Objectives: The skin aging exposome encompasses internal and external factors that contribute to clinical signs of facial aging. Aging skin can be characterized by distinctive features such as wrinkles, lentigines, elastosis, and roughness. Optical coherence tomography (OCT) is capable of noninvasively measuring skin characteristics. This study aimed to assess bilateral features using OCT to explore temporal skin changes among decades and potential changes in facial skin aging based on laterality. Methods: A total of 97 subjects between 20 and 89 years old with Fitzpatrick skin types I to IV were enrolled. VivoSight, a Multi-Beam OCT system intended to gather topographical and histological images of skin, was used to scan the area inferolateral to the lateral canthus, bilaterally. Investigators compared characteristics of skin roughness, attenuation coefficient and blood flow across age groups and based on laterality to determine any differences. Results: Only data from successful OCT scans were used. Seventy subjects, 10 from each specified decade, had successful bilateral scans and were thus included in the analysis. Chronological aging was characterized by significantly decreased dermal attenuation coefficient with increased age. Skin roughness measurements showed trends of increased roughness with age; however, no statistically significant changes were seen between groups. Qualitative differences amongst scans taken on right and left sides of the face showed no significance regarding roughness, density or blood flow at depths ranging from 0.05 to 0.5 mm. Conclusions: OCT is an effective method for evaluating changes in aging skin. Our results illustrate a decline in skin density with chronological age. Additionally, it was illustrated that structural change in the epidermis and dermis does occur, however on a microscopic scale, there are no significant differences based on laterality. OCT holds promise as a noninvasive technique for characterization of aging skin. Its utility and application in the clinical management and treatment of aged skin requires further research; however, the technology has potential to personalize therapies based on objective findings.
Background: Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A four-finger approach has been previously described to determine adequate treatment of lid retraction. In the authors’ experience, they have found that even the most aggressive treatment approach—subperiosteal cheek lift with canthopexy and interpositional graft—is inadequate to address severe lower lid retraction. Methods: The authors propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all five fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed. Results: The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but one patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty, resulting in resolution of the lateral ectropion. Conclusion: The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of causes.
Background Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. While lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. Objectives This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. Methods Subjects underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3- and 6-months post-treatment. Scars were assessed via standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed using Subject and Clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. Results Ten subjects between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. CGAIS and SGAIS score showed clinical improvement at both 3- and 6-month follow-up compared to baseline (p<.05) Blinded CGAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (p<.0001). Attenuation coefficient increased at 6-month follow-up suggesting collagen remodeling and reorganization over the study period. Subjects experienced anticipated post-treatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. Conclusions Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring.
Background While validated scales must be created in order to systemically evaluate patients and quantify outcomes of aesthetic hand treatments, scales currently available are limited to analysis of volume loss alone. Objectives The purpose of this study was to develop three validated scales for the assessment of dorsal hand aging that also take into consideration wrinkling and pigmentation. Methods Fifty (50) healthy volunteers (40 females, 10 males) with Fitzpatrick skin types I-IV were recruited, and standard photographs of their left and right dorsal hands were taken with a Nikon D7100 (Nikon; Minato, Tokyo, Japan) camera. Using 25 randomized photographs, eleven Plastic Surgery physicians (three chief residents, six senior residents, and two aesthetic surgery fellows) were trained on the three scales under investigation, as well as the already-validated Merz Hand Grading Scale. The evaluators then viewed the remaining 75 photographs independently and assigned a grade for each of the four scales to each photograph. Interrater variability was calculated for each scale. Results The Kappa score for the Merz Hand Grading Scale was 0.25, indicating fair agreement, 0.40 for wrinkle scale, indicating fair agreement, and 0.48 and 0.46 for the pigmentation density and intensity scales, respectively, indicating moderate agreement (p<0.001). Conclusions The results show that after receiving training, the interrater agreement for the three scales under investigation was similar or slightly higher than that for the Merz Hand Grading Scale. These three photographic classification systems can be used consistently and reliably to characterize multiple signs of dorsal hand aging.
BACKGROUND Intense pulsed light (IPL) is a noninvasive therapeutic option to treat benign pigmented lesions by targeting melanin. OBJECTIVE The purpose of this study was to assess IPL as a treatment for benign pigmented dorsal hand lesions. MATERIALS AND METHODS A total of fifteen subjects, 40 to 73 years old, received 3 monthly IPL treatments over the dorsal hands. Subjects followed up 1 and 3 months after treatment. At every visit, photographs were taken using the VISIA Complexion Analysis System (Canfield Scientific, Fairfield, NJ) and analyzed using the RBX Brown Spots Analysis algorithm. The Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale were completed at both follow-up visits. RESULTS A total of fifteen subjects completed all six visits. The number of brown spots decreased 9.26% (p = .0004) and 7.52% (p = .0132) at each follow-up visit. The mean brown intensity decreased 6.15% (p = .0183) and 7.67% (p = .0178), whereas the mean contrast intensity decreased 8.88% (p < .0001) and 6.60% (p = .0007) 1 and 3 months after treatment, respectively. The mean Clinician Global Aesthetic Improvement Scale was 2.03 and 2.23, whereas the mean Subject Global Aesthetic Improvement Scale 1 and 3 months after treatment was 1.6 and 1.8, respectively. CONCLUSION Objective analysis, along with clinician and subject assessments, showed an improvement in the appearance of benign pigmented lesions in the treated area after 3 IPL treatments.
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