Daily Cosmetic Research Analysis
Two randomized clinical trials and one expert consensus advance cosmetic and regenerative practice. A double-blind RCT shows tranexamic acid/niacinamide creams match 4% hydroquinone efficacy in melasma with fewer adverse events, while a single-blind RCT supports adding extensor hallucis longus tenotomy to minimally invasive hallux valgus surgery for enhanced radiographic correction. LATAM-focused consensus provides practical, ethnicity-aware guidance for collagen biostimulators (CaHA, PLLA).
Summary
Two randomized clinical trials and one expert consensus advance cosmetic and regenerative practice. A double-blind RCT shows tranexamic acid/niacinamide creams match 4% hydroquinone efficacy in melasma with fewer adverse events, while a single-blind RCT supports adding extensor hallucis longus tenotomy to minimally invasive hallux valgus surgery for enhanced radiographic correction. LATAM-focused consensus provides practical, ethnicity-aware guidance for collagen biostimulators (CaHA, PLLA).
Research Themes
- Evidence-based aesthetic dermatology beyond hydroquinone
- Technique optimization in minimally invasive foot surgery
- Region-specific consensus in regenerative aesthetics (CaHA, PLLA)
Selected Articles
1. Safety and efficacy of niosomal and conventional tranexamic acid/niacinamide vs. hydroquinone creams in melasma: A randomized, double-blind, case-controlled clinical trial.
In a 99-patient, double-blind randomized trial, both niosomal 2% TXA/2% niacinamide and conventional 5% TXA/4% niacinamide creams achieved melanin index and mMASI reductions comparable to 4% hydroquinone over 3 months. Adverse reactions and relapse were observed in the hydroquinone group, suggesting TXA/NCA formulations as safer alternatives with equivalent efficacy.
Impact: Provides high-quality comparative evidence supporting TXA/niacinamide as a hydroquinone-sparing option for melasma with fewer adverse effects, addressing a key safety limitation of HQ.
Clinical Implications: TXA/niacinamide creams can be considered first-line or maintenance therapy for melasma, especially in patients intolerant to hydroquinone or at risk of adverse events/relapse.
Key Findings
- Both TXA/NCA formulations matched 4% hydroquinone in reducing melanin index and mMASI over 3 months.
- Hydroquinone group experienced adverse reactions and relapse; TXA/NCA groups had a more favorable safety profile.
- Quality of life improved across all groups during treatment.
Methodological Strengths
- Randomized, double-blind, active-controlled, three-arm design
- Clinically relevant endpoints (melanin index, mMASI, QoL) with dermatology visits across treatment
Limitations
- Single trial with 3-month follow-up; long-term durability and relapse rates beyond treatment are unknown
- Single-center design and formulation-specific results may limit generalizability
Future Directions: Head-to-head multicenter RCTs with longer follow-up to assess sustained remission, relapse after cessation, and optimal maintenance strategies; inclusion of objective imaging and pigment biomarkers.
Melasma is a common hyperpigmentary skin disorder. Because of its high prevalence and serious complications, including negative psychiatric effects, early diagnosis and treatment would be essential. This randomized, double-blind, case-controlled clinical trial compared the efficacy of niosomal tranexamic acid (TXA) 2%/niacinamide (NCA) 2% cream and conventional TXA 5%/NCA 4% cream with topical hydroquinone (HQ) 4% cream as a gold standard in melasma patients. A total of 99 patients were randomly assigned to three groups: Group A received niosomal TXA/NCA cream, Group B received conventional TXA/NCA cream, and Group C received HQ cream for three months. Each patient attended five dermatologist visits to evaluate clinical efficacy. All treatment groups showed a considerable reduction in melanin index and modified melasma area and severity index (mMASI) scores, as well as a notable improvement in patients' quality of life. Although both niosomal TXA/NCA cream and conventional TXA/NCA cream were as effective as HQ cream in management of melasma, adverse reactions and relapse were observed in HQ group. Niosomal or conventional TXA/NCA creams are as effective as HQ 4% cream and due to less serious adverse reactions they would be better choices than HQ-containing preparations in hyperpigmentary disorders. Clinical Trial Registration No.: IRCT20220609055116N1 (Approval date: 07/23/2023).
2. Multimodal evaluation of partial zig-zag tenotomy of the extensor hallucis longus in minimally invasive hallux valgus surgery: a randomized trial.
This single-blind randomized trial (n=46) found that adding a zig-zag EHL tenotomy to MIS hallux valgus correction yielded similar primary HVA improvements as MIS alone, but greater reductions in PASA, IMA, and IPA and a significant increase in mean plantar pressure only in the tenotomy group. Functional recovery was not impaired, supporting tenotomy in complex deformities or high tendon tension.
Impact: Provides randomized evidence on an adjunct maneuver within MIS HAV correction with multimodal outcomes, informing surgical planning for complex deformities.
Clinical Implications: Surgeons may consider EHL tenotomy when tendon tension or radiographic parameters suggest limited correction with osteotomies alone, aiming for improved alignment and plantar load redistribution.
Key Findings
- Both groups had significant 12-month HVA reductions with no between-group difference in the primary outcome.
- The tenotomy group showed greater improvements in PASA (-5.68°), IMA (-4.16°), and IPA (-12.17°).
- Mean plantar pressure increased significantly only in the tenotomy group, indicating load redistribution without functional impairment.
Methodological Strengths
- Prospective randomized, single-blind design with trial registration (NCT06243471)
- Multimodal outcomes including radiographic angles, baropodometry, and AOFAS with effect sizes and 95% CIs
Limitations
- Single-center private clinic with modest sample size (n=46)
- 12-month follow-up; longer-term stability and recurrence are unknown
Future Directions: Larger multicenter RCTs with longer follow-up to assess recurrence and durability; stratified analyses by tendon tension and deformity severity; patient-reported outcomes and gait analysis.
BACKGROUND: Hallux abductus valgus (HAV) is a common, complex forefoot deformity with significant clinical and functional implications. While minimally invasive surgery (MIS) often results in better recovery and improved cosmetic outcomes, adjunctive procedures such as zig-zag tenotomy of the extensor hallucis longus (EHL) tendon remain poorly documented. This study aims to evaluate the clinical, structural, and functional outcomes of MIS with and without EHL tenotomy in patients with moderate to severe HAV. METHODS: This was a prospective, randomized, controlled, single-blind clinical trial conducted in a private clinic in Alicante, Spain, between February 2024 and June 2025. Adults aged 20-90 years with moderate/severe HAV and hallux hyperextension were randomized (ABBA sequence, concealed by independent investigator) to MIS with zig-zag EHL tenotomy (n = 25) or MIS without tenotomy (n = 21). Both groups underwent Reverdin-Isham and Akin osteotomies plus adductor tenotomy. PRIMARY OUTCOME: change in the hallux valgus angle (HVA) at 12 months. SECONDARY OUTCOMES: changes in PASA, IMA, DASA, MPA, IPA, mean and peak plantar pressure (static baropodometry, S-Plate®), and AOFAS score. Intra- and intergroup differences were analyzed using t-tests and repeated-measures ANOVA, reporting p-values and effect sizes (Cohen's d, 95% CI). RESULTS: Of 49 patients assessed, 46 were randomized (4 men, 42 women; mean age 62.0 ± 13.6 years). At 12 months, both groups improved significantly in HVA: tenotomy group - 18.2° (95% CI - 21.9 to - 14.5; d = 1.73; p < 0.001) vs. no-tenotomy - 16.9° (95% CI - 21.5 to - 12.3; d = 1.83; p < 0.001), with no significant between-group difference. The tenotomy group showed greater reductions in PASA (- 5.68°, d = 1.12), IMA (- 4.16°, d = 1.30), and IPA (- 12.17°, d = 1.20). Mean plantar pressure increased significantly only in the tenotomy group (+ 18.7 g/cm CONCLUSIONS: In moderate/severe HAV, adding zig-zag EHL tenotomy to MIS may provide additional benefits in radiographic correction and plantar load redistribution without impairing functional recovery. These findings support its use in complex deformities or high tendon tension, though longer-term follow-up is needed to assess stability and recurrence. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06243471 (Feb 2024).
3. Optimizing Collagen Biostimulator Choice in LATAM: Expert Consensus on Patient Selection, Ethnic Skin Phenotypes, and Accessibility.
Using a modified Delphi process with 14 LATAM experts, strong consensus (51/58 statements) was reached on selecting CaHA for thicker skin and immediate volumization and PLLA for thinner skin and long-term remodeling, along with specific dilution protocols, cannula use, and vigorous post-PLLA massage. This is the first LATAM-specific practical framework integrating ethnic skin phenotypes and accessibility.
Impact: Delivers region-specific, implementable guidance for collagen biostimulators that addresses ethnic skin diversity and resource constraints, likely improving safety and outcomes in regenerative aesthetics.
Clinical Implications: Practitioners can personalize CaHA vs PLLA selection, dilution, and technique based on skin thickness and treatment goals, standardize safety (cannula use), and incorporate aftercare (post-PLLA massage).
Key Findings
- Strong consensus on 51/58 statements; 4 achieved moderate consensus.
- Recommendation: CaHA for thicker skin/immediate volumization; PLLA for thinner skin/long-term remodeling.
- Specified dilution protocols (e.g., CaHA 1:1 face, 1:4 body), cannula use for safety, and vigorous post-PLLA massage.
Methodological Strengths
- Modified Delphi with predefined consensus thresholds following a systematic literature review
- Multidisciplinary LATAM expert panel addressing ethnic diversity and practice realities
Limitations
- Consensus-based guidance without prospective clinical validation
- Expert panel size (n=14) and LATAM focus may limit generalizability
Future Directions: Prospective, standardized outcome studies to validate recommendations across ethnic skin types; cost-effectiveness and accessibility analyses; training and implementation research.
BACKGROUND: The diverse ethnic skin phenotypes and socioeconomic landscape of Latin America (LATAM) necessitate tailored approaches to collagen biostimulators, calcium hydroxylapatite (CaHA) and poly-l-lactic acid (PLLA). A region-specific consensus on their optimal use is lacking. OBJECTIVES: To establish expert consensus guidelines on patient selection, techniques, and practical application of CaHA and PLLA for collagen biostimulation in LATAM populations. METHODS: A modified Delphi process was conducted with 14 LATAM experts. Following a systematic literature review, 58 statements were drafted across key clinical domains. Consensus was defined as ≥ 75% agreement, stratified as strong (≥ 85%) or moderate (75%-84%). RESULTS: Strong consensus was achieved on 51 statements (87.9%), with 4 reaching moderate consensus. Key recommendations include: selecting CaHA for thicker skin and immediate volumization, and PLLA for thinner skin and long-term collagen remodeling; using specific dilution protocols (e.g., CaHA 1:1 for face, 1:4 for body); employing cannulas for safety; and implementing vigorous post-PLLA massage. Initial disagreements on age-based restrictions were resolved through literature review, achieving final consensus. CONCLUSION: This consensus provides the first LATAM-specific framework for CaHA and PLLA use, integrating ethnic diversity, anatomical considerations, and accessibility to optimize safety and efficacy in regenerative aesthetics.