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SummaryBackground Jawline reshaping by replacing volume has become an indispensable component of modern facial rejuvenation. Aim To evaluate calcium hydroxylapatite (CaHA) for the treatment of an aging jawline in a routine setting. Methods Five investigators enrolled 35 subjects requesting jawline rejuvenation with CaHA. Injections were performed according to investigators usual practice. Baseline and post-treatment scores were evaluated using Merz Aesthetics Scales®. Follow-up visits took place at Day 30 (Day 60 for those with touch-up at Day 30), 180, and 360. Physician and patient satisfaction, esthetic impact of treatment, and adverse events were recorded. Results Improvements in jawline contour compared with baseline were statistically significant at each visit, with scores of 2.42 (moderate to severe sagging) at baseline, 1.02 (mild) at Day 30/60 (P≤.0001), 1.11 at Day 180 (P≤.0001), and 1.45 at Day 360 (P=.0015). Statistically significant improvements in marionette line scores were also observed. Investigators rated results as “improved” to “very much improved” in all subjects up to Day 180, and in 81% of subjects at Day 360. Satisfaction with treatment was very high. Adverse events were mostly mild and related to either the procedure or injection technique. Conclusion CaHA is a very effective agent for restoring jawline contour in routine practice and is associated with high levels of physician and patient satisfaction.

Background Glycolic acid (GA) chemical peels are a popular treatment for photoaged skin rejuvenation, but retinaldehyde (RAL)-based cosmetic creams have also demonstrated efficacy in improving photoaging, and are potentially better tolerated than chemical peels. Aims To compare the efficacy and safety of an antiaging cream containing 0.1% RAL associated with Glycylglycine Oleamide (GGO, Relastide® ) and Pre-tocopheryl® , to GA peels sessions in the treatment of photoaging. Patients and methods Fifty-five women with photoaging were randomized in 2 treatment groups: (1) Daily application of the antiaging cream for 8 weeks or (2) Three sequential GA peels (20%, 50%, and 70%), 2-3 weeks apart. Skin surface texture, length of wrinkles, complexion radiance, and evenness of pigmentation and texture were assessed by profilometry using skin replicas, computer image analysis, and self-assessment. Results Efficacy of both treatments was similar in reducing crow's feet wrinkles depth (STm -7.61%, P = .0007 vs -4.34%, P = .0348; P = .3049 intergroup) and volume, crow's feet and periorbital wrinkle length, and number of fine lines and wrinkles at end of treatments. The efficacy of the cream in refining skin texture was superior to the peels (contrast: -5.61%, P = .0025 vs +3.54, P = .08; P intergroup = .0252). The 8-week treatment with the antiaging cream was well tolerated; adverse events were fewer and of milder intensity than with the peels, (12-fold lower incidence of physical signs). Conclusion A dermocosmetic cream containing 0.1% RAL, GGO (Relastide® ) and Pre-tocopheryl® is as effective as 3 sequential GA peels, better tolerated, and is an alternative in the management of photoaged skin.

SummaryBackground Age-associated volume loss is now known to play an important role in the structural changes of the aging face. In the lower face, this manifests as drooping of the corners of the mouth and jowl leading to a loss of the oval jawline of youth. Jawline reshaping by replacing volume has therefore become an indispensable component of modern facial rejuvenation. Aim Calcium hydroxylapatite (CaHA; Radiesse®, Merz Pharmaceuticals GmbH, Frankfurt, Germany) is an injectable filler with a cosmetic indication for tissue augmentation. The ability of calcium hydroxylapatite to provide immediate and long-lasting volume enhancement makes it an ideal agent for restoring an oval jawline. Method This consensus statement has been developed to assist clinicians who would like to gain more experience in the use of volumizing agents to achieve an optimal outcome with this procedure. Results Using the recently developed Merz Aesthetics Scale® for jawline, the consensus provides a treatment protocol for individuals at each stage of oval loss and presents a series of before and after images to illustrate the improvements that can be achieved. Specific recommendations for calcium hydroxylapatite including type of anesthesia, injection techniques, volume for injection, use in combination with other procedures, and expected duration of corrections are provided. Techniques for minimizing and managing expected problems and potential complications are also described. Conclusion Calcium hydroxylapatite is appropriate for treating patients at any stage of oval loss.

Summary Background Onabotulinumtoxin A has been used for many years in the aging face treatment. A survey was organized to identify current practices in France. Objective To develop consensual recommendations for treating aging lower face and neck with onabotulinumtoxin A. Methods and materials Fifty-seven participants to six regional surveys reviewed practices and techniques for each individual treatment indication. From conference summaries and data from a questionnaire, consensual recommendations were developed. Results General considerations, key treatment rules, injection specifics (dose, site, and techniques), associated procedures/treatments, and procedure follow-up were defined by indication, i.e., nasolabial angle, nasal tip repositioning, dilated nostrils, lips and perioral area, Marionette lines and depressor anguli oris, gingival smile, risorius and zygomatic perioral muscles, masseters, chin, and platysma. For the consensus participants, current onabotulinumtoxin A use is a global preventive and corrective treatment. Overall, judicious treatment of multiple sites and adjunctive modalities, such as fillers, peels, and laser, leads to satisfactory results with a youthful, harmonious, animated, and natural-looking face. Conclusion Years of experience using onabotulinumtoxin A result in sophisticated treatment approaches, more specific targeted injections, and better understanding of lower facial and neck aging, leading to satisfying therapeutic results for patients and clinicians.

RESULTS Final results showed that 86% of patients were satisfied or better on a 6-point scale. At week 12, investigators expressed high satisfaction, with a 93% satisfaction rating or better. At weeks 2 and 12, physicians evaluated 98% of patients as improved or better on the Global Aesthetic Improvement Scale. Mild adverse events generally resolved within 2 weeks. Three cases of delayed edema reported 7 to 14 days after treatment resolved without intervention. CONCLUSION Ease of use, minimal postprocedure events, desirable cosmetic outcome, and duration underscore the benefits of CaHA as a safe, efficient, noninvasive treatment option for the aging hand. BioForm Medical Europe commissioned this study and the attendant postmarketing surveillance. BioForm Medical Europe reimbursed each physician a designated sum for each completed patient treatment, including five sets of questionnaires and photos. In return for their participation and completion of the Media Release Form, patients received a maximum of three syringes of BioForm Medical product for treatment of the hands. The individual treating physician determined total cost of treatment.

Botulinum toxin A (BTX-A) is used to treat glabellar lines but the rigorous demonstration of its efficacy in a well-designed study had never been reported.This study was designed to evaluate the efficacy and the safety of 3 doses of BTX-A in the treatment of glabellar lines.A total of 119 patients with moderate to severe glabellar lines at rest were treated with 25, 50, or 75 U of BTX-A (Dysport, Ipsen) or placebo divided into 5 intramuscular glabellar sites. Outcome measures included evaluations of glabellar lines by independent experts from blinded standardized photographs at rest 1 month after treatment, physician evaluations, and patient assessments during a 6-month period.A significant efficacy was reported for the 3 BTX-A groups for at least 3 months after injection (at least P.015). Investigator and patient evaluations suggested that 50 U was the optimal dose. BTX-A was well tolerated. No blepharoptosis was reported. An evaluation in blinded conditions by independent experts was necessary because the results were overestimated by the investigators.BTX-A is an effective and safe treatment for glabellar lines.

Les traitements conventionnels par retinoides topiques, peroxydes de benzoyle, zinc, antibiotiques topiques et oraux ou encore isotretinoine restent les premieres lignes dans l’algorithme decisionnel de l’acne. Pourtant, la diminution de l’efficacite des antibiotiques sur le Propionibacterium acnes, la legislation de plus en plus contraignante entourant la prescription d’isotretinoine, le retrait momentane de certaines molecules comme la Diane 35® et la necessite d’une compliance sans faille, ont incite les praticiens a se pencher sur des solutions alternatives. Or d’importants progres interventionnels sont en marche dans ce domaine et devraient bientot modifier la prise en charge des patients acneiques. Pour schematiser, on considere que l’action des lasers et techniques apparentees peut se faire de deux manieres : en reduisant la charge bacterienne du P. acnes (la cible etant les porphyrines qu’il produit) ou en reduisant la taille des glandes sebacees et donc la production de sebum. Les techniques ciblant le P. acnes via ses porphyrines naturelles sont la lumiere bleue (autour de 410 nm), les IPL, le laser KTP (532 nm) et le laser a colorant pulse (595 nm), ces deux derniers ayant egalement un effet sur la microcirculation dermique. Les techniques ciblant les glandes sebacees ont pour but de diminuer leur taille et de reduire la production de sebum, ce qui laisserait presager un effet durable par photothermolyse des glandes sebacees. Il s’agit des lasers infrarouge (laser diode 1450 nm, laser Erbium glass 1540 nm), de la radiofrequence (monopolaire, ou plus recemment, fractionnee par microneedling) et de la phototherapie dynamique. Les LED rouges (autour de 630 nm) quant a elles, diminuent l’inflammation de ces structures, et agissent synergiquement a la lumiere bleue en minimisant l’impact pro-oxydatif de la lyse bacterienne. Par leur action de remodelage, elles permettent une prise en charge plus globale ( Fig. 1 ). Elles peuvent en outre s’associer aux peelings dont elles potentialisent les effets tout en diminuant les suites. L’espoir le plus recent viendrait d’un protocole innovateur inspire de la nanotechnologie. Le protocole « SEBACIA » est une sorte de PDT amelioree faisant appel a un photosensibilisant artificiel, les microparticules d’or qui s’accumulent dans les glandes sebacees. La photothermolyse selective des glandes sebacees est obtenue sous un laser diode 810 nm (comme pour une epilation). Peut-on imaginer un avenir ou pour traiter ses patients acneiques, le dermatologue n’aura plus recours a son ordonnancier mais installera directement son patient pour lui proposer un traitement interventionnel simple, court et bien tolere ?

Les lampes diodes electroluminescentes (LED) medicales delivrent d’etroites franges de longueurs d’onde issues du spectre visible et infrarouge. Elles n’ont pas d’effets deleteres directs sur leurs cibles mais agissent par « photobiomodulation ». Cela signifie qu’elles interferent sur le metabolisme cellulaire, aboutissant a des phenomenes d’activation et d’inhibition de voies de signalisation essentielles pour la synthese et la proliferation cellulaire. Selon les parametres utilises (longueur(s) d’onde, leur association, l’energie delivree, les temps d’irradiation, le mode de delivrance pulse ou non), mais aussi selon l’etat initial de la cible cellulaire, les effets sont differents. Si certaines publications manquent de rigueur scientifique, ont des biais et/ou des conflits d’interets, d’autres sont de tres bonne qualite. Les LED ne se limitent pas a diminuer les effets secondaires des traitements agressifs : resurfacages, peelings… Seules ou associees a d’autres techniques, elles sont une aide considerable en matiere de medecine esthetique : prise en charge de l’heliodermie, des cicatrices, des vergetures, des alopecies, de la cellulite mais aussi au-dela de l’esthetique pour la cicatrisation des plaies torpides, les mucites, les acnes inflammatoires rebelles, les poussees de rosacee subintrantes, les peaux hyper-reactives, les pelades… Les parametres de base sont : – le spectre lumineux (longueurs d’onde, association de longueurs d’onde) determine les cibles : le « rouge » est incontournable mais d’autres longueurs d’onde ont des effets et certaines associations sont synergiques ; – l’irradiance (ou « densite de puissance ») en watt/cm2. – la duree d’exposition par seance et le mode de delivrance, pulse ou continu. L’irradiance et la duree d’exposition determinent la dose administree en J/cm2. Cependant, il ne suffit pas de regler l’appareil car in vivo comme in vitro, les effets de la photobiostimulation dependent aussi de l’etat physiologique de la cellule avant l’irradiation. Il faut donc aussi selectionner la bonne indication, le bon « candidat » sous peine d’echec. Les effets photo-therapeutiques seront generalement meilleurs sur les cellules non proliferatives et/ou en « mauvais etat ». Il faut aussi considerer les protocoles de traitement : nombre de seances et intervalles entre les seances. Le champ des indications potentielles des LED depasse largement les domaines de la dermatologie et de la medecine esthetique. Les protocoles sont de plus en plus precis pour de nombreuses indications. Cependant, il reste a optimiser certains parametrages et pour cela l’experience des nombreux utilisateurs et les nouveaux travaux en cours seront determinants.

La toxine botulique est toujours d’actualite avec comparaison entre les toxines surtout avec l’arrivee annoncee d’une quatrieme toxine, d’origine coreenne, en cours d’AMM… La toxine agit non seulement sur les muscles mais aussi modifie notre perception de l’âge et rend nos visages feminins plus attirants surtout si des comblements sont associes. Les produits de comblements sont de plus en plus nombreux : de nouveaux acides hyaluroniques avec ou sans anesthesie, mais aussi de nouveaux produits de stimulation tissulaire et peut-etre un retour du collagene. Les peelings sont toujours d’actualites avec de nouvelles combinaisons d’acides de fruits, mais aussi d’association avec des LED. Le role des UVA et du visible dans le melasma est bien defini aussi les cremes solaires se renforcent en anti-UVA et se teintent. L’esthetique du corps se developpe avec des techniques de moins en moins invasives mais souvent repetitives. Bref beaucoup de nouveautes encore cette annee avec en plus beaucoup d’interrogation sur ce que nous ingerons.

Data demonstrating the efficacy of hyaluronic acid (HA)-based mesotherapy for skin rejuvenation are scarce. The aim of the study is to assess the efficacy of non-reticulated HA-based mesotherapy on skin elasticity and complexion radiance. 55 women with cutaneous ageing signs included in the Full Analysis Set (FAS) population blindly received intradermal micro-injections (50 × 0.02 mL) of non-cross-linked HA filler with mannitol (Glytone 1, HA concentration: 14 mg/g) in one cheek and saline physiological solution in the other according to hemifacial randomisation in 3 monthly sessions. Elasticity (E1 and E2 stiffness parameters) and dermis thickness were measured by cutometry and 20 MHz echography, before (D0) treatment and 1 (1M) and 3 months (3M) after the last injection. A trained panel blindly scored skin complexion radiance from standardised and calibrated photographs, using 100 mm analogue scales. In the FAS population, only HA filler significantly decreased E1 at 1M (−10.9 %, p = 0.026) and 3M (−10.5 %, p = 0.035) compared with D0; its effect versus the control tended to be more persistent, with a difference between treatments at 3M close to significance (p = 0.063). E2 also decreased at 1M (−8.2 %, p = 0.027 in the per protocol population, n = 53) and 3M after HA-treatment only. Dermis thickness significantly increased after HA-treatment at 1M (+3.4 %, p = 0.028) and 3M (+4 %, p = 0.008), and after control-treatment at 1M only (+2.5 %, p = 0.015). The HA filler significantly improved complexion radiance at 3M compared with the control (p = 0.012) and for 51 % of subjects, their skin status. Non-reticulated HA-based mesotherapy significantly and sustainably improves skin elasticity and complexion radiance.