Daily Cosmetic Research Analysis

BACKGROUND AND OBJECTIVE: Fractional radiofrequency was developed as a potentially lower-risk and downtime alternative to traditional fractional ablative and nonablative lasers for skin resurfacing. Pin-based FRF (pFRF) delivers radiofrequency heat in focal, high-energy density columns within intact skin, without microneedle insertion. The main objective of this publication was to get an expert consensus on best-in-practice protocols for treating common aesthetic indications for resurfacing using a novel pFRF device. METHODS: An international panel of 10 dermatologists and plastic and reconstructive surgeons from 6 countries and a variety of practice settings was assembled to develop updated consensus recommendations for using pFRF. A modified Delphi method included: a preliminary questionnaire, video conference roundtable discussion, individual review of initial data, a secondary questionnaire, and multiple rounds of email discussion until a group consensus was reached. RESULTS: The panel developed standardized pFRF protocols for the treatment of acne scars, enlarged pores, skin texture, rhytides, and striae. For each diagnosis, device parameters and techniques are outlined. General requirements for patient preparation, anesthesia, and post-treatment care are described. Special consideration was given to device settings for condition severity and Fitzpatrick skin type. These guidelines are meant to provide new practitioners with a starting point for safe and effective patient treatment. CONCLUSIONS: pFRF without microneedles is a useful alternative to fractional laser technology and radiofrequency microneedling for resurfacing patients’ skin texture irregularities. Patients tolerate the procedure and recovery well. Here, protocols for the treatment of 5 common aesthetic skin complaints with a novel pFRF device are provided.

INTRODUCTION: While traditionally focused on treating glabellar and forehead rhytids through direct neuromodulator injections, recent findings on the biomechanics of facial muscles suggest that glabellar treatments alone may influence forehead wrinkles by altering the dynamic balance between depressor and elevator muscles. OBJECTIVE: To evaluate whether glabellar-only neuromodulator treatments can reduce forehead wrinkle severity without direct injections into the frontalis muscle. METHODS: This prospective, interventional study included 18 participants with moderate to very severe glabellar lines. Neuromodulator (AbobotulinumtoxinA; 37.5 sU (= 15 IU)) injections were administered exclusively in the glabella at three intervals over 7 months. Glabellar Severity Scale (GLSS), Forehead Wrinkle Scale (FWS), Frontal Skin Displacement (FSD), and Eyebrow Position Scoring (EPS) were assessed at baseline and 30 days after each cycle. RESULTS: GLSS scores significantly improved across treatment cycles (baseline: 3.0; post-third cycle: 1.0; p < 0.001). FWS improved from 3.0 at baseline to 1.0 after the third cycle (p = 0.005), while FSD showed a significant reduction from 37.2 mm to 17.9 mm (p < 0.01). No changes in eyebrow position were detected following EPS assessment. CONCLUSION: Glabellar-only neuromodulator treatments with 37.5 sU (= 15 IU) effectively reduced forehead rhytid severity, likely by altering the balance between depressor and elevator muscles. This approach minimizes risks associated with direct frontalis injections and offers a novel strategy for forehead rejuvenation. Moreover, the observed progressive improvement across treatment cycles suggests that this strategy may continuously enhance aesthetic outcomes over time, supporting the rationale for maintenance treatments at regular intervals.

BACKGROUND: Volume replacement after breast-conserving surgery (BCS) can help achieve a good cosmetic outcome, especially in patients with small breast size, where volume displacement is limited. Latissimus dorsi myocutaneous flaps, which are widely used, require a longer hospital stay and have a risk of donor site morbidity. Chest wall perforator flap (CWPF) could be used as an alternative option. Although this has the advantage of a shorter hospital stay and muscle preservation, the dissection of perforator vessels is required. Using indocyanine green (ICG) intraoperatively can help the surgeon to visualize the perforators and assess the flap perfusion. Our study aimed to examine the roles of these techniques for CWPF reconstruction in BCS. METHODS: We retrospectively reviewed 22 patients who underwent CWPF reconstruction at the Queen Sirikit Centre for Breast Cancer, King Chulalongkorn Memorial Hospital from January 2023 to October 2024. Patients' baseline characteristics, types of CWPF, number of perforators identified by ICG and by direct visualization, complications, and perfusion time of ICG were reviewed. RESULTS: Eight patients had anterior intercostal artery perforator (AICAP) flap reconstruction. Thirteen patients had lateral intercostal arterial perforator (LICAP) flap reconstruction with or without lateral thoracic arterial perforator (LTAP) flap reconstruction. One patient had thoracodorsal arterial perforator (TDAP) reconstruction. The ICG was used in 21 flaps. ICG perfusion was completed within 2 minutes (range, 20-110 seconds). Most of the patients had two perforators identified by ICG. In 88% of cases, ICG perfusion of the perforator flap and adjacent normal tissue was visualized simultaneously. There was a difference in ICG perfusion onset time between flaps with one versus multiple perforators. CONCLUSIONS: ICG angiography can be used intraoperatively for flap assessment with helpful information. A perfusion time of less than 2 minutes was correlated with a good clinical outcome. Intraoperative ICG angiography can guide surgeons in evaluating flap perfusion, which can help address both immediate and long-term morbidity concerns.