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Background: As facial aesthetic procedures have become more widely accepted, the racial and ethnic diversity of aesthetic patient populations has increased. Asian Americans represent a growing segment of this population and have specific aesthetic concerns that should be differentiated from the broader Caucasian population. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Asian American women. Materials and Methods: A total of 403 participants ages 30 to 65 years reported perspectives on facial aging, current facial conditions, most bothersome facial areas, most/least likely to be treated first, awareness of treatment options and consideration rates, and motives/barriers impacting the consideration rate of injectable treatments. Results: Treatment interests reflected predominant issues; uneven skin tone, wrinkles, and sun damage. Most bothersome facial areas included the periorbital area, forehead, and submental area, and also among areas designated as most likely to treat first. The majority of participants would consider injectables. However, safety/side effects, cost, and concerns about not looking natural were primary barriers. Conclusion: Understanding the aesthetic concerns and priorities specific to Asian American women may help guide treatment plans more aligned with the goals and expectations of this patient population. J Drugs Dermatol. 2019;18(7):633-641.

Bruising after dermal filler and neuromodulator injections is a common side effect and can have durations of 1 to 2 weeks. While it ultimately resolves, faster resolution can produce better outcomes for patients and also make patients more likely to return for future treatments. We report the successful reduction in bruising following injections of fillers with an intense pulsed light source. We also documented the onset of action of bruising resolution with serial photographs. Resolution started within the first hour of treatment and continued rapidly over 48 hours. This is the first-time reported study of resolution of bruising from injectables with intense pulsed light. Patient satisfaction is improved when such adverse events are minimized.

Background: Men are a growing patient population in aesthetic medicine and are increasingly seeking minimally invasive cosmetic procedures., Objective: To examine differences in the timing of facial aging and in the prevalence of preventive facial aging behaviors in men by race/ethnicity., Methods: Men aged 18 to 75 years in the United States, Canada, United Kingdom, and Australia rated their features using photonumeric rating scales for 10 facial aging characteristics. Impact of race/ethnicity (Caucasian, black, Asian, Hispanic) on severity of each feature was assessed. Subjects also reported the frequency of dermatologic facial product use., Results: The study included 819 men. Glabellar lines, crow's feet lines, and nasolabial folds showed the greatest change with age. Caucasian men reported more severe signs of aging and earlier onset, by 10 to 20 years, compared with Asian, Hispanic, and, particularly, black men. In all racial/ethnic groups, most men did not regularly engage in basic, antiaging preventive behaviors, such as use of sunscreen., Conclusion: Findings from this study conducted in a globally diverse sample may guide clinical discussions with men about the prevention and treatment of signs of facial aging, to help men of all races/ethnicities achieve their desired aesthetic outcomes.

The importance of training in minimally invasive cosmetic procedures is essential to insure safe outcomes for patients. Board certification in the appropriate specialty is one way to improve aesthetic outcomes. Meetings that consider appropriate residency training for admission can help achieve this goal.

Background: There is a paucity of data describing male attitudes toward age-related changes to their facial features and associated preferences for prioritizing treatment., Methods: Injectable-naive but aesthetically oriented men aged 30 to 65 participated in an online study (N = 600). Respondents indicated how concerned they were by the appearance of 15 age-related facial features, and the Maximum Difference scaling system was used to explore which features were most likely to be prioritized for treatment. The correlation between the features of most concern and the areas of treatment priority was assessed. Other aspects regarding the male perspective on aesthetic procedures, such as awareness, motivating factors, and barriers, also were explored., Results: Crow's feet and tear troughs were rated as the most likely to be treated first (80% of first preferences) followed by forehead lines (74%), double chin (70%), and glabellar lines (60%). The areas of most concern in order were tear troughs, double chin, crow's feet, and forehead lines. There was a strong correlation between the features of most concern and the areas of treatment priority (r = 0.81)., Conclusion: The periorbital areas, in particular crow's feet and tear troughs, are of most concern and likely to be prioritized for treatment among aesthetically oriented men.

Background: Physicochemical properties and performance in nonclinical animal models can provide insights into soft tissue filler performance., Objective: To evaluate the in vivo performance of fillers with different compositions and physicochemical properties., Materials and Methods: Physicochemical properties were measured in vitro. Rat models were developed and used to compare lift capacity, resistance to deformation, and tissue integration. Four homogeneous hyaluronic acid (HA) fillers, 2 nonanimal stabilized HA (NASHA) fillers, and 1 calcium hydroxylapatite/carboxymethyl cellulose (CaHA/CMC) filler were evaluated., Results: Filler lift capacity correlated better with filler composition/type (homogeneous > NASHA > CaHA/CMC) than with specific rheological properties. The CaHA/CMC filler had high initial resistance to deformation relative to other groups; all HA fillers exhibited lower initial resistance to deformation, which increased over time. Homogeneous HA fillers were integrated with surrounding tissue, whereas integration within particle-based fillers (NASHA and CaHA/CMC) was variable, with some areas void of tissue., Conclusion: The animal models provide a platform to make comparative evaluations among fillers. The results indicated that biological interaction plays an important role in how the filler performs. Rheology alone was not sufficient to understand filler performance but was most useful when comparing within fillers of similar composition.

Objective: This trial compares the effectiveness and safety of HYC-24L (Juvéderm Ultra XC; Allergan plc, Dublin, Ireland) (24 mg/mL of hyaluronic acid, 0.3% lidocaine) and CPM-22.5 (Belotero Balance; Merz Aesthetics, Raleigh, NC) (22.5 mg/mL of hyaluronic acid) for the treatment of perioral lines., Materials and Methods: Men and women aged 35 years or older with moderate-to-severe perioral lines were recruited for this randomized controlled, rater-blinded, 2-arm trial. The primary endpoint was a comparison of rater-assessed responder rates by the validated 4-point Perioral Lines Severity Scale at Month 6; responders were those who showed a ≥1 point improvement. A secondary endpoint was subject-assessed change in perioral lines measured by the Global Assessment of Change Scale., Results: A total of 136 subjects received treatment and 132 completed the trial (mean age: 58 ± 8 years). Total volume injected was 1.18 mL (HYC-24L) and 1.32 mL (CPM-22.5). At Month 6, a significantly greater proportion of HYC-24L subjects responded to treatment (87%) than CPM-22.5 subjects (72%) (p < .04). At all time points, HYC-24L subjects reported significantly greater improvement in their perioral lines than CPM-22.5 subjects, with the greatest difference at Month 6. No unexpected adverse events occurred., Conclusion: HYC-24L subjects showed a higher response rate and a greater improvement in their perioral lines than CPM-22.5 subjects for up to 6 months.

Background: Individuals typically self-identify symptoms of facial aging that lead them to seek facial aesthetic treatments. No systematic data exist to describe preferences for facial areas requiring treatment., Objective: To determine (1) the facial areas most likely to be treated first, (2) the relationship between the most bothersome facial area and the area first planned for treatment, and (3) differences between younger and older women., Methods: A total of 603 women aged 30 to 65 years considering aesthetic treatments participated in an online research survey using Maximum Difference scaling., Results: Maximum Difference analysis revealed that crow's feet lines (CFLs) were most likely to be treated first (82% of the first preferences), followed by oral commissures (74%) and tear troughs (72%). There was a strong correlation between the most bothersome facial area and the area first planned for treatment. In women younger than 45 years, features of the upper face were more likely to be treated first, whereas women aged 50 years or older had an increased preference for treating features of the lower face, with a reduction in preference for upper face treatment., Conclusion: This cross-sectional survey suggests that aesthetically oriented women have changing facial treatment preferences with age; however, CFLs are of most concern.

Background: Approximately 25% of patients exploring treatments for wrinkle reduction, have reservations about toxins. Therefore, a nonsurgical, minimally invasive, and toxin-free approach to eliminate facial hyperdynamic lines is desirable., Objective: To assess the clinical safety and effectiveness of focused cold therapy (FCT) for the reduction of hyperdynamic forehead wrinkles., Methods: Forty-one subjects received FCT to temporal branches of the facial nerve. Hyperdynamic forehead wrinkles were assessed by the investigator and subject before treatment, immediately after procedure, and at 7, 30, 60, 90, and 120 days after treatment. A validated 5-point wrinkle scale and a 9-point global improvement scale were used to measure line severity., Results: Five subjects received a lower treatment dose and were therefore excluded from analysis. In the remaining 36 subjects, 91% had at least a 1-point improvement in forehead line severity at 30 days after treatment and 70% had at least a 2-point improvement. There were no serious adverse events., Conclusion: Subjects treated for forehead wrinkles showed significant clinical improvement with high subject satisfaction and no serious adverse events. Focused cold therapy seems to be an effective, safe nontoxic alternative to popular wrinkle-reducing treatments.

Localized facial fat deposits are common, and treatment to restore and reshape the lower aspect of the face is mainly limited to surgical procedures. There has been a rapid growth in nonsurgical aesthetic procedures, and physicians and patients are seeking less invasive, nonsurgical facial rejuvenation options. Few data are published, however, on physician and patient perceptions and treatment of submental fat. This contribution reviews data from surveys of 78 physicians (dermatologists and plastic surgeons) and 385 patients who received nonsurgical facial rejuvenation. On average, physicians discussed fat reduction options with 19% of their patients; 18% of these discussions involved fat under the chin. Most patients surveyed (80%) had submental fat, assessed by a clinician using a 5-point rating scale. Submental fat was of concern to patients surveyed; 77% reported noticing extra fat under their chin and 61% wanted it reduced. Most patients (63%) surveyed would use an effective and well-tolerated noninvasive pharmacologic treatment for submental fat reduction. Patients were more likely to wish to reduce the fat below their chin if they had higher chin grade scores based on clinician assessment. Interesting insights are provided into the perceptions and behavior of physicians and patients with regard to submental fat reduction.

Background: Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology., Objective: A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types., Materials and Methods: Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings., Results: Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae., Conclusions: We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters.

Fractional resurfacing has become an increasingly popular treatment for photodamage. Non-ablative and ablative fractional resurfacing modalities both have a variety of different devices that may be utilized for treatments. Each modality has its own benefits and drawbacks. In this article, the authors offer preliminary observations from hands-on experience with several different ablative fractional lasers presently available.

Objective: Treatment of acne vulgaris with light sources necessitates multiple targets including Propionibacterium acnes and sebaceous glands. Traditional light sources such as blue light capitalize on P acnes bacteria as targets while infrared lasers and radiofrequency devices target the sebaceous gland. A novel device combining vacuum and a unique broadband light source was designed to combine multiple targets for the effective treatment of acne. The objective of this study was to demonstrate the safety and efficacy of a novel device that uses a combination of broadband light and pneumatic energy for the treatment of acne vulgaris., Methods: In a retrospective multicenter study, clinical data were collected from 56 patients with mild to severe acne. Patients had been treated 2 to 4 times with a portable photopneumatic device (Aesthera PPx, Aesthera Corporation, Pleasanton, CA) that delivers broadband light (400 to 1200 nm) to the treatment site via a hand piece. For 11 of the 56 patients, 3 independent physicians blinded to the study treatment or duration evaluated PPx efficacy by comparing photographs taken before and after PPx treatment., Results: For the 56 patients, the median physician-rated clearance increased from 50% after a single treatment to 90% after the fourth treatment, whereas the median patient-rated clearance improved from 50% after a single treatment to 78% after the fourth treatment. On a 4-point scale, both physician-rated and patient-rated median overall satisfaction levels increased from a 3 after a single treatment, to 4 after the second, third, and fourth treatments. Clinically significant adverse events were not observed. For the 11 patients evaluated by photography, the median papule and pustule lesion counts decreased from 8 to 3 and from 2 to 0, respectively. Median acne severity (Burton scale) decreased from 4 before treatment to 2 after the final treatment, and the median improvement was 4.5 (scale 1-5). The median erythema rating decreased from 2 before treatment to 1 after the final treatment (scale 1-4). Adverse events were limited to mild erythema. The median acne clearance was 3 (scale 1-4)., Conclusion: Photopneumatic technology provides a safe and effective treatment of mild to severe acne vulgaris.

Background and Objectives: Soft tissue augmentation represents a cosmetic procedure performed with increasing frequency., Study Design/materials and Methods: Correct utilization permits precise correction of facial rhytids and scars. Novice injectors occasionally inject too superficially in tissue with the resultant appearance of discoloration secondary to the Tyndall effect., Results and Conclusion: In this article, we will review the Tyndall effect in the skin and management options for this growing problem in aesthetic dermatology., (2006 Wiley-Liss, Inc.)

Background: Eccrine syringofibroadenoma is a rare benign eccrine ductal proliferation with a predilection for the extremities, most often found in middle-aged and elderly patients. Reported treatments have included excision and conventional destructive modalities; however, recurrences may be common., Objective: We describe a patient with a chronic ulcerated verrucoid eccrine syringofibroadenoma that persisted despite cryotherapy or curettage and electrodessication., Results: Treatment with a dual pulse width flashlamp pumped pulsed dye laser (FPDL) produced an excellent clinical response., Conclusion: Treatment of eccrine syringofibroadenoma with a FPDL may provide both a vascular specific injury, analogous to the treatment of verruca vulgaris, and nonspecific thermal destruction at high fluences.

Background: Lymphangioma circumscriptum is a relatively rare cutaneous disorder, consisting of superficial and deep lymphatic cisterns. These vascular blebs are difficult to treat, frequently recur, and can cause patients significant morbidity., Objective: We report a difficult case of lymphangioma circumscriptum, recurrent from a two prior surgical treatments, which was treated in a straightforward manner by one of the newer, high-energy, short-pulse carbon dioxide (CO2) lasers., Methods: Report of a case and literature review., Conclusion: Like continuous-wave CO2 laser systems, the newer, high-energy, short-pulse CO2 laser may be effective in vaporizing some of the surface lymphatic vessels, which may in turn seal some of the communicating channels to the deeper cisterns, yielding functionally and cosmetically acceptable results for this difficult disorder. However, given the nature of the lesion, the potential for recurrence exists no matter what modality is chosen.

Mucoepidermoid carcinomas are tumors that usually arise from salivary glands and have a characteristic histologic pattern of atypical squamous cells showing focal mucin production. Mucoepidermoid carcinomas are uncommon neoplasms that metastasize most commonly via lymphatic and hematogenous channels. We report what we believe to be the first case of a mucoepidermoid carcinoma arising from a sublingual salivary gland with metastasis to a distant site on the skin. The patient is a 58-year-old black woman who was initially diagnosed with a high grade mucoepidermoid carcinoma of the salivary glands of the tongue. Approximately 18 months after presentation, and 6 months following surgery, chemotherapy, and radiation therapy, the patient noted a firm nodule on her flank. Biopsy showed malignant squamous epithelium. Periodic acid-Schiff and alcian blue stains revealed focal mucin production. The histologic differential diagnosis included an eccrine carcinoma, mucin-producing adenocarcinoma with squamous differentiation, a primary cutaneous adenosquamous (mucoepidermoid) carcinoma and a malignant mixed tumor of the skin. Clinical correlation was essential in making the correct diagnosis. While mucoepidermoid carcinomas only uncommonly show distant metastasis, and even less frequently involve the skin, this entity should be included in the differential diagnosis of mucin-producing neoplasms in the skin.