase in follicular unit density, and improvements in hair thickness.
2. Exhibited results in hair count (before AMT 156 N/cm², after AMT 171 N/cm² in the frontal area), thickness (48 μm to 51 μm), and reduced hair fall. Trichoscan showed an increase in thick hair count (from 41% to 58%), and cumulative hair thickness (7.4 mm/cm² to 8.7 mm/cm²) post-AMT.

Conclusion: The highlighted cases underscore the efficacy of Autologous Micrografting Technology (AMT) in addressing Androgenetic Alopecia. Integration of AMT, coupled with adjunctive therapies like mesotherapy, resulted in substantial improvements in hair count, density, and thickness. These cases advocate for the viability of AMT as a promising intervention for AGA and warrant further exploration and consideration in clinical practice.

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Combined mesotherapy with abobotulinum toxin A, hyaluronic acid and aminoacids, appears to be more efficient as a rosacea treatment method in comparis

Objectives: A case series study,was conducted to investigate if the combined mesotherapy with abobotulinum toxin A,hyaluronic acid and aminoacids,appears to be more efficient as a rosacea treatment method in comparison to mesotherapy by abobotulinum toxin A alone.

Introduction: Erythematelangiectatic rosacea(ETR)is characterized by erythema, telangiectacia and flushing.Abobotulinum toxin A mesotherapeutic injections have shown to ameliorate the symptoms of rosacea,so has major therapeutic interest to observe the mixture containing also hyaluronic acid and specific aminoacids(l-lysin mono hydrochloride,l-proline,glycine,l-leucine) in treatment plan.

Materials / method: Twenty three ETR rosacea patients were divided into 2 groups: group 1with 16 patients(subgroups1A,1B: 8 received 2cycles of mesotherapy with abobotulinum toxin A,hyaluronic acid and aminoacids at week 0and12,and 8 followed the same treatment at week 0 and24) and group 2 with 8patients received mesotherapy alone with abobotulinum toxin A(subgroup 2A with 4 participants at weeks 0 and 12,and subgroup 2B at weeks 0 and 24).Every mesotherapy session(intradermal infusion)was performed by a mixture:40-45iu abobotulinum toxin A,3ml low molecular hyaluronic acid and aminoacids.

Results: Group1was highly successful in completing the treatment-only1patient didn’t.On the contrary,only1patient from group2 was able to complete the treatment schedule because of the bothersome side effect of facial paresis,apparently due to the toxin.

Conclusion: Mesotherapy with BTX, hyaluronic acid and specific aminoacids is an effective and safe ETR rosacea treatment,offering an excellent cosmetic and therapeutic
outcome.It should be emphasized that the incorporation of BTX into the prespecified agents of the mesotherapeutic vehicle,was shown to offer remarkable protection against the toxin’s side effects(facial paresis),while the same toxin dilution, but without aminoacid mixing, was noted as almost always harmful causing facial paralysis.This study may worth to be extendend in a larger group,to enlight the mechanism of the therapeutic intervention

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Platelet-rich plasma and topical minoxidil 5% in the treatment of severe multifocal alopecia areata: report of two cases

Objectives: This abstract reports two cases showing significant hair-growth results in severe multifocal alopecia areata with the use platelet-rich plasma and topical minoxidil 5%.

Introduction: Alopecia areata is an autoimmune non-scarring hair-loss. Corticosteroids are considered first line traditional treatment, but their long-term use may lead to undesirable side effects. Platelet-rich plasma is an autologous product, which includes concentrated platelets with rate above the baseline.Topical minoxidil has been used for mild cases of alopecia areata and other types of non-scarring hair loss. The combination of both treatments hasn’t been scientifically researched. We report two cases showing significant hair-growth results in severe multifocal alopecia areata with the use of both.

Materials / method: PRP prepared by double-spin methodology and was applied once monthly for a total of 6 sessions, and topical minoxidil 5%, twice daily, as an at home treatment. The obtained 8ml PRP was aspirated in 3ml syringes, and 0.1 ml of PRP, 1 cm apart, was injected in the scalp in the subfollicular plane through multiple intradermal injections with a 30G needle. Trichoscopy was performed with Dino-Lite Edge Digital Microscope AM7915MZT(R7), x70 magnification. SALT Score was used to evaluate the severity of hair-loss.

Results: Case 1
A 38-year-old female patient had first episode of alopecia areata with estimated SALT 65 (Figure 1). The duration of the episode was 12 months. She hasn’t received any previous treatment and refused corticosteroid therapy. Trichoscopy showed black dots, exclamation mark and vellus hairs (Figure 2). The patient was treated with PRP once monthly for a total of 6 sessions, and used topical minoxidil 5%, twice daily. One month after the last PRP SALT was 4,5 (Figure 3). Trichoscopy showed upright regrowing hairs, pigmented terminal hairs and increased hair shaft thickness (Figure 4).

Conclusion: Case 2
A 49-year-old female, with a recurrent severe alopecia areata for 6 months with SALT 82% (Figure 5). Trichoscopy: yellow dots, black dots, broken hairs, vellus hairs (Figure 6). At follow-up SALT was 19 and trichoscopy showed upright regrowing hairs and terminal hairs (Figure 7, 8).
Conclusion:
The autologous PRP and topical minoxidil are both treatment alternatives for alopecia areata. However, the combination of both therapeutic approaches for alopecia areata hasn’t been explored. Additional controlled trials with more subjects are needed to validate the reported results.

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Dermatological assessment of dermal tolerance and performance in post-inflammatory hyperpigmentation lightening - a clinical, subjective, and instrumental study

Objectives: To evaluate safety and clinical efficacy of a novel serum formulation containing salicylic acid, succinic acid, gluconolactone, zinc gluconate and niacinamide in reducing post-inflammatory hyperchromia and porphyrins (related to Cutibacterium acnes) in patients with female adult acne.

Introduction: Hyperchromias are intricately linked to factors like aging, hormonal changes, inflammation, acne, allergies, and sun exposure. The inflammatory processes of acne lesions stimulate melanin deposition and melanogenesis, contributing to post-inflammatory hyperpigmentation (PIH). These pigmentary alterations can be long lasting and are often more distressing to patients than the active acne lesions. The treatment of PIH remains a complex challenge and novel formulations may help reduce post-inflammatory disorders in acne.

Materials / method: Open-label prospective study, conducted in Brazil between April-August 2023 with female participants aged 18-45 years (Fitzpatrick III-V) with mild acne and PIH. Ethical approval was granted. Individuals were instructed to apply a thin layer of this novel cosmetic serum twice daily to clean skin, followed by sunscreen (FPS30) and to return to the center at day 42 (+/- 2 days) and day 84 (+/- 2 days) to be clinically evaluated by a dermatologist. Facial photographs, quantification of porphyrins and blemishes/spots were assessed using a skin analysis system (3.1 VISIA®, Canfield).

Results: From the 37 screened individuals, 4 did not meet all inclusion criteria. Valid data were obtained from 30 (up to 42 days) and 20 participants (up to 84 days). 2 participants reported mild adverse events, 1 possibly related to study product and 1 unlikely related to study product. Statistically significant improvements were observed (p<0,05) in all evaluated parameters (luminosity, uniform skin tone, skin spots number, pigmentation intensity) after 84 days. Over 60% considered the product to be effective in lightening spots, evening skin tone, and 90% or more considered it easy to apply.

Conclusion: The cosmetic serum containing salicylic acid, succinic acid, gluconolactone, zinc gluconate and niacinamide demonstrated efficacy in the reduction in porphyrins and improving luminosity, skin tone uniformity, and the number of spots after 42 and 84 days of continuous use with a favorable safety profile.

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Concurrent Application of Injectable Poly-L-lactic Acid (PLLA) and SB-NASHA Skin Quality Injectable for Post-pregnancy Abdominal Contour Improvement

Objectives: To present a clinical recommendation for the concurrent use of hyaluronic acid (SB-NASHA skin quality injectable) and PLLA for post-pregnancy abdominal contour improvement. This strategy was designed to achieve immediate and enduring enhancements in skin firmness, reduction in abdominal distension and dimensions, and enhancement of the laxity in the umbilical area.

Introduction: Post-pregnancy can lead to skin changes, such as increased laxity and stretch marks. Additionally, the appearance of the umbilicus may change from concave to convex presenting another aesthetic concern. Non-invasive tissue tightening and the reduction of abdominal circumference and sagging in the umbilical region can be achieved by different techniques. The combination of hyaluronic acid (SB-NASHA skin quality injectable) and PLLA provides a minimally invasive solution for enhancing the texture of the skin, resulting in significant improvements in skin flaccidity and density over time.

Materials / method: The treatment plan is determined based on an abdominal sagging scale. Assessments were performed before treatment and 30, 60, and 90 days after treatment with Quantificare Life Camera (USA). PLLA should be reconstituted with sterile water for injection before use with recommended final volume for dilution of 16mL + 1-2mL of lidocaine 2%. The authors inject more volume in the supraumbilical region to achieve a lifting effect and suggest 6 vials of PLLA in a single session or divided into 2 sessions with one-month interval. SB-NASHA skin quality injectable recommended volume is 2 mL.

Results: Clinical results obtained with the presented technique results are portrayed in clinical cases showing improvement observed with concurrent PLLA-SCA and SB-NASHA skin quality injectable injection after 90 days of treatment.

Conclusion: The concurrent application of PLLA and hyaluronic acid SB-NASHA skin quality injectable revealed a successful post-pregnancy abdominal contour improvement, marked by a significant reduction in abdominal distension and dimensions, and enhancement of the laxity in the umbilical area. The technique has a favorable safety profile.

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Concurrent Application of Injectable Poly-L-Lactic Acid (PLLA) and SB-NASHA Skin Quality Injectable for Facial Rejuvenation

Objectives: This poster presents clinical recommendations of five Brazilian experts for the combined use of injectable PLLA-SCA and SB-NASHA skin quality injectable for facial rejuvenation, targeting immediate and lasting enhancements in facial contour, skin texture, hydration, firmness, wrinkle reduction, and pigmentation attenuation.

Introduction: Facial aging encompasses a gradual decline in skin thickness and elasticity, along with diminished dermal collagen, hyaluronic acid (HA), and elastin. Facial rejuvenation techniques now focus on restoring lost volume, with injectable dermal fillers like Poly-L-Lactic Acid (PLLA) and hyaluronic acid (SB-NASHA skin quality injectable). This combination offers a minimally invasive method for enhancing facial texture, leading to significant improvements in skin density over time, contributing to overall facial rejuvenation.

Materials / method: Treatment selection was based on a clinical assessment using a “mandala tool” that evaluates five facial parameters: skin quality (radiance and firmness), facial shape (volume, sagging), proportions (balance), symmetry (asymmetry), and expression (lines), with a grading scale from 0 to 3. Quantificare Life Camera (Quantificare Inc., USA) was employed for imaging and a corneometer (SkinAnalyser, Brazil) to measure the levels hydration, oiliness, and elasticity of the skin through biological impedance. These assessments were conducted before treatment and at 30, 60, and 90-days post-treatment.

Results: Substantial and sustained enhancements in multiple facial aspects were observed with the technique, including the reduction of skin flaccidity, improved lifting effects, enhanced skin radiance, overall appearance, and diminished dynamic wrinkles. Notably, improvements were also observed in pore texture and facial pigmentation over both short and long-term periods. In the volumetric analysis performed with Quantificare Life Camera, a noticeable enhancement in skin quality was observed, without a concurrent increase in volume. Furthermore, corneometry indicated increase in skin hydration.

Conclusion: The facial use of PLLA and SB-NASHA skin quality injectable in the same session, different anatomic areas, resulted in a successful rejuvenation, characterized by a notable improvement in facial contour sagging, a lifting effect, enhanced skin radiance, an overall improved appearance, reduced dynamic wrinkles, and enhanced pore texture and facial pigmentation. This treatment achieved an improvement in skin quality and proper hydration without increasing facial volume.

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Concurrent Application of Injectable Poly-L-Lactic Acid (PLLA) and SB-NASHA Skin Quality Injectable in Rejuvenating the Dorsal Hands

Objectives: This poster presents recommendations of five Brazilian experts to offer clinical guidance for the simultaneous use of injectable PLLA and SB-NASHA skin quality injectable for hands rejuvenation. This strategy is designed to attain both immediate and enduring enhancements in skin hydration, firmness, wrinkle reduction, and pigmentation.

Introduction: Aging affects the appearance of hands in various ways. Loss of subcutaneous fat makes veins, tendons, and bony contours more prominent on the dorsal hand. Age-related changes also include thinner skin and increased laxity, exacerbated by lifelong UV exposure, leading to pigmentation alterations. Hand rejuvenation is becoming increasingly common as patients are concerned about the noticeable contrast between their youthful facial appearance and aging hands, making the latter the second most reliable indicator of age after the face. Traditionally, dermal fillers were primarily used on the face.

Materials / method: Clinical assessment using a dorsal hand aging grading scale to assess pigmentation, vascular issues, and erythema. Clinical assessment was assisted by the Quantificare Life Camera (USA) and skin hydration assessment was conducted using a corneometer (0, 30, 60, and 90 days). PLLA was reconstituted with final volume of 16mL + optional 1-2mL of lidocaine 2%. The authors used a 22G cannula and for PLLA (first) and a 22G cannula/29G needle for of SB-NASHA skin quality injectable (afterwards). Entry point at approximately 1 cm from the wrist. For fingers treated only needle is used.

Results: Overall improvement of the hand aspect was observed with reduction of fine lines, brighter skin and blooming, and tendons and veins were less apparent after 30 and 60 days. At day 90, intense improvement of wrinkles, furrows, hand contour and skin hydration was observed. Results revealed a notable enhancement in skin hydration. Quantificare demonstrates at day 90 significant reduction in spots and erythema compared to day 0. Evident increase in density and concentration of type 1 collagen fibers (Picrosirius) and glycosaminoglycans (Alcian blue) was observed 90 days after treatment.

Conclusion: The combination of PLLA and SB-NASHA skin quality injectable is an attractive synergistic treatment modality. While the collagen biostimulation effects of PLLA are taking place, the SB-NASHA skin quality injectable promote tissue biorevitalization with immediate results. The presented technique and treatment was well-tolerated and promotes hands rejuvenation, marked by restoration of lost tissue volume, reduction in fat loss, attenuation of skin atrophy, diminished pigmentation and visibility of blood vessels, tendons, and bones, along with an improvement in hydration.

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Concurrent Application of Injectable Poly-L-Lactic Acid (PLLA) and SB-NASHA Skin Quality Injectable in Rejuvenating the Décolleté and Neck

Objectives: This poster presents clinical recommendations of five Brazilian experts for the concurrent use of injectable PLLA and SB-NASHA skin quality injectable in the rejuvenation of the neck and décolleté. This strategy was designed to attain both immediate and enduring enhancements in skin hydration, firmness, wrinkle reduction, and pigmentation.

Introduction: The skin of the neck and décolleté ages faster than other body regions, often due to factors such as poor posture, sun exposure, and natural muscle weakening. Age-related changes in this area include skin sagging, reduced elasticity, increased visibility of blood vessels and tendons, platysmal band hypertrophy, wrinkles, rough texture and photoaging effects. Restoring a youthful appearance to the neck and décolleté area is a significant challenge for medical practitioners due to the lack of minimally invasive alternatives comparable to surgical neck lift procedures.

Materials / method: Assessment was performed using a subjective neck and décolleté skin aging scale to assess pigmentation, vessels, and erythema. Clinical evaluation was assisted by Quantificare Camera (USA) and a corneometer at 30-60-90-days. PLLA-SCA was reconstituted with sterile water for injection before use with final volume for dilution of 16mL + optional 1-2mL of lidocaine 2%. 22-G cannula and for PLLA-SCA and either a 22-G cannula or a 29-G needle for SB-NASHA skin is recommended. Entry points are shown in poster figures. Appropriate product dosage and number of sessions are described in poster tables.

Results: A neck/décolleté skin aging grading scale was used to assess pigmentation, vessels, and erythema. Clinical evaluation was assisted by the Quantificare Life Camera (Quantificare Inc., USA) and skin hydration was assessed using a corneometer (SkinAnalyser, Brazil) at 30, 60, and 90-days. PLLA was reconstituted with sterile water for injection and final volume is 16mL including optional 1-2mL of lidocaine 2% before the injection. The authors use a 22G cannula for PLLA and a 22G cannula/29G needle for SB-NASHA skin quality injectable. Entry points are shown in an image scheme.

Conclusion: Skin aging impacts on the neck and décolleté skin can be effectively treated with simultaneous use of PLLA and SB-NASHA skin quality injectable with a favorable safety profile. Combining PLLA and SB-NASHA skin quality injectable successfully revitalized the neck and décolleté, restoring lost tissue volume, reducing fat loss, alleviating skin atrophy, diminishing pigmentation and the visibility of blood vessels, tendons, and bones, while improving skin hydration.

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Successful treatment of adiponecrosis secondary to fat grafting with calcium hydroxyapatite filler

Objectives: -To report a successful case of repair with calcium hydroxyapatite of adiponecrosis secondary to gluteal fat grafting

Introduction: Calcium hydroxyapatite (CaHa) filler is a well-established, safe, minimally invasive and effective agent for increasing soft tissue and substantially improving the skin of the face and body through endogenous stimulation of type 1 and 3 collagen and type 7 elastin production with minimal inflammatory response. The surgical procedure called “Brazilian butt lift” is one of the most popular in recent years and consists of liposuction plus fat grafting in the gluteal region of the aspirated adipose tissue. However, there is a risk of necrosis of the fat graft.

Materials / method: Female patient, 32 years old sought a dermatological clinic stating that she had undergone a liposuction and buttock lift procedure and developed necrosis and infection. After complications resolution the treatment with CaHa fillers was started in the gluteal region. The treatment was carried out using a multilayer injection technique with different dilutions for each specific objective. 1:4 dilution with injection plane in subdermis was used with the aim of improving sagging. 1:2 dilution with an injection plan in the deep subcutaneous layer was used to improve the shape, contour and volume.

Results: An increase in volume, better gluteal contour and lift effect were observed, in addition to the skin quality improvement and complete correction of depression caused by adiponecrosis. The patient did not experience any adverse effects during the course of treatment.

Conclusion: CaHa is a safe alternative for correcting surgical complications, such as adiponecrosis and lipodystrophy secondary to fat grafting, thanks to its collagen stimulation properties with minimal inflamatory response. The safety profile of calcium hydroxyapatite fillers is better, as it does not require general anesthesia, is less invasive and requires less technical complexity and structure compared to the surgical procedure.

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Treatment of Folliculitis Decalvans with Erbium-YAG Laser

Objectives: We intend to present a case of a 35-year-old man recalcitrant Folliculitis Decalvans treated successfully with Erbium-Yag (Er: Yag) laser with quick response and without hair loss. We also describe the mechanisms in which the Er: Yag laser acts on FD, involving the action on fibroblasts, skin microbiota, immune cascade triggering hair growth and angiogenesis, as well as improvement of hyperkeratosis.

Introduction: Folliculitis decalvans (FD) is a neutrophilic scarring alopecia characterized by erythematous follicular papules, pustules and patches associated with follicular hyperkeratosis and tufted folliculitis. The etiology involves bacterial infection, particularly Staphylococcus aureus, and a genetic predisposition has also been suggested. The treatment mainly involves antibiotic therapies, tacrolimus ointment, external beam radiation, isotretinoin, human immunoglobulin, adalimumab, and infliximab. The use of techonologies has also been reported such as of long-pulse ND: Yag aiming hair removal.

Materials / method: We present a 35-year-old man diagnosed with FD recalcitrant to multiples oral antibiotics. He came presenting erythematous follicular papulopustules, confluent fibrotic papules, nodules and polytrichia in the occipital and vertex region (Figure 1). We chose to perform fractional ablative erbium laser therapy, associated with infiltration of 1ml of pure triancinolone 20 mg/ml in the keloid and drug delivery in the entire folliculitis area. It was performed 3 sessions with a 4 weeks inter-treatment of Erbium-Yag fractional ablative 2940nm, 10J/cm2, 2ms and 2Hz.

Results: After three months, the patient presented an amazing response of the clinical condition (Figure 2), without the need of further teraphies.

Conclusion: The action on fibroblasts, skin microbiota, immune cascade triggering hair growth and angiogenesis, as well as improvement of hyperkeratosis are mechanisms in which Er: Yag may improve FD. We present a case of FD with rapid improvement and no hair loss with the use of Er: Yag. More clinical studies are needed to better define its benefits.

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A Novel Therapeutic Approach for Nodule Treatment Following Polycaprolactone Injectionhetic Interventions on Quality of Life

Objectives: To report a novel management approach for a 40-year-old woman with bilateral anterior cheek nodules after PCL injection.

Introduction: Dermal fillers, specifically Polycaprolactone (PCL), have gained significant popularity over the years due to their roles in volume restoration and facial contouring. The unique attributes of PCL position it as a preferred option within cosmetic procedures, particularly for its enduring nature and its capacity to stimulate collagen production[1]. Such collagen stimulators not only offer immediate volume correction but also encourage the body's natural collagen synthesis for sustained effects.
However, with every medical advancement comes associated concerns about potential complications. One o

Materials / method: The patient presented one year post-PCL injection with bilateral cheek nodules. Initial signs included palpable firm masses with erythema and warmth. Initial measures included oral antibiotics and ultrasound evaluation. Novel Therapeutic Approach for Nodule Treatment Following Polycaprolactone Injectionhetic Interventions

Results: No signs of redness or inflammation.
No discoloration or atrophy observed post-treatment.
Notably, no fibrosis observed in subsequent ultrasound images.
Significant Changes Before and After Treatment:
The size of the nodule on the:
Left side decreased by about 20% in length and significantly in thickness.
Right side decreased by approximately 30% in length and also significantly in thickness.
This indicates a notable reduction in the size of the nodules post-ment.
Left side: Hyper-heteroechoic region measuring 20x5mm with a 0.7mm distance from the skin, no fibrosis observed.

Conclusion: The therapeutic approach led to the absence of erythema and inflammation, with no observed color change or atrophy post-treatment. The noteworthy observation was the absence of fibrosis in follow-up sonographic images. This treatment signifies the importance of collagenase in breaking down fibrotic matrices, supported by various studies.

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Picosecond laser with a combination of serums to treat dark skinned women with melasma

Objectives: OBJECTIVE
Evaluate the efficacy of a combinated treatment with different seruns and picosecond laser in dark skinned female patiens.

Introduction: INTRODUCTION
The treatment of melasma is one of the most challenging fields to dermatologists4. It usually starts with preventions of sun, topical agents, oral therapies, chemical peels, microneedling, laser and light treatment. However, most have limited clinical efficacy, high rates of recurrence, and adverse reactions1. Topical hydroquinone alone or combinated with retinoid and a corticosteroid has the greatest evidence of efficacy 5, however not all patients tolerate the use and the safety has been established of daily use up to 12 months. These patients need safe options for long term tre

Materials / method: MATERIALS AND METHOD
Four dark skinned female patients were treated with four sessions of picossecond laser (HandPico, Vydence, Brazil) with 3 weeks intervals in a sunny city of Brazil in spring time. They were instructed to use a serum (3% tranexamic acid, 5% niacinamin, 1% kojic acid, 5% enzymatic peeling) twice a day for two weeks before the first session. The same product was applied right after the session (collimated, 7mm, 1,10 – 1,20 mJ, 7 Hz). Between sessions the instructions were to apply in the morning a serum (4,5% botanic extract, hyaluronic acid and glicerin) plus another serum

Results: RESULTS
All patients were satisfied with treatment and the melasma got moderately better in two patients and slightly better in the others. There were no sides effects and the treatment were tolerated.

Conclusion: CONCLUSION
Treatment of melasma is challenging, especially in dark skinned patiens that live in sunny areas. Laser treatment is emerging as a relatively safe and effective to treat melasma with minimal side effects. More trials with longer follow-up period are needed to understand de recurrence and the best ingredients association for topical treatment.

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