IMCAS

Digital Dermatology: Evaluating the Efficacy of Skin Health Apps

Objectives: This study aims to critically assess the landscape of dermatology-focused mobile applications, identifying their functionalities and potential benefits for both patients and healthcare providers. By the end of this exploration, learners will understand how these apps address specific challenges in dermatologic care, evaluate their usability and relevance, and recognize the implications of user feedback on their effectiveness in enhancing patient management and education within dermatology.

Introduction: The advent of mobile technology has revolutionized dermatologic care, offering unprecedented opportunities for patient management and education. Mobile applications now play a pivotal role in this evolution, providing specialized tools that cater to the unique needs of both patients and healthcare providers. This study explores the growing landscape of dermatology apps, focusing on their diverse functionalities, the challenges they address, and their potential to enhance the quality and accessibility of dermatologic care.

Materials / method: We conducted a comprehensive review of dermatology-focused mobile applications, analyzing their functionalities in the context of dermatologic care. Our assessment focused on how these apps address clinical challenges, with criteria including user interface design, the depth of provided information, and integration with broader healthcare systems. This systematic approach allowed us to evaluate the apps' relevance, usability, and overall contribution to enhancing dermatologic care.

Results: Our review identified a diverse array of dermatology-focused mobile applications, each tailored to specific facets of dermatologic care. These apps encompass functionalities ranging from patient education and self-assessment to teledermatology and virtual consultations. Many of these applications are designed with user-friendly interfaces, enhancing accessibility and integration into clinical practice. The potential of these tools to augment patient management and improve healthcare delivery in dermatology is significant.

Conclusion: Dermatology-focused mobile apps are revolutionizing dermatologic care by enhancing patient management, education, and remote consultations. These tools hold great potential but require rigorous validation and regulatory oversight to ensure clinical efficacy and prevent misinformation. While technology advances, challenges in accurate diagnosis and the psychological impact of conditions underscore the enduring importance of direct patient care and physical examination. Ongoing research and development are essential to fully realize the benefits of these innovations.

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Transforming Dermatological Practice: The Promise of Smart Wearables

Objectives: This study seeks to unlock the potential of smart wearable medical devices in dermatology, focusing on their ability to revolutionize skin disorder management amidst environmental and lifestyle challenges. By examining cutting-edge technologies, this research aims to highlight how these devices can enhance proactive care, real-time monitoring, and precise diagnosis. The ultimate goal is to provide a comprehensive understanding of their integration into dermatologic practice, offering a glimpse into the future of patient-centered skin care.

Introduction: Skin disorders challenge global healthcare, worsened by environmental and lifestyle changes. Smart wearable devices offer a new era of proactive management, real-time monitoring, and accurate diagnosis in dermatology. This paper explores their transformative potential, assessing their features and impact through comprehensive literature and technological review. By examining current and emerging devices, we highlight their role in advancing dermatologic care and improving patient outcomes.

Materials / method: We conducted a detailed review using PubMed, Google Scholar, and Web of Science to find literature on smart wearable devices in dermatology. Search terms included "smart wearables," "dermatology," "wearable sensors," and "cutaneous monitoring." We analyzed articles from 2010 to 2024 and manually reviewed reference lists to ensure comprehensive coverage and relevance.

Results: Smart wearable devices leverage IoT for real-time monitoring and diagnostics. Equipped with sensors embedded in garments or directly on the skin, these devices enable continuous data collection without mobility constraints. Notable innovations include intelligent dressings and UV exposure sensors. Emerging trends highlight advances in miniaturization, sensor technology, and data transmission, all promising significant enhancements in patient care and management.

Conclusion: Smart wearable medical devices mark a transformative leap in dermatology, offering real-time data for enhanced diagnosis and personalized care. Their integration into dermatologic practice facilitates continuous monitoring and proactive management of skin conditions. Innovations in miniaturization and sensor technology promise further advancements, improving patient outcomes. Embracing these devices can optimize care and resource allocation. Collaborative efforts are crucial for ethical deployment, marking a shift toward a more responsive, patient-centered model of dermatologic care.

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Quantifying Safety: A Meta-Analysis of Botox Cosmetic vs. Competitors

Objectives: This meta-analysis evaluates the complication profile of Botox® compared to other competitors.

Introduction: Demand for facial rejuvenation has increased, with a projected market value of 6.9 billion dollars by 2026 (Statista et al., 2023). The number of types of BoNTA (X-BoNTA) injections has grown over time including Botox®, Dysport®, Xeomin®, PurTox®, Chinese Lantox® and others (Walker et al., 2014).

Materials / method: e performed a PubMed literature review to search for studies that used botulinum toxin injections for glabellar rhytids over 10 years. Types of Botox included in the X-BoNTA group included: Dysport® (AbobotulinumtoxinA), Xeomin® (IncobotulinumtoxinA), and Chinese Lantox® (Hengli BTX-A). We performed a meta-analysis on the following complications: headache, blepharoptosis, edema, erythema, and brow ptosis.

Results: Eleven studies were selected and included in the analysis (Figure 1). There were no significant differences between Botox® and placebo for all 5 outcomes. Brow ptosis (RD = 0.03; 95% CI = 0.00 to 0.05; P=0.05), erythema (RD = 0.03; 95% CI = 0.01 to 0.06; P=0.02), and headache (RD = 0.04; 95% CI = 0.01 to 0.06; P = 0.003) were significantly higher in the X-BoNTA group when compared to placebo. Glabellar edema and blepharoptosis were not significantly different in either Botox® or X-BoNTA groups when compared to placebo.

Conclusion: Complication profiles for Botox® and alternative forms of BoNT-A are predominantly similar; however, other forms of Botox other than Botox® were associated with a significantly increased risk of brow ptosis, erythema, and headache when compared to a control group.

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Enhancing Gluteal Beauty with the “S” Technique using combination of CaHa and HA body dermal filler

Objectives: The objective of this presentation is to detail the steps of the "S” technique developed based on gluteal anatomy for volumization, lifting and projection effect. This technique combines biostimulator and hyaluronic acid injected in different planes for gluteal beautification. We will discuss the fundamentals, practical application, and outcomes, highlighting its efficacy in promoting natural and harmonious gluteal aesthetics.

Introduction: In recent years, interest and demand for minimally invasive procedures in the gluteal region have significantly increased. As this field is relatively new, established techniques are lacking. This scenario places the gluteal region as a promising area for the development of tailored approaches1,2. The “S” technique described here aims to address this gap by presenting a combined approach for gluteal aesthetic procedures for both lifting and projection effect while improving skin quality.

Materials / method: The proposed "S” Technique involves two main steps (CaHA and HA application. Four application points—S1, S2, S3, and S4—are identified, forming an "S" pattern on each gluteal (Fig.1). Calcium Hydroxyapatite (CaHA) with Lattice Pore microspheres structure is injected (2 syringes per side at 1:1 dilution) and distributed among the four points. In the second step, a body multilayer hyaluronic acid dermal filler is used at S1 for hipdips correction (when required) and S2 point for projection.

Results: The results of the "S” technique showed improved aesthetics in the gluteal region, promoting a youthful appearance (Fig.2 and Fig.3). The combined use of CaHA and HA not only offers improvement in the skin quality through improvement of dermal strength and elasticity, but also increase in volume, lifting and projection effect, for a naturally aesthetic gluteal area. High patient satisfaction was observed, with reports of satisfactory outcomes and no adverse events.

Conclusion: In conclusion, the "S” technique represents an innovative and promising combined approach for minimally invasive gluteal procedures. Its efficacy and safety are evidenced by improved aesthetics and high patient satisfaction with no adverse events. The careful combination of the medical devices demonstrates potential to meet individual aesthetic demands, providing natural and harmonious results.

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CASE REPORT ON THE USE OF TOPICAL METFORMIN 30% CREAM TO TREATING DARK CIRCLES

Objectives: The objective of this paper is to report a case of dark circles treated with Metformin 30% cream which showed a very reasonable clinical improvement.

Introduction: Dark circles under the eyes are a common condition1 worldwide with multiple treatment options. Due of its multifactorial etiology2.
The aim of this work is to report a case of dark circles treated with Metformin 30% cream, which showed a very reasonable clinical improvement.

Materials / method: A female patient, 18 years, has been complaining about dark circles under his eyes for years. Suffers from chronical allergies (allergic rhinitis) and asian family with the same dark circles.

The patient underwent topical creams with hydroquinone 3% , retinol, chemical peeling, and microneedling and tranexamic acid mesotherapy wich made the darks circle worse .

We suggested to the patient the use of Metformin 30% cream in the infraorbital area in the night. The only recommendation was to use sunblock.

Results: After 6 weeks dark spot under the eyes efficiently disappeared (Figure 3).

Conclusion: There are several conditions for the development of dark circles under the eyes, although the pathogenesis of periorbital hyperpigmentation is unclear7. In this case, the patient has a multifactorial etiology that includes genetics3, heredity, and chronic allergy.

Metformin inhibits melanogenesis by reducing intracellular cyclic adenosine monophosphate accumulation, but is low lipophilicity obligates its use in high concentrations for topical efficacy4. The Improvement of dark circles using topical Metformin 30% cream was observed in our patient after 6 weeks.

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The Association between Atopic Dermatitis Severity and Mood Disturbance among Adults: A Cross‐sectional Study

Objectives: This study was carried out to assess the correlation between AD disease severity and mood disturbance in adult AD patients in King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City, Riyadh, Saudi Arabia.

Introduction: Atopic dermatitis (AD), also known as eczema, is a chronic skin condition characterized by inflammation, itching, redness, and irritation of the skin. It affects a significant percentage of the global and local population. Eczema is associated with mood disturbances such as anxiety and depression. However, data on the impact of eczema severity on psychological health in adult eczema patients remain scarce. Addressing this correlation is crucial for improving therapy and clinical outcomes for eczema patients.

Materials / method: This study is a cross‐sectional study targeting adults diagnosed with AD in KKUH. Patients visiting the dermatology clinic during the study period from March 2023 to August 2023 were asked to fill out an online based self‐administered questionnaire to assess AD severity and psychological distress using the Patient‐Oriented Eczema Measure (POEM) tool and the Patient‐Reported Outcomes Measurement Information System Itch Questionnaire Mood and Sleep instruments respectively. Only patients who fulfilled the inclusion criteria were included in the study.

Results: Among 507 participants with AD, allergic rhinitis, sinusitis, and asthma were the highest concomitant associations. About 42.8% of participants with very severe AD had moderate mood disturbance. Among participants with very severe AD, 66% of them were diagnosed more than 5 years ago, and 71% had their last AD symptoms less than 6 months ago. AD severity was significantly associated with female gender, longer disease duration, and more recent episodes of AD symptoms. Mood disturbances were significantly associated with AD severity, disease duration, and the presence of sinusitis.

Conclusion: Given the high prevalence of mood disturbances among AD patients, it is critical for health‐care professionals and caregivers to recognize the mental health impact of AD and incorporate appropriate psychiatric screening methods into the management plan of AD patients so that they can be properly assessed and referred for appropriate therapy.

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Efficacy of systemic retinoids in treating Hidradenitis Suppurativa: A systematic review

Objectives: The aim of our study is to systematically review the existing literature on the use of systemic retinoids in the treatment of HS, comparing isotretioin and acitretin, to draw robust conclusions about the efficacy of systemic retinoids in treating HS and lessen the prevailing uncertainty associated with the clinical usage of systemic retinoid in HS.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the follicular portion of follicular pilosebaceous units. It is a disease with a poor prognosis, and it has a great negative impact on patients' quality of life. The choice of treatment depends on the severity of the disease, and the goal is to reduce inflammation, prevent new lesions, and improve the quality of life of patients. Medications like retinoids; isotretinoin, and acitretin, can help relieve symptoms. Current literature shows discrepant reports of effectiveness among this group of drugs.

Materials / method: The following database were searched for relevant publication without date limits: PubMed, Web of science, Cochrane. Inclusion criteria were as follows: (1) Primary studies that used oral retinoid as a treatment for HS and mention an outcome. (2) Articles in english language. (3) Oral retinoid was used as the main treatment.
Data extraction from the 15 previously published studies selected to be used as data sources was conducted using Microsoft Excel. The total number of patients involved in these studies were 221 patients.The average age of patients was 35 years old with female predominance

Results: Based on our study, acitretin seemed to be more effective in HS treatment than Isotretinoin. However, the results of effectiveness were based on fewer patients and were of a lower level of evidence than the results of isotretinoin. Moreover, almost all the patients who are treated with acetritin were kept previously on other treatment modalities, unlike the isotretinoin receiving patients, a factor that could affect the treatment response of these patients. As a result of these points, the efficacy comparison between the two drugs is not completely justifiable.

Conclusion: This review indicates that oral retinoids are effective in treating HS and acitretin is the most effective drug among this group despite the absence of randomized controlled clinical trials that evaluated this drug in HS patients. However, its association with showed more serious but rare side effects in comparison to isotretinoin.

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From Mouth to Eyes: A New Paradigm in Aesthetic Treatments Focused on Attention Redistribution

Objectives: This study aims to assess the effectiveness of Botulinum Toxin Type A injections in correcting a gummy smile by not only reducing gingival display but also redistributing visual attention across facial regions. By reducing attention to the mouth and increasing it to other areas such as the eyes, nose, and cheeks, the treatment seeks to achieve a balanced and harmonious facial aesthetic. Eye-tracking data before and after treatment will be used to quantify these changes and validate the success of the attention redistribution approach.

Introduction: In facial aesthetics, achieving a balanced distribution of attention across all features is crucial [2,3] . A single facial element with a defect, asymmetry, or exaggerated function—such as an overactive muscle causing a gummy smile—can disproportionately draw attention, detracting from the overall harmony of the face. This imbalance can overshadow other features, leading to an uneven aesthetic perception. Effective treatment must therefore not only correct the defect but also restore a natural, balanced focus across the entire face.

Materials / method: The study involved injecting 4 units of Botulinum Toxin Type A at each Yonsei point and 2 units into the Depressor septi nasalis muscle [1]. This precise administration aimed to reduce the gummy smile from 3.2 mm to 0.2 mm post-treatment. Eye-tracking data was collected before and after treatment to quantify the changes in visual attention distribution across various facial regions.

Results: Before treatment, attention to the mouth region was 25% of the total, reducing to 12% after treatment, confirming a decrease of 13%. The percentage of attention redistributed from the mouth was mainly directed to the left eye (increasing from 14% to 18%), right eye (from 16% to 20%), and nose (from 18% to 22%). Attention to the cheeks also increased, with the left cheek going from 8% to 12% and the right cheek from 9% to 11%. The total magnitude of redistribution across all regions was 12.78%, indicating significant shifts in visual focus that align with the aesthetic goal.

Conclusion: This study highlights that correcting a facial imperfection, like a gummy smile, is not merely about addressing a single issue but about redistributing visual attention to create facial harmony. The significant reduction in attention to the mouth and increased focus on the eyes, nose, and cheeks confirms that effective aesthetic treatments must integrate both structural correction and strategic attention redistribution. Such an approach ensures that all facial features contribute cohesively to a balanced and youthful appearance, fundamentally redefining aesthetic success.

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An Online Micro Case Series Was Highly Effective in Improving Physicians’ Knowledge and Confidence in Using Microtoxin Strategies

Objectives: We assessed whether an educational online micro case series could improve physician knowledge and confidence in the appropriate use of microtoxin strategies in clinical practice.

Introduction: Botulinum toxin type A is typically used in facial aesthetics as a neuromodulator for the treatment of dynamic facial lines. However, it can also be used to improve skin quality and overall skin appearance when injected intradermally as microdroplets, referred to as a microtoxin strategy.

Materials / method: Learners participated in a chapterized online case-based activity consisting of 4 micro videos: an introduction to microtoxins followed by 3 individual cases. Educational effect was assessed using a repeated-pair design, pre/post assessment.
A McNemar’s test determined if a statistically significant improvement (5% significance level, P < .05) existed in the number of correct responses between the pretest and posttest scores. Cohen’s d estimated the effect size of the education. The activity launched 29 Sept 2023 with data collection through 27 Nov 2023.

Results: PS/AMs answered 64% of the questions correctly pre-, rising to 86% post-assessment; dermatologists answered 66% of questions correctly pre-,rising to 88% post-assessment
Significant improvement (P <.001) in knowledge of the rationale for using microtoxin strategies
Significant improvement (P <.001) in knowledge of the skin conditions/ characteristics that microtoxin strategies can treat
Significant improvement (P <.001) in knowledge of the clinical implications of immunogenicity differences between toxins
Post education, over 50% of learners gained confidence in using microtoxin strategies

Conclusion: Participation in this educational online micro case series was highly effective in improving PS/AMs’ and dermatologists’ knowledge and confidence in using microtoxin strategies appropriately in clinical practice.

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Por favor indique a entidade (pessoa ou empresa): Dr Lim received an honorarium for his participation as faculty in the online activity from which these results are derived

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Este trabalho foi realizado com o patrocínio de: an independent educational grant from Merz Aesthetics

An Interactive Online Case-Based Activity Was Highly Effective in Improving Physicians’ Knowledge and Competence on the Use of Microtoxin Treatments

Objectives: We assessed whether an online case-based educational activity could improve plastic surgeons/aesthetic medicine specialists (PS/AMs') and dermatologists' knowledge and competence in the use of microtoxin strategies for appropriate skin conditions.

Introduction: Botulinum toxin type A is typically used in facial aesthetics as a neuromodulator for the treatment of dynamic facial lines. However, it can also be used to improve skin quality and overall skin appearance when injected intradermally as microdroplets, referred to as a microtoxin strategy.

Materials / method: Learners participated in an online case-based activity consisting of 3 segments, each with a video portraying realistic physician–patient interaction, a test question and expert commentary. Educational effect was assessed using a repeated-pair design, pre-/ post-assessment. A McNemar’s test determined if a statistically significant improvement (5% significance level, P < .05) existed in the number of correct responses between the pretest and posttest scores. Cohen’s d estimated the effect size of the education. The activity launched 27 Dec
2023 with data collection through 13 Feb 2024.

Results: PS/AMs answered 20% of the questions correctly pre- rising to 38% post-assessment; dermatologists answered 24% of questions correctly pre- rising to 38% post assessment (both P <.001).
Significant improvements in PS/AM knowledge of long-term considerations in using microtoxins (P <.05)
Significant improvement in PS/AM in knowledge of skin conditions/ characteristics treatable with microtoxins (P <.001)
Significant improvement in competence regarding dilution of microtoxins (P <.01 for both groups)
~1/3 of learners gained confidence in their knowledge of microtoxin strategies

Conclusion: Participation in this interactive case-based activity was highly effective in improving PS/AMs’ and dermatologists’ knowledge and competence in the use of microtoxin treatment strategies for appropriate skin conditions. However, despite the significant knowledge and competence improvements, posttest scores for both groups for all questions remained below 50%, suggesting that further education
is required to enhance and embed knowledge of microtoxin strategies and equip clinicians with the confidence and competence to apply these techniques safely and appropriately in clinical practice.

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Por favor indique a entidade (pessoa ou empresa): Dr Voropai received an honorarium as the expert faculty in development of the online case activity from which these results are derived.

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Comparison of Diffusion Characteristics of Letibotulinumtoxin A, Ona-, and Abobotulinumtoxin A: A Double-Blind, Randomized Split-Face Study

Objectives: The targeted diffusion and migration of the botulinum toxin A (BTX-A) formulations used have been repeatedly discussed as one of the factors that may influence the overall therapeutic outcome. Therefore, the diffusion characteristics of Letibotulinumtoxin A, the market leader in South Korea, were compared with other BTX formulations in a randomized, double-blind, intra-individual split-face comparison.

Materials / method: Subjects:
30 healthy male and female subjects aged 24-64 years with symmetrical forehead wrinkles were enrolled. Subjects suffering from symmetric dynamic forehead lines and having not received any treatment with BTX-A in the previous 6 months.

Treatment Regime:
All patients were randomized to receive two of the three BTX-A formulations, Letibotulinumtoxin A guaranteed. The subjects were injected in the frontal muscle with an intramuscular (i.m.) application of 4 U/ injection point.
A total of 2 injection points per forehead side (each treated with 4 U Leti/ Ona or 10 U Abo), i.m.

Results: Of the total subjects, 27 successfully completed the observation period and demonstrated a positive response to treatment with Botulinumtoxin Type A (Fig 1 and 2). Over the complete study period (Fig. 3) was a significant difference in both patient satisfaction and anhidrotic areas with Letibotulinumtoxin A compared to Ona- and Abobotulinumtoxin A within the 6 weeks.

Conclusion: The significant differences in the diffusion characteristics of various BTX A formulations should be considered, particularly when switching products. Selecting the appropriate formulation for each indication is important, as diffusion properties may influence therapeutic efficacy. Further studies are needed to explore the correlation between anhidrotic area and muscle relaxation for each area, as well as the impact of diffusion on the therapeutic index of different BTX-A formulations.

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VULVAR LICHEN SCLEROSUS: CASE REPORT. HOW TO MANAGE SYMPTOMS AND ADHESIONS IN CONSULTATION

Objectives: A description of a complicated clinical case involving a patient sufferig from lichen sclerosus, whose symtoms persist despite standard treatment, accompanied by adhesions, managed using an innovative regenerative technique

Introduction: Lichen Sclerosus is a chronic inflammatory mucocutaneous disease that primarily affects the anogenital areas. In women, it may be associated with decreased estrogen levels, genetic predisposition, autoimmune diseases , and chronic trauma.
The lesions can present as flat, ivory-colored plaques with a waxy texture, thin and hyperkeratotic skin, erythema, Koebner phenomenon, ecchymosis, excoriation, and fissures. Other clinical manifestations may include genital dryness, pruritus, edema in the periclitoral area, and dysuria. It commonly involves the clitoris, labia minora, labia majora, perineum.

Materials / method: A 69-year-old female patient, she began medical consultations in 2020, reporting vulvar pruritus, with evidence of atrophy but no lesions. In 2021 with evidence of vulvar synechia. In 2022, lichenification of the posterior fourchette and perianal area, with an ulceration at the 6 o’clock position. She was treated with topical estrogens, vulvar moisturizers, prasterone, and oils.In April 2024,Marked atrophy was observed, predominantly in the anterior vulva, with no visible clitoris and an inability to explore the vagina due to severe stenosis.

Results: Treatment with PRP (Platelet-Rich Plasma) combined with hyaluronic acid was scheduled, and the patient signed informed consent. Serologies were negative, and two sessions were conducted at three-week intervals using a multi-puncture technique and debridement with a needle of the synechiae at the anterior raphe and clitoris. She was scheduled for a follow-up after 15 days, reporting significant symptom improvement and evidence of reduced atrophy, visualization of the clitoris, and significant reduction of introital stenosis, allowing for speculum insertion and Pap smear collection

Conclusion: ● Lichen Sclerosus is a multifactorial autoimmune disease.
● Lichen Sclerosus typically affects the “8” area: clitoris, inner labia, perineum.
● There is a risk of malignancy, necessitating regular follow-ups.
● Standardized treatments include topical estrogens (for atrophy), corticosteroids, moisturizers, and lubricants. Emerging therapies are considered complementary.
● PRP involves growth factors that promote tissue remodeling.
● New therapies include fat grafting, exosomes, and laser treatments.

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USE OF HETEROLOGOUS COLLAGEN FOR PATIENTS WITH THE CONSEQUENCES OF GUNSHOT POLYSTRUCTURAL INJURIES OF THE EXTREMITIES

Objectives: The aim is to improve the treatment outcomes of patients with polystructural limb injuries using heterologous collagen type 1

Introduction: At the present, the development of new approaches to the rehabilitation of injured after reconstructive and plastic interventions got a great significance. It becomes especially relevant in cases of severe gunshot polystructural injuries of the extremities, when denervation-ischaemic and scarring processes, as well as mutual burden factors cause considerable severity of the course of treatment and not always successful results.

Materials / method: We analysed the results of treatment of 36 patients, who underwent a rehabilitation course. After reconstructive-plastic interventions, 36 patients completed a course of heterologous collagen type 1 No. 4: once every 14 days to the area of scars.
Monitoring protocols were created, and patients’ condition was analysed based on function increase. Function was evaluated using 2 complementary techniques: DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) and modified AOOS system. For the prediction, the disposing of the replaced soft tissue defects based on depth (А, В, С, D) was used

Results: The attention was given to involvement of all segments of the affected extremity, with a reasonable and balanced focus on the presence of scarring process for the specialised effect of heterologous collagen. Thus, reconstructive treatment consisted of relevant rehabilitation complexes with the use of heterologous collagen type 1 and with consideration of types of damaged structures. Herewith, the function increase in dynamics was considered as the criterion of efficiency (use of the proposed approach ensured average function increase for 39,1±13,8 vs 68,5±14,0 loss before treatment).

Conclusion: The feasibility of the approach with the use of injectable heterologous collagen to achieve the desirable result in provision of specialised aid to patients with gunshot polystructural injuries of extremities was proved.The main guarantee of the optimum result after multistage reconstructive surgeries is benign scars. In patients who underwent rehabilitation according to the plan, extremity function increase was significantly higher (61,7±12,1 points) and was achieved in the shorter term (65,0±14,0 days) than in the patients of the comparison group with function increase, 48,1±11,2 points.

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Skin anti-aging effect of stem cell exosomes induced by a novel combination (DENA; DHA, EPA, NMN, and 5-ALA)

Objectives: The purpose of this study was to investigate the area of action and mechanism of action of a new compound "DENA"; Docosahexaenoic acid (DHA), Eicosapentaenoic acid (EPA), Nicotinamide adenine dinucleotide (NMN), and 5-aminolevulinic acid (5-ALA) on human skin, as well as part of its anti-aging effect. In addition, we also examined the effect of human mesenchymal stem-cells (hMSCs) cultured with DENA or individual components, and exosomes (DENA/MSC-Exo.) derived from hMSCs, which were extracted from the culture medium. The effect changes depending on the preconditioning of Exosme.

Introduction: In this study, we prepared the following five types of stimulants to be added to cultured human dermal fibroblasts (Human Dermal Fibroblast; HDF) to verify a new compound (DENA) and its individual effects on human skin aging. hMSC-derived exosomes (DENA/MSC-Exo.) collected from culture medium in which hMSC was cultured with DHA, EPA, NMN, and 5-ALA, respectively, and DENA, were added to HDF and a similar study was performed. In addition, it was examined whether the addition of each of DENA to HDF would show resistance or repair damage caused by stress (H2O2 or AGE).

Materials / method: 1. Purified water (DW), 2. DHA&EPA, 3. NMN, 4. 5-ALA, 5. All mixed DENA were added to HDF for 4 hours, after which total RNA in HDF was extracted and collagen, elastine, and hyaluronic acid synthase-mRNA levels were measured by qRT-PCR.
2. Verification of resistance to damage in HDF exposed to oxidative stress (H2O2)
3. Verification of AGE receptor-mRNA expression in HDFs subjected to glycation stress (AGE)
After adding various samples to HDFs for 4 hours along with AGE glycation stress, or with oxidative stress of 0.2 mM H2O2, each mRNA levels were measured by qRT-PCR.

Results: 1. Effects on normal HDF
There was no change in mRNA levels due to the addition of DENA.
2. Verification of resistance to damage in HDFs subjected to oxidative stress (H2O2)
DHA & EPA showed an increase in hyaluronic acid synthase-mRNA levels.
3. Verification of resistance to damage in HDFs subjected to glycative stress (AGE)
Collagen showed a tendency to decrease, while elastine and hyaluronic acid synthase-mRNA levels both tended to increase.
4. Effect of preconditioned exosomes on normal HDF
DENA increased collagen and elastine-mRNA levels in a concentration-dependent manner.

Conclusion: In normal skin fibroblasts, DENA were not found to have any particular effect. However, the collagen and elastine mRNA levels in HDFs increased in a concentration-dependent manner only in the exosomes obtained by individually administering DENA containing all the components to hMSCs. These results indicate that components 1, 2, and 3 have an additive effect, and it is important to further verify their effects under various stresses. In the future, we plan to accumulate evidence on the whole body and skin and consider developing them into an anti-aging product.

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Hyaluronic acid injection technique for full face feminization

Objectives: A 2D photographic results of a case of patient’s feminization undergoing gender transition with hyaluronic acid-based fillers.

Introduction: Since the 1980s, there has been a 20-fold increase in the number of transgender people treated in the United States. This trend is confirmed in France and around the world. Facial treatment is the first request for modification in transgender women. Anatomoclinical characteristies can be attenuated by facial surgeries. In aesthetic medicine, injectables may be possible for patients who are not candidates for surgery or as a complement to certain surgeries and may be available throughout the treatment pathway.

Materials / method: 7 syringes of 1 mL of VYC-20L, in the latero-external part of the face,
temples and nasolabial folds
3 syringes of 1 mL of VYC-17.5L in the superficial lips, temple and SOOF,
4 syringes of 1 mL VYC-25L in the chin and sub-chin area,
1 syringe of 1 mL of SGD-30XP in the deeplips.
Thedetailed treatment plan is available on the right

Results: A feminized face can be observed thanks to work on the oval with better projection of the chin, cheekbones and pre-auricular area. Afeminization of the eye look with less hollow temples, the tail of the eyebrow raised. A fuller red lip that further feminizes the face and less marked furrows. Hormones will redistribute the fatty volume of the face, therefore, the plan must be reassessed during each intervention.

Conclusion: This clinical case of feminization enriches the literature on the effectiveness of treatment with injectable hyaluronic acid in addition to facial feminization surgery. Combined injectables can be considered as a complementary approach to the structural deficits encountered in patients in transition: improvement of the gaze, feminization of the cheekbone and projection of the middle 1/3 of the face, improvement of the projection of the chin and feminization of the lips.

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The efficacy and safety of combination therapy in the management of rosacea

Objectives: The aim of the study is to evaluate the efficacy of combination therapy in rosacea patients.

Introduction: Rosacea is a chronic inflammatory disease affecting the face with erythema, telangiectasia, papules and pustules.

Materials / method: Two groups of 15 patients with erythematotelangiectatic or papulopustular rosacea of mild severity and their combination were enrolled in the study. All patients used topical therapy: azelaic acid gel 15% in the morning, ivermectin cream 1% in the evening daily.
The first group received laser treatment of PDL 595 nm: repeated passes using subpurple settings with a spot size of 7 to 10 mm, pulse duration of 6, 10 and 20 ms and intensity of 6-10 J/cm2. The course consists of three procedures with an interval of a month. The mean age of patients is 36.0 (28.0 ÷ 45.0) years.
In the second group,

Results: In the first group, the DISS index reduction was 70.2% (from 5,7 ± 1,4 to 1,7 ± 1,2, p <0.05), in the second group — 88.9% (from 6,3 ± 1,7 to 0,7 ± 1,0, p <0.05). The DLQI reduction before and after treatment in the first and second groups was 89.6% and 93.4%, (from 4,8 ± 4,7 to 0,5 ± 1,8 and from 7,6 ± 6,5 to 0,5 ± 0,9, p <0.05) respectively. After 12 weeks of treatment according to IGA - 84% of patients in the first and 87,5 % in the second group achieved a score of "pure" or "almost pure", (p <0.05). No side effects were reported.

Conclusion: The combined use of PDL 595nm, injections of incobotulinumtoxinA and topical therapy with azelaic acid and ivermectin is a safe and effective method to reduce the severity of rosacea symptoms and increase patient satisfaction.

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EVALUATION OF ORAL SUPPLEMENTATION OF DECARBOXY CARCININE HCL IN THE TREATMENT OF MELASMA

Objectives: To assess the safety and efficacy of a combination of a oral Oral supplementation of decarboxy carcinine HCL for melasma treatment.

Introduction: Advanced glycation end products (AGEs) are the final heterogeneous products of the nonenzymatic reaction of reducing sugars and reactive aldehydes with proteins, lipids, and nucleic acids.
• AGE accumulation is significantly increased in the dermis of photoaged skin and plays crucial roles in photoaging. Although AGEs have been found to contribute to the yellowish discoloration of photoaged skin, their roles in photoaging-associated hyperpigmentation disorders have not been extensively studied.
It was shown that incubation of melanocytes with AGEs could directly promote melanin synthesis.

Materials / method: Twenty subjects (age, 20–60 years; Fitzpatrick skin types II to VI) were given the oral supplement decarboxy carnosine HCL 200 mg a day for 90 days. Patients were evaluated 90 days using photographs, patient questionnaires, and Visia evaluation. The analysis of the photographs were done by by 2 blinded dermatologists.
40 subjects (Fitzpatrick IV-V) underwent one NAFL session (Nd: YAP 1340 nm Zye Vydence, Brazil). Subjects were divided into two groups, 20 received 200 mg ω-3 PUFAs, for 15 days before and 45 days after NAFL and 20 did not receive supplementation.

Results: The treatment was well tolerated, and no unexpected adverse effects were observed. All patients stated that they were satisfied with their results and would recommend treatment. No adverse event was observed. Patient satisfaction was high with improvement of self-esteem.
According to the assessment made by by 2 blinded dermatologists: 60% of patients had a significant improvement.

Conclusion: This original work portrays for the first time the possible benefits of 90 days of decarboxy carcinine HCl treatment for melasma treatment.
• There is promising evidence for the oral supplementation of decarboxy carcinine HCL in the treatment of melasma, in isolation and in conjunction with other melasma therapies.

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CASE REPORT: COLD PANNICULITIS AFTER CRYOLIPOLYSIS TREATMENT OF THE THIGHS

Objectives: • Main: To describe cold panniculitis as a very rare adverse event following cryolipolysis procedures and review the literature.
• Secondary: To describe the management, treatment, and progression of cold panniculitis.

Introduction: Cryolipolysis is a non-invasive procedure with a growing market, with over 4 million treatments completed worldwide 1-2. Cryolipolysis involves the application of controlled local cooling (-4ºC to -11ºC) for the reduction of subcutaneous fat without damaging the surrounding tissue 1,3-4.
Adipocytes exposed to this temperature start an apoptosis process between the 2nd and 3rd day, reaching its peak at 2 weeks post-procedure and completing the apoptotic process by the 3rd month of treatment 1. The mechanism of action in adipocytes due to cryolipolysis is through direct damage to intracellular l

Materials / method: A literature review was conducted on cold panniculitis following cryolipolysis procedures, revealing only three studies with information on panniculitis and its evolution 6,9-10.
CLINICAL CASE
A 36-year-old female patient with no relevant personal history underwent cryolipolysis on April 5, 2024, in the inner thigh area, with two cycles per side. Symptoms began 5 days after the procedure, including inflammation, erythema, pain, and small nodules. Pain was managed with paracetamol, leading to improvements in inflammation and nodule induration.

Results: The incidence we obtained for cold panniculitis is 0.03% in a sample of 3,316 patients, which is higher than in other studies 8-10. The prescribed treatment differs from those found in the literature 6,9-10, but it aligns with the subsequent residual hyperpigmentation, which can also be successfully treated. Our treatment protocol appears to shorten the recovery period.

Conclusion: Cold panniculitis following cryolipolysis procedures has an incidence ranging from 0.002% 7-8 to 0.03%, and with our oral treatment protocol, the adverse effect resolves completely in a shorter time frame compared to other studies.

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NOVEL COMBINATION TREATMENT FOR FACIAL AND BODY ACNE SCARRING IN A YOUNG FEMALE PATIENT

Objectives: Our study assessed the remarkable improvement in skin texture and patient satisfaction for a young woman with disfiguring acne scars. She underwent a combination treatment protocol, including a peel, scar revision, and PRP mesotherapy, with cHA-AA used on alternate procedures.

Introduction: Acne scarring can significantly impact the mental well-being of young adult women. Atrophic scars, which can be rolling, box-like, or icepick in appearance, are not fully responsive to current treatment methods such as lasers, chemical peelings, scar revision and Plasma-Rich Platelet (PRP) mesotherapy, which promote cell proliferation and the generation of extracellular matrix, alone or in combination.
Medical devices containing 1,4-Butanediol ether (BDDE) cross-linked hyaluronic acid and protective buffer (amino acids) (cHA-AA) have recently emerged as novel modalities for skin regeneration.

Materials / method: A 24-year-old Caucasian woman with facial and sternal acne scarring visited our Dermatologic Clinic seeking improvement of her skin appearance due to stigmatisation and severe psychological burden.
Clinical examination revealed extensive depressed box-like, scattered icepick, and rolling scars on both cheeks, jawline, marionette lines, and centrally on her sternum. A 3-step standard treatment protocol was applied on the face and sternum at week 0 and again at 16 weeks, including a peel, scar revision, and PRP mesotherapy, with cHA-AA used on alternate procedures

Results: Photos and patient feedback on side effects and satisfaction level were used to assess changes. This treatment approach resulted in consistently high satisfaction and photographic evidence of improvements. The most considerable patient satisfaction was noted at week 16, eight weeks after the cHA-AA mesotherapy on acne scars.

Conclusion: The triple combination of scar revision, peel and PRP (to stimulate neocollagenesis and to release dermal connective tissue tethering) on alternate procedures with cHA-AA mesotherapy appears to be effective and safe for the treatment of all types of atrophic acne scars. Randomised, controlled clinical trials with more significant patient numbers are needed to support these observations.

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Case Report: Combination therapy approach to treat a persistent and severe facial melasma in Brazilian woman.

Objectives: In this case report, the main objective is to present the optimal clinical results obtained from combination plan to treat a persistent and severe facial melasma that included the association of procedure interventions such as nanosecond (NS) laser, retinoic acid (RA) peeling, injectable tranexamic acid (TXA), and platelet-rich plasma combined with hyaluronic acid (PRP-HA) additionally to topical and systemic therapies (sunscreen, whitening agents and nutraceuticals).

Introduction: In Brazil, melanodermatosis, including melasma, was the third most frequent cause dermatological consultations among 57,343 patients. Despite that, the melasma management is complicate due to the multifactorial pathophysiology and high UV incidence in the region, resulting in treatment resistance and high recurrence rates. An optimal melasma management strategy should address the different pathomechanisms in order to maximize results. Thus, the current treatment strategies include various topical and systemic therapies, procedural interventions, as well as combinations of these methods.

Materials / method: One Caucasian, adult, woman with persistent and severe facial melasma was submitted to a 7-months treatment of alternating 4 sessions of NS laser (1064 nm, 10 Hz, 3 J in double pass) and 3 sessions of PRP-HA once a month each one. Immediately post-laser, 2 mL of sterile TXA 4% was injected in the melasma lesions per hemi-face. After that, a 5% of RA peeling was applied and kept for 6 hours. The home-care treatment included sunscreen SPF 99 (2x/d), oral antioxidants and photoprotector (1x/d), oral TXA (250 mg/d) and 0.05% RA + whitening agents hydroquinone free cream (3x/w) for 1 year.

Results: There was a clinically significant reduction of the melasma after the combined treatments (Figure 1). The patient was also observed to have an improvement of global skin quality, including fine lines and radiance. No unexpected adverse events.

Conclusion: The experience herewith reported suggests that the combination of nanosecond laser, PRP and chemical peeling additionally to traditional topical and systemic treatments could benefit the clinical practice in terms of optimal results in the persistent and severe facial melasma without unexpected adverse events. Despite being an interesting procedure, future studies with a large sample should be carried out to demonstrate the safety and the efficacy of these applications.

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WHEN COSMETIC ENHANCEMENTS GO WRONG: A CASE OF TOXIC SHOCK AFTER ABLATIVE CO2 LASER THERAPY

Objectives: Emphasize the importance of comprehensive patient screening, proper post-operative care, and the need for clear guidelines on training personnel for cosmetic laser treatments to prevent serious complications.

Introduction: Carbon dioxide (CO2) fractionated lasers are widely used for ablative resurfacing due to their water chromophore specificity and availability. Despite their benefits, risks exist. Erythema is the most common side effect and usually resolves quickly. HSV infection is a risk due to epidermal compromise and immune suppression. Antiviral prophylaxis is recommended for those with a history of HSV or full-face treatments, but antibiotic prophylaxis is controversial. We report a case of toxic shock syndrome after a CO2 laser procedure by a non-board-certified physician.

Materials / method: A 67-year-old Caucasian female with hyperlipidemia, alcohol use disorder, and TIA presented to the emergency department with altered mental status and exanthem. She had undergone CO2 laser resurfacing at a medical spa five days earlier. Two days post-op, she developed fever, blurry vision, headache, nausea, vomiting, and diarrhea. On arrival, she was disoriented, hypotensive, and had a mask-like rash. Methicillin-sensitive Staphylococcus aureus (MSSA) was treated with Clindamycin, cephalosporins, and fluids. After an ICU stay complicated by cardiogenic shock, she was discharged with follow-up.

Results: Bacterial culture: Heavy growth of methicillin-sensitive staph aureus.
PCR: Herpes simplex and Zoster negative.
Diagnosis: Staphylococcal toxic shock syndrome.
Treatment: ICU resuscitation. Clindamycin, cefazolin, mupirocin, and prophylactic
acyclovir in addition to cephalexin at discharge.

Conclusion: This case highlights the severe complications that can arise post-cosmetic laser treatments, emphasizing the importance of a thorough patient history, post-operative care and communication, and proper training of personnel performing laser procedures.

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Split-Face Study of Anti-Aging Skincare Regimen Combined with 1540 nm Non-Ablative Laser: Impact on Skin Quality, Firmness, and Collagen Density.

Objectives: To compare the efficacy of an anti-aging skincare regimen (topical antioxidant serum containing 15% ascorbic acid, 0,5% ferulic acid, and 1% of tocopherol, moisturizer containing blueberry extract and pomegranate fruit extract and brightening sunscreen SPF 50) combined with a 1540 nm non-ablative laser in improving wrinkles and firmness, while also evaluating patient satisfaction

Introduction: Facial aging is influenced by genetic, biological, and environmental factors, with oxidative stress accelerating the process. This split-face study compared an anti-aging regimen (topical serum with 15% ascorbic acid, 0.5% ferulic acid, 1% tocopherol, moisturizer with blueberry and pomegranate extracts, and SPF 50 sunscreen) to a control regimen (moisturizing cream and sunscreen). Both sides received 1540 nm non-ablative fractional laser, which enhances penetration via Laser Drug Delivery (LDD) and stimulates collagen, improving firmness and reducing wrinkles.

Materials / method: A non-randomized split-face study with 10 women showing signs of aging. Side A (right) received an antioxidant serum, glycation inhibitor cream, and brightening sunscreen, while Side B (left) used a moisturizing cream and sunscreen. Both sides had two 1540 nm non-ablative laser sessions over six weeks. Patients assessed skin quality using a 4 point numerical scale at weeks 3 and 6. Investigators measured changes in wrinkles, volume, density, and firmness using the same scale, 3D photos, ultrasound, and elastography at baseline, week 3, and week 6

Results: At week 6, patients reported a 12.12% improvement on the right side (anti-aging skincare regimen) and 10.34% on the left. The right side's improvement was statistically significant (p = 0.045), while the left did not reach significance (p = 0.083). Investigator evaluations showed a 9.37% improvement on the right and none on the left, with neither reaching significance. Elastography revealed increased collagen and elastic fibers in 60% of patients on the right and 50% on the left, with no significant difference. There were no serious adverse events, and the treatments were well-tolerated.

Conclusion: This study demonstrates that combining the anti-aging skincare regimen with 1540 nm non-ablative laser treatment improved skin quality on the right side compared to the control regimen. Despite patient and investigator evaluations showing greater improvement on the anti-aging treated side, objective measures of collagen and elastin increases did not reach statistical significance, likely due to the small sample size and short study duration.

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Surgical, non-surgical & combination approaches to the mid-face and tear trough

Objectives: Structured approach to examination and selection of non-surgical and surgical treatments for the mid-face and tear trough

Introduction: The mid-face and under-eye area presents a complex range of aesthetic concerns. A thoughtful approach to treatment is required to select the best treatment to achieve optimal results.

Materials / method: This is a structured approach to selecting the most appropriate treatment based on different anatomical considerations, vector, heterogenous pathology of the under-eye and mid-face needs to be considered when treating this area.

Results: Treatments including non-surgical interventions, energy-based devices, surgery and combination treatments have their own efficacy and risk profiles. These depend on a variety of factors including indications, technique and expertise. The effectiveness and limitation of each of the different approaches will be discussed. Patient selection and management of expectations are key to achieving optimal aesthetic results and patient satisfaction. This is a guide to the key pearls and pitfalls in the assessment of patients and selection of treatments for mid-face and under-eye indications.

Conclusion: This guide will hopefully provide some clarity on how to assess patients and choose the best treatments for this anatomical region of the face to achieve predictable and optimal aesthetic results.

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Safety and tolerability of HA dermal fillers using cannulas

Objectives: This retrospective observational study aimed to evaluate the safety and tolerability of hyaluronic acid (HA) filler injections using microcannulas for infraorbital volume restoration and nasal reshaping. Key objectives included assessing the incidence of minor and major complications, patient comfort and recovery following the procedures, including time taken to return to normal activities, comparing outcomes between infraorbital and nasal treatments, and the overall rate of minor complications like swelling, pain and ecchymosis.

Introduction: HA fillers are widely used for volume restoration in the infraorbital hollow and for nasal reshaping. The use of microcannula in these areas has gained popularity in recent years, as it is believed to enhance patient comfort, safety, and treatment tolerability compared to sharp needle injections. The cannula offers the advantage of a single entry point, allowing treatment over a larger area. Additionally, cannulas are associated with a lower risk of vessel penetration compared to needles of similar size and are thought to cause fewer minor complications such as pain, edema, and bruising.

Materials / method: A retrospective study of medical records from the author’s private practice from January 2023 to July 2024 was conducted on 514 patients. In all cases, 0.7-1 ml of 20mg/mL cross-linked HA with 0.3% lidocaine was injected using a flexible blunt 25G dome-shaped cannula. 395 patients were treated in the infraorbital area (Group A) at a supraperiosteal level, while 119 patients were treated for nasal reshaping (Group B) using a single entry point from the anterior nasal spine to the nasal tip in the supraperichondral and supraperiosteal layers. Follow-up was conducted on days 5-10 post-procedure.

Results: The most common minor complications reported during the first 10 days post-injection for both groups were mild to moderate malar edema (Group A: n=45, 11.4%; Group B: n=10, 8.4%), mild pain (Group A: n=8, 2.0%; Group B: n=5, 4.2%), and bruising (Group A: n=18, 4.6%; Group B: n=2, 1.7%) at the injection site. No major complications, such as vascular complications or infection, were observed. All patients, except for one (n=513, 99.8%), were able to resume their normal activities immediately after the procedure.

Conclusion: Using the microcannula technique for injecting HA fillers is a safe and well-tolerated procedure for both tear-trough rejuvenation and nasal reshaping, with minimal and reversible complications. Major complications are rare, and patients generally experience a comfortable procedure with no significant recovery time.

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Abdome-sculpt with multilayer approach: Case series

Objectives: The Abdomen Sculpt technique proved effective, with minimal adverse effects such as mild erythema and edema, which resolved quickly. Results became visible within 30 days, with further improvements observed over three months. The use of
macrofocused and microfocused ultrasound tailored to specific tissue depths resulted in enhanced fat reduction and skin tightening, particularly in the lower abdomen. The study supports the Abdomen Sculpt method as a valuable non-invasive option for abdominal contouring, though further research with larger samples is needed to confirm these findings.

Introduction: The abdomen is a frequent area of concern for individuals seeking aesthetic treatments, often due to skin laxity and fat accumulation. The
accumulation of fat in the central abdomen is influenced by reduced lipolytic sensitivity of adipocytes, and the structure of the superficial fascial system (SFS), which varies in density across the trunk. This method targets
multiple layers of abdominal tissue, providing fat reduction and skin tightening.

Materials / method: Before the procedure, patients were photographed using the Vectra system, and treatment areas were marked. The Atria® scan device, featuring CRI technology for radial thermal coagulation, was used with ultrasound gel applied to the treatment area. Various transducers (13mm, 9mm, 6mm, and 4.5mm) were utilized based on the thickness of the adipose tissue, ensuring treatment from deeper to more superficial layers. Patients were evaluated immediately post-procedure and at 30 days and 3 months to assess outcomes.

Results: All patients showed improved skin laxity and enhanced abdominal definition. Additionally, reductions in abdominal circumference were noted, with decreases ranging from 0.8 to 2.1 inches across five patients.

Conclusion: The Abdomen Sculpt technique offers a promising non-invasive approach for abdominal contouring, with potential advantages over traditional single-layer treatments.

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"Drug delivery" in the treatment of pre-malignant lesions

Objectives: Review the most recent literature to identify the main substances and techniques for the treatment of premalignant skin lesions.

Introduction: Actinic keratosis (AK) is a pre-cancerous neoplasm derived from keratinocytes that arise in chronically sun-exposed skin. AK tends to occur in fair-skinned individuals chronically exposed to UV radiation. AK can potentially progress to invasive squamous cell carcinoma in the skin. 'Drug delivery' use in the treatment of premalignant lesions is essential to prevent AK from evolving into squamous cell carcinoma, improving the quality of life of patients with AK.

Materials / method: A narrative literature review was adopted to identify the main substances and techniques used to treat premalignant lesions. We analyzed national and international scientific articles published between 2011 and 2024. All articles were indexed in Pubmed.

Results: The literature highlighted the importance of investigating the best ways of intervening, and utilizing different medications to treat AK. The 'Drug delivery' method is commonly used to treat several pathologies, including AK, aiming to reduce chances of progression to SCC. Drug Delivery consists of several medications, such as 5-fluorouracil (5-FU), imiquimod, diclofenac gel 3%, among others. Regarding different ways of using it, we point out chemical peeling, microneedling, laser-assisted drug delivery, CO2 laser, iontophoresis, sonophoresis, photodynamic therapy and the use of nanoparticles.

Conclusion: Drug delivery has become the baseline choice in the AK treatment because it can surpass the stratum corneum. Drug delivery reaches the necessary concentration without many of the side effects that would eventually occur in systemic therapy. The Drug Delivery method has several ways of application, together with different medications to be adopted. In this way, Drug Delivery is a viable method to reach the needs of diverse patients. We note that each technique and medication use has particularities and is more suitable depending on specific lesion types and anatomical sites.

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Innovative Hybrid Filler Approach: Calcium Hydroxyapatite and Hyaluronic Acid with Multilayer Bio-Stimulation for Enhanced Body Contouring

Objectives: This study proposes a comprehensive treatment strategy aimed at optimizing aesthetic outcomes and patient satisfaction in buttocks enhancement.
The proposed method represents an innovative and comprehensive approach to buttocks beautification, with the potential to optimize patient outcomes and satisfaction.

Introduction: The demand for body contouring and enhancement procedures has seen a significant rise in recent years, with buttocks beautification becoming one of the most requested treatments in both dermatological and plastic surgery practices. Addressing the aesthetic concerns of the buttocks, such as sagging, cellulite, contour irregularities, and volume loss, presents a complex challenge. This study explores a novel approach utilizing a hybrid solution of hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) for comprehensive buttocks enhancement.

Materials / method: In this study, a total of the patients underwent buttocks enhancement using a combination of HA and CaHA. Lidocaine without vasoconstrictor was used for local anesthesia, and saline solution was employed for dilution purposes. For deep-plane injections, 2 mL of Belotero Volume was combined with 4 mL of diluent, and 3 mL of CaHA premixed was administered per side 1:2 proportion . For subdermal applications, 3 mL of CaHA was diluted with 12 mL of saline solution and lidocaine and injected using the fanning technique with three entry points to address shape and skin laxity.

Results: The results of this study indicate that the combination of HA and CaHA in a hybrid solution offers significant improvements in buttocks contour and skin laxity. The deepplane application of CaHA, combined with the use of a diluted solution for subdermal biostimulation, appears to effectively address the multifaceted aesthetic challenges of this area. The tailored dilution and injection techniques facilitated an individualized approach, optimizing volume replacement, dermal strengthening, and superficial fascia thickening.

Conclusion: This study demonstrates that a hybrid solution of HA and CaHA, applied using a tailored dilution and injection protocol, can provide significant improvements in buttocks aesthetics, including contour enhancement and skin laxity reduction. The proposed method represents an innovative and comprehensive approach to buttocks beautification, with the potential to optimize patient outcomes and satisfaction. Future studies should focus on the long-term efficacy and safety of this treatment, as well as the development of standardized protocols for broader clinical application.

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Rheological and Morphological Characteristics of Hyaluronic Acid Fillers for Gluteal Augmentation: A Comparative Analysis

Objectives: This study aims to compare the rheological and structural properties of four commercially available HA fillers used in gluteal augmentation to determine their effectiveness for gluteal contouring and assist clinicians in selecting the most appropriate filler for different patient needs.

Introduction: The growing demand for non-surgical gluteal augmentation has positioned hyaluronic acid (HA) fillers as a popular, minimally invasive alternative to surgery. Their success largely depends on rheological properties like elastic modulus and viscous modulus which influence tissue support, volume retention, and injection ease.1,2,3

Materials / method: Four HA gels for body contouring were analyzed:
Up Max by Ilikia (UpM)
Rennova Body Shape (RBS)
Rennova Lift Shape Lido (RSL lido)
Sofiderm Derm Sub Skin (SSS)
Rheological Testings were conducted with a TA Instruments DHR-3 Rheometer using grooved parallel plates. Key parameters were measured:
Storage Modulus (G′)
Loss Modulus (G″)
Complex Modulus (G*)
Damping Factor (tan δ)

Results: The rheological and morphological properties of HA fillers directly impact clinical outcomes like elasticity and volume retention. UpM (G′ = 382 Pa) offers better structural support due to its high elasticity, while RBS (G′ = 55 Pa) may be limited in regions needing more flexibility. SSS (G′ = 248 Pa) provides a balanced profile for firm yet flexible support. RSL shows intermediate values, suitable for moderate support. SEM imaging confirmed these differences: UpM has a porous, uniform structure; SSS moderate porosity; RBS a dense structure; and RSL intermediate porosity.

Conclusion: The choice of HA filler for gluteal augmentation should consider rheological properties and microstructure. UpM, with its superior volumization and lifting capacity, is ideal for regions needing greater support. SSS, though having lower G′ and G* than UpM, performed similarly. In contrast, RSL exhibited inferior rheological properties, and RBS, with a lower elastic modulus, is unsuitable for gluteal areas. Understanding these characteristics helps professionals plan techniques, select the right filler, and optimize treatment outcomes.

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Biodegradable PLLA nanofibrous scaffold with piezoelectric charge induced hydrohillecity and electrotopographical enhancement on neural stem cell growth

Objectives: Cell-traction driven in situ electrical stimulation of piezoelectric nanofiber mediates cell behaviors without chemical factors and external stimuli, indicating a promising therapy at cell level.

Introduction: Generally, surface modification is required for favorable cell adhesion which is the bridge for cells to sense electromechanical cues from extracellular environment (ECM). Nevertheless, these modulation methologies either easily fade away or destroy the nanostructure and piezoelectric property of fibrous scaffold.

Materials / method: With the assistance of surface charges activated by ultrasound, a robustly hydrophilic poly(lactic acid) (PLLA) scaffold maintaining intrinsic nanostructure and piezoelectric performance was proposed as a proper platform for neural stem cell adhesion. The mechanism of piezoelectric charges inducing dopamine (DA) in situ modulation is also discussed.

Results: With the assistance of piezoelectric charges generated by ultrasonic, we fabricate a controllably hydrophilic scaffold retaining its nanostructure and piezoelectric performance for neural stem cell adhesion. This modulated scaffold effectively induce large-scale expansion and significant differentiation from the neural stem cultured in normal medium on day 7.

Conclusion: This study demonstrates an excellent scaffold for cell significant differentiation and large-scale expansion in normal medium on day 7 which is beneficial for neural tissue regeneration. And the principle of electrotopographical effects on stem cell paves the way for future electroactive scaffold design.

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Palestrantes	Título da apresentação	Resumo	Número
Dr Anood AL ISSA	Digital Dermatology: Evaluating the Efficacy of Skin Health Apps	Visualizar	142156
Dr Anood AL ISSA	Transforming Dermatological Practice: The Promise of Smart Wearables	Visualizar	142160
Dr Khaled ALAMEDDINE	Quantifying Safety: A Meta-Analysis of Botox Cosmetic vs. Competitors	Visualizar	142580
Dr Alessandro ALARCAO	Enhancing Gluteal Beauty with the “S” Technique using combination of CaHa and HA body dermal filler	Visualizar	143516
Dr Elaine ALCALDE	CASE REPORT ON THE USE OF TOPICAL METFORMIN 30% CREAM TO TREATING DARK CIRCLES	Visualizar	141987
Dr Layan ALSANAD	The Association between Atopic Dermatitis Severity and Mood Disturbance among Adults: A Cross‐sectional Study	Visualizar	143272
Dr Layan ALSANAD	Efficacy of systemic retinoids in treating Hidradenitis Suppurativa: A systematic review	Visualizar	143276
Dr Aida ASKARIAN	From Mouth to Eyes: A New Paradigm in Aesthetic Treatments Focused on Attention Redistribution	Visualizar	142450
Dr Elaine BELL	An Online Micro Case Series Was Highly Effective in Improving Physicians’ Knowledge and Confidence in Using Microtoxin Strategies	Visualizar	143066
Dr Elaine BELL	An Interactive Online Case-Based Activity Was Highly Effective in Improving Physicians’ Knowledge and Competence on the Use of Microtoxin Treatments	Visualizar	143068
Dr Maxine BENNEK	Comparison of Diffusion Characteristics of Letibotulinumtoxin A, Ona-, and Abobotulinumtoxin A: A Double-Blind, Randomized Split-Face Study	Visualizar	143415
Dr Sara Sofia BERMUDEZ SPARICE	VULVAR LICHEN SCLEROSUS: CASE REPORT. HOW TO MANAGE SYMPTOMS AND ADHESIONS IN CONSULTATION	Visualizar	142535
Dr Natalia BORZYKH	USE OF HETEROLOGOUS COLLAGEN FOR PATIENTS WITH THE CONSEQUENCES OF GUNSHOT POLYSTRUCTURAL INJURIES OF THE EXTREMITIES	Visualizar	143001
Dr Katsuaki DAN	Skin anti-aging effect of stem cell exosomes induced by a novel combination (DENA; DHA, EPA, NMN, and 5-ALA)	Visualizar	143100
Dr Sebastien DURIEUX	Hyaluronic acid injection technique for full face feminization	Visualizar	143139
Dr Gyulnara FIMOCHKINA	The efficacy and safety of combination therapy in the management of rosacea	Visualizar	142649
Patricia FRANCA	EVALUATION OF ORAL SUPPLEMENTATION OF DECARBOXY CARCININE HCL IN THE TREATMENT OF MELASMA	Visualizar	143280
Dr Maria GALINDO RODRIGUEZ	CASE REPORT: COLD PANNICULITIS AFTER CRYOLIPOLYSIS TREATMENT OF THE THIGHS	Visualizar	143298
Dr Kanella KALAPOTHAKOU	NOVEL COMBINATION TREATMENT FOR FACIAL AND BODY ACNE SCARRING IN A YOUNG FEMALE PATIENT	Visualizar	143518
Dr Claudia MARCAL	Case Report: Combination therapy approach to treat a persistent and severe facial melasma in Brazilian woman.	Visualizar	143334
Dr Alan SNYDER	WHEN COSMETIC ENHANCEMENTS GO WRONG: A CASE OF TOXIC SHOCK AFTER ABLATIVE CO2 LASER THERAPY	Visualizar	142898
Dr Ivania SOARES	Split-Face Study of Anti-Aging Skincare Regimen Combined with 1540 nm Non-Ablative Laser: Impact on Skin Quality, Firmness, and Collagen Density.	Visualizar	143486
Dr Kian TAN	Surgical, non-surgical & combination approaches to the mid-face and tear trough	Visualizar	143445
Dr Anastasia TZOUMA	Safety and tolerability of HA dermal fillers using cannulas	Visualizar	143205
Dr Rossana VASCONCELOS	Abdome-sculpt with multilayer approach: Case series	Visualizar	143233
Dr Rossana VASCONCELOS	"Drug delivery" in the treatment of pre-malignant lesions	Visualizar	143253
Dr Rossana VASCONCELOS	Innovative Hybrid Filler Approach: Calcium Hydroxyapatite and Hyaluronic Acid with Multilayer Bio-Stimulation for Enhanced Body Contouring	Visualizar	143401
Dr Renata VIANA	Rheological and Morphological Characteristics of Hyaluronic Acid Fillers for Gluteal Augmentation: A Comparative Analysis	Visualizar	143124
Dr Guobao WANG	Biodegradable PLLA nanofibrous scaffold with piezoelectric charge induced hydrohillecity and electrotopographical enhancement on neural stem cell growth	Visualizar	147793

IMCAS World Congress 2025
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NON-SPONSORED SCIENTIFIC E-POSTERS

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IMCAS World Congress 2025 Programa

NON-SPONSORED SCIENTIFIC E-POSTERS

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IMCAS World Congress 2025
Programa