Aesthetic and Cosmetic Dermatology: 2nd Edition

Permanent makeup (PMU) is a popular form of tattooing applied to the eyebrows, eyelids, and lips for corrective and aesthetic purposes. It also has medical applications, such as reconstructing the breast areola, mimicking hair follicles on the head, and covering scars and vitiligo. Unlike body tattoos, PMU often requires reapplication to maintain color density and shape, as the pigments fade over time. This fading is likely due to the characteristics of PMU colorants rather than the application methods or apparatuses. The aim of our study was to assess the application depth of PMU colorants and tattoo ink after procedures. PMU colorants typically contain larger pigment particles in their composition compared to the nanoparticles found in traditional tattoo inks. We applied both tattoo ink and PMU colorants on SKH-1 mice using a PMU apparatus and a tattoo apparatus. To clarify the semi-permanent nature of PMU compared to the more permanent body tattoos, skin biopsies were performed at various intervals throughout this study. The results showed that PMU and tattoo ink were placed at approximately the same depth but exhibited key differences in behavior. PMU with larger inorganic pigments fades over time, while tattoos with smaller, stable organic pigments ensure permanence. Full article

Cosmetic procedures using fillers have gained importance over the last decades due to their ability to offer rejuvenation and beautification quickly with no (or minor) side effects. Hyaluronic acid (HA) gel is the most used filler in cosmetic dermatology; its physical and chemical properties vary according to the manufacturing process. The characteristics of the final product are crucial for its clinical indication. Specific physicochemical properties of HA gel are required to fill, volumize, sustain, and contour different anatomical areas and layers. Ideally, HA gels should have a consistency similar to that of the surrounding tissue to promote a natural feel, but, at the same time, they should be able to sustain their shape against constant physical strain caused by muscle contraction during mimic movements. Generally, softer gels are indicated to fill superficial layers, and are not usually meant to perform lifting or volumizing, for which stiffer gels are proposed. Therefore, combining gels with different characteristics is indicated for global facial treatment. The Brazilian market recently introduced a new Korean HA filler. Still, clinical evaluation of global facial treatment using these products is lacking in the literature. This study aims to describe clinical results, patient satisfaction, and side effects of facial treatment using these fillers. We analysed the clinical impact of global facial treatment in 35 patients performed by seven dermatologists. Patients of both sexes desiring beautification or rejuvenation were included, and all of them had indications for the filling procedure. Three Korean HA gels (e.p.t.q. S100, S300, and S500, Jetema ^®) with high HA concentrations and cohesiveness, varying only in their crosslinking degree, were used. The dermatologists chose the product for each procedure based on their rheological properties and clinical assessment. S100 gel was indicated for refinement, and S300 and S500 gels for structure and volume. The doctors evaluated the clinical outcomes of rejuvenation or beautification using the Global Aesthetic Improvement Scale (GAIS), and patient satisfaction using the Likert scale, 1, 3, and 6 months after the procedures. Patients treated included 4 males and 31 females with a mean age of 43.08 years. An average of 6.33 syringes was used. After 30 days, 80% of patients showed excellent or accentuated improvement, with 94.2% satisfaction. After 3 and 6 months, 80% of patients showed excellent or accentuated improvement, which increased their happiness (97%). Immediate common side effects occurred in 17 patients. One patient had a vascular occlusion, which was quickly reverted using hyaluronidase. Most patients had accentuated improvement and great satisfaction. This new cohesive, highly concentrated HA gel promoted a sustained global improvement and patient satisfaction with expected transitory side effects. Full article

Background and Objectives: Hair removal is a common aesthetic concern for patients referred to dermatologists and aesthetic physicians. Lasers and lights are one of the mainstays in the management of this condition. Among these devices, intense pulsed lights (IPLs) are broadly used in order to reduce the number and width of the hair present. Currently used techniques are associated with a high risk of side effects, such as hyper or hypopigmentation. Materials and Methods: Thirty patients seeking hair removal in one or more body areas with skin phototypes 1 to 4 were recruited to perform this study. All areas to be treated were divided into two equal regions; one side was treated with the standard IPL hair removal procedure, while the other was treated with a new “in-motion” IPL technology. Results and hair removal rates were evaluated six months after the last treatment. Results: Out of the 30 patients treated, all patients experienced hair reduction. No statistically significant difference in hair removal was noted among the two sides. A statistically significant reduction in pain during the procedure was observed in the side treated with the “in-motion” technique. Conclusions: Traditional and “in-motion” IPL techniques have similar results in hair removal; the “in-motion” technology seems to guarantee a better safety profile than the traditional technique, as well as maintains the same results over time and a faster treatment time. A more extensive clinical study will be necessary to confirm our study’s results. Full article

The increase in urban society in the use of cosmetic practices to rejuvenate oneself or obtain a more appealing appearance has influenced the practices of cosmetic dermatologists, general medical practitioners, plastic surgeons, and dental practitioners, among others. The pharmaceutical industry has evolved to meet customers’ desire to be more physically attractive irrespectively of age and gender. This study aimed to preliminarily explore Jordanian adults’ awareness of dental, facial, and other cosmetic procedures. The reasons for undergoing such cosmetic procedures and self-reported knowledge of the side effects or risks associated with these interventions were also explored. The results show that the participants had undergone various procedures to enhance their looks, attractiveness, and confidence. None of the female participants wanted to emulate a celebrity. Most participants were aware of the side effects associated with cosmetic procedures, which may be attributed to their educational backgrounds, as the participants’ minimum qualification was 12th grade and their easy access to information services such as electronic media. A multicenter, large-scale, regional study is required to determine the associations, correlations, and recommendations for individuals seeking cosmetic treatment, cosmetic health providers, and policymakers. Full article

Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords “facial rehabilitation”, “acne scars”, “traumatic scars”, “oral restoration”, “facial lipoatrophy”, “facial asymmetry”, “periocular correction”, “nasal obstruction”, “ear lobe restoration”, “morphea”, AND “hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence. Full article

Melasma is a challenging chronic skin condition associated with hyperpigmentation and unknown aetiology. This scoping review maps evidence of available treatments and their effectiveness in darker skin types. A comprehensive, systematic online search was conducted in Scopus, PubMed, CINAHL Complete, Cochrane, ScienceDirect, and Web of Science Core Collection. All eligible titles were exported to an EndNote20 library (Clarivate analytics, US). Thematic content analysis was performed to summarise data on current melasma treatments for darker skin types. The quality of included articles was appraised using the Mixed Methods Appraisal Tool (MMAT) 2018 version. A total of 2863 articles were retrieved from the databases, and 10 met the eligibility criteria following abstract and full-text screening. Our findings demonstrate that topical treatments, chemical peels, lasers, and tranexamic acid are common treatment modalities used in darker skin types. Although these treatments may be effective in the short term, they bring about undesirable side effects and sometimes worsen or result in reoccurrences of melasma. Based on the evidence mapped, current treatment modalities are not suitable for darker skin types. There are very few studies conducted on individuals of African descent. Further research is necessary to investigate treatment interventions that may be user-friendly when dealing with darker skin types. Full article