Objectives: Controlled thermal heating of dermal connective tissue has been shown to improve skin laxity and wrinkling. We describe a novel, non-invasive, high intensity ultrasound (U/S) with multiple array of low divergence beams technology generating isolated regions of tissue coagulation in the mid-dermis with no epidermal damage. The results of the numerical simulation and in vivo animal model will be presented. A prospective, IRB- approved 60 patient multi-center clinical study evaluated the clinical effects of this U/S technology on facial and neck lines and was the basis of FDA clearance.

Introduction: The technology utilizes multiple ultrasonic transducers that simultaneously emit low divergence ultrasonic beams perpendicularly to the skin surface and into the dermis. Simultaneous skin surface cooling is applied via the applicator and real time measurement of skin temperature ensures the prevention of epidermal thermal damage. A numerical simulation of the ultrasonic beam was performed using a proprietary 3D time dependent code to solve the bio-heat equation in order to analyze temporal and spatial temperature distribution in the tissue at different U/S power levels.

Materials / method: Treatment parameters were further optimized in an in vivo pig model. Sixty patients with mild to moderate facial wrinkles were enrolled. A single full face and anterior neck was performed after the application of an anesthetic (7% tetracaine/30% lidocaine) cream. Overall, 295 areas were treated. Standardized 35 mm photography was performed before treatment and at the 1 week and 3 months follow up visits. The treatment endpoints were a change in the Fitzpatrick Wrinkle Score (FWS) and improvement in a 5-point global aesthetic improvement score (GAIS).

Results: Well-defined volumetric cylindrical shaped fractionated coagulation zones in the mid dermis with no epidermal and fat damage were shown by histology. Control of coagulation volume was achieved by varying ultrasonic intensity. At 3 months, investigators rated 88% of the subjects to be improved to very much improved on the GAIS and 86% of the subjects were improved by either -1 or -2 or -3 FWS scores. 72% of the subjects were satisfied with their results and rated them as improved to very much improved on the GAIS. Safety profile was excellent with no adverse events reported.

Conclusion: This novel, non-invasive, U/S technology resulted in no downtime, no unanticipated adverse events and produced demonstrable improvement in wrinkles of the face and neck. Histologic studies showed cylindrical volumetric fractionated mid-dermal coagulation zones with sparing of the epidermis and no damage to fat. Stimulation of long-term tissue remodeling and associated generation of inflammatory mediators is likely the result of the activation of the wound healing cascade leading to unique induction of directional collagen remodeling to restore natural skin tightening.

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请注明名称（个人，公司，学会等等）: SofWave Medical

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请注明名称（个人，公司，学会等等）: SofWave Medical

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Objectives: Studies are increasingly demonstrating the damage caused to skin by environmental pollutants: aging, hyperpigmentation and skin barrier alteration. A novel new plant-base extract, EDAFENCE®, has been demonstrated in vitro and in human skin models to help prevent these alterations by inhibiting AhR activation. Specifically, topical application of the extract reduces oxidative stress, melanogenesis, DNA damage and alterations to skin architecture.

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请注明名称（个人，公司，学会等等）: medical director at Cantabria Labs

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请注明名称（个人，公司，学会等等）: MEDICAL DIRECTOR AT CANTABRIA LABS

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Objectives: Presented material will describe jet-injection of hyaluronic acid as an alternative correction method of upper lip rhytidosis.

Introduction: Upper-lip rhytidosis is an age-related process of dermal thinning and changes in skin anatomy. Current therapy options are limited to dermal fillers or use of energy-based devices which are associated with either short efficacy span or thermal damage to the epidermis and dermis, which prolongs downtime. As an alternative, administration of the filler material through needle-free jet injection bypasses the epidermis and stimulates dermal regeneration without causing inflammation.

Materials / method: Published data (Naranjo et al. 2019) demonstrated safety and efficacy of the jet-injection approach on a group of females with moderately deep upper-lip wrinkles treated with HA injected by the jet-injection device (EnerJet2.0, PerfAction, Israel). The devices provided needle-free delivery of liquefied HA with the software control of the depth of penetration and delivered volume.
The treatment of the upper lip wrinkles performed as the series of subsequent 1-cm step injections along the upper lip line, at the minimal injection pressure.

Results: All patients tolerated the treatment well. Re-assessment at 6 months post-treatment showed a decrease in the wrinkle severity score (LRS) from 3.7 to 2.3. The patients expressed better perception and improvement of the treated areas (average GAIS of 1.7). Objective analysis of the wrinkle appearance captured by 3-D imaging confirmed wrinkle reduction in all patients. The dermis height measured by skin sonography revealed a mean increase by 0.4mm, or 20% comparing to pre-treatment baseline.

Conclusion: Jet injection of hyaluronic acid showed promising results in the correction of upper-lip rhytidosis. The treatment was safe and reported to be pain-free. The therapeutic synergistic effect resulted from the dermal micro-trauma generated by the dispersion of HA nanoparticles.

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请注明名称（个人，公司，学会等等）: PerfAction Technologies

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Objectives: comparing the efficacy of High Molecular Weight HA (HMW HA) with Low Molecular Weight HA (LMW HA) in skin injections.

Introduction: Hyaloronic acids are polysaccharides of natural glycosaminoglycan type. It is formed by repetitions of two different dimers:
• N-Acetylglucosamine
• Glucuronic acid
It is present naturally in all human body cells, but especially in skin and articulations. An adult weighting 70 Kg has around 15 gr of HA in body.
Some intrinsic effects of HA :
o Facilitates cells mobility and acts as a lubricant.
o Participates in wounds healing because it enables the cells to move around the injured area.
o Slows down the intrinsic and extrinsic ageing, specially the wrinkle formation because it replaces coll

Materials / method: HA used in cosmetics can have different characteristics and molecular weight :

_ HA of molecular weight 3.000 kDa is the closest type of HA to the natural and physiologic one.
Being a large molecule, and less concentrated cause the degradation process slower.
It is not crosslinked but the large size of molecule give the long lasting effect to these HAs .
_ HA molecular weight <1.000 kDa : The molecule is smaller, and more concentrated, so its degradation will be much faster and its effects disappear sooner.

Results: Initially there will be no differences between the efficacy of these two types of HA. so
These two biorevitalizers will produce a similar effect on skin in the begining, but after 2-3 weeks, body has degraded small molecules HA almost in total, but the higher molecular weight HA will take longer to be degraded by skin.

Conclusion: the effect of HMW HA will be more lasting compared with LMW HA.

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请注明名称（个人，公司，学会等等）: unrestricted grant of Toskani cosmetics

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Objectives: In the last decade we have witnessed an increasing demand for skin remodeling treatments with micro-invasive techniques through platforms that could offer more wavelengths within a single system, this for better practicality and also for a reduction in costs of purchase.
The different wavelengths available allow to selectively reach different targets within the skin structure to cope with all those changes inevitably induced by traumas (scars, dyschromias, etc.) and by aging (cronoaging and photoaging) under load of the skin itself, obtaining a vascular, pigmentary normalization and a new coll

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这项工作的完成感谢以下机构的支持： DEKA MELA Srl

Objectives: Hyaluronic Acid Threads: a split-face study for skin quality improvement

Threads with embedded hyaluronic acid represent a big innovation: it offers the chance for face reshaping along with simultaneous skin rejuvenation.
This split face study allow to highlight the differences between traditional PLLA-PCA threads and new HA-PLLA-PCA threads.

Introduction: Thread lifting of the face is an effective technique to deal with facial tissue ptosis. The inner PLA stimulation of collagenesis allow to enhance the results obtained by the long lasting PCA perfomance, but it needs to develop over months after thread insertion.
With Hyaluronic Acid (HA)-PLLA-PCA thread is possibile to achieve simultaneous skin rejuvenation along with the mentioned results.

Materials / method: The results of split-face study are presented in order to asses the effect of the hyaluronic acid (HA) embedded in the PLLA-PCA thread: results are quantitatively assessed by a dedicated skin analysis software and discussed with respect to known histological experimental results

Results: HA-PLLA-PCA threads provide for a better outcome of the post-insertion period, with less inflammation and prompt recovery.
The assessed results confirm the histological findings, pointing out the innovative aspect and the clinically positive outcome of this new device

Conclusion: HA-PLLA-PCA threads provide for an innovative and unique tool in order to obtain simultaneous lifting effect and skin rejuvenation for patient with mild to moderate ptosis of the facial tissues

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请注明名称（个人，公司，学会等等）: Aptos LLC

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请注明名称（个人，公司，学会等等）: Aptos LLC

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请注明名称（个人，公司，学会等等）: Skinceuticals

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