Abstracts

A summary of the latest clinical studies

Title: A Comparative Study of Efficacy and Safety of Autologous Fat Grafting Vs. Platelet-Rich Plasma in the Treatment of Post-Acne Scars Authors: Shetty V, et al. Published: Journal of Cosmetic Dermatology, October 2021 Keywords: Acne Scars, Fat Grafting, Platelet-rich Plasma Abstract: Platelet-rich plasma is a useful adjuvant therapy in the treatment of acne scars. Fat is an ideal soft tissue filler. 24 patients were divided into two groups with 12 patients in each. One group subjected to a single session of subcision with autologous fat grafting. The second group was treated with subcision followed by intradermal platelet-rich plasma once monthly for three months. High resolution digital photographs were taken before and after every session. A single blinded physician assessment was also done. In quantitative acne scar assessment scoring, both group of patients showed a significant percentage of improvement in acne scars, 9.48% in patients treated with subcision followed by autologous fat grafting and 7.28% in patients treated with subcision followed by intradermal PRP. At the time of enrolment, 33.3% of patients had Grade A (mild) scarring, 50% had Grade B (moderate) scarring while 16.7% had Grade C (severe) scarring. After the completion of the treatment, it was found that 75% of patients were in Grade A while 20.8% of patients were in Grade B. Both the treatment modalities were effective and safe for the treatment of acne scars and results in each group was significant, but there were no statistically significant differences between the two treatment groups.

Title: Long-term Effects of Repeated Botulinum Toxin Injection in Cosmetic Therapeutics Authors: Crook J, et al. Published: Annals of Plastic Surgery, October 2021 Keywords: Botulinum Toxin, Injections, Wrinkles Abstract: Botulinum toxin (BT) has been used in clinical medicine since the 1970s for cosmetic and therapeutic purposes. Studies have consistently shown positive outcomes with a very limited adverse effect profile and a conventional understanding that results dissipate after three to five months. To examine the potential implications of these findings on cosmetic use of BT injections in reduction of lines and wrinkles, we needed to further our understanding of the current literature on long-term outcomes after repeated BT injections. A comprehensive review of the literature on long-term outcomes after repeated BT injections for cosmetic indications was performed. We evaluated the study designs, and results were compared. 22 publications met our inclusion criteria, of which 14 were clinical trials. Few studies extended outcome measurement past six months post-injection, and many were funded or supported by industry. However, the studies that extended followup saw changes after BT injection, in some cases as far as four years post-injection. The current body of knowledge on the long-term results after repeated cosmetic BT injections is limited, and available literature provides insufficient evidence on how prolonged effects could alter clinical use of BT. Further clinical studies with extended follow-up periods with inclusion of both subjective and objective measured outcomes of appearance and muscle function are required to understand the long-term impacts of repeated BT injections. Title: Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned from Functional Anatomy Authors: Calomeni M, et al. Published: Aesthetics Surgery Journal, October 2021 Keywords: Injectables, Tear Trough, Ultrasound Abstract: The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying fascial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. The aim of the study is to evaluate the location and function of the angular vein in the tear trough in three different facial expressions: repose, smiling, and max. orbicularis oculi contraction. 20 participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein, the velocity, and direction of venous blood flow were analysed in repose, smiling and during max. orbicularis oculi contraction. The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle within the tear trough whereas the angular artery was not identified in this location. The distance between the angular vein the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/ sec and was 7.3 cm/sec at max. orbicularis oculi muscle contraction; no blood flow was detectable during smiling. The diameter and the venous blood flow of the angular vein varied between the three facial expressions. Based on these findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.

Title: An In Vivo Model of Postinflammatory Hyperpigmentation and Erythema Authors: Vellaichamy G, et al. Published: British Journal of Dermatology, October 2021 Keywords: Hyperpigmentation, Trichloroacetic Acid Abstract: Post-inflammatory hyperpigmentation (PIH) is a common disorder of the skin associated with quality of life impairment, especially in skin of colour individuals. Treatment for PIH is limited, due to a poor understanding of disease pathogenesis and lack of a representative disease model. This study is to further develop, update, and validate our designed in vivo model of acne-induced PIH/post-inflammatory erythema (PIE) using different concentrations of trichloroacetic acid (TCA). 29 patients with skin types I-VI and clinician-confirmed presence of two or more truncal acne pustules and PIH/PIE were included. On the basis of IGA, CPP, colorimetry, and skindex, we experimentally determine an optimum TCA-concentration and assessed our model’s ability to exhibit a dose-response relationship between inciting insult and severity of pigmentation. We performed differential microRNA profiling and pathway analysis to explore the potential of microRNAs as molecular adjuncts to our model. Application of 30% TCA produced lesions indistinguishable from acne induced PIH and PIE lesions on the basis of data without causing epidermal necrosis. Increasing TCA doses from 20%-30% resulted in concentration-dependent increases in CPP, IGA, and colorimetry scores at points during the study.