Tetracycline Injections for Undereye Festoons

 A long-term follow-up study of patients who underwent teatracyline injections for festoons revealed that 59% of patients saw improvement and 67% would repeat the procedure. Authors Brian H. Chon, MD, Catherine J, Hwang, MD, and Julian D. Perry, MD, of the Cole Eye Institute, Cleveland Clinic Foundation, invited all patients undergoing tetracycline injection for treatment of lower eyelid festoons at the Cole Eye Institute, Cleveland Clinic, between 2008 and 2018 to participate in a questionnaire based on the FACE-Q checklist.

Of 102 patients who received tetracycline injection during the study period, 61 responsed to the questionnaire. The average follow-up time after injection was 3.6 years. Of the 61 respondents, 36 (59%) noted improvement in their festoons after treatment, and 27 of 33 noted that improvement occurred within two months of treatment. Overall, 40 of 60 respondents (67%) responded that they would consider repeating tetracycline treatment.

The most common adverse effects included discomfort (18%), swelling (15%) and bruising (13%). The authors noted that, although the majority of patients experienced improvement with an acceptable side-effect profile, “more data are needed to determine the optimal dose and frequency and to identify possible rare and/or significant side effects.”

The study, "Long-Term Patient Experience with Tetracycline Injections for Festoons," was published in Plastic and Reconstructive Surgery (December 2020).

Source 

Tetracycline Injections for Undereye Festoons | MedEsthetics (medestheticsmag.com)

Microneedling with Tranexamic Acid as Effective as 4% Hydroquinone for Melasma

 Patients with dermal melasma benefit from combination treatment with microneedling plus topical application of 4% tranexamic acid, according to a randomized study published in the November 2020 issue of the Journal of Cosmetic Dermatology. 

Authors Simin Shamsi Meymandi, MD, et al, of Kerman University of Medical Sciences, Kerman, Iran, evaluated the efficacy of microneedling plus tranexamic acid in comparison with 4% hydroquinone in the treatment of melasma. They treated 70 patients with melasma (60 patients completed the study), who were randomized based on simple randomization into two groups. Group A (30 patients) underwent monthly microneedling plus topical 4% tranexamic acid. Group B (30 patients) applied a topical 4% hydroquinone product nightly. The researchers evaluated melasma area severity and index (MASI) scores and patient satisfaction at baseline, four weeks, eight weeks and 12 weeks.

At the end of treatment, the mean MASI score was significantly lower in both groups with no statistical difference between two groups. Mean MASI score in group A was significantly lower at the end of the treatment (6.84 ± 4.31) than at the baseline (12.89 ± 5.16). Mean MASI score in group B was significantly lower at the end of the treatment (7.16 ± 4.38) than at the baseline (13.56 ± 4.88). The percentage of patient satisfaction was significantly higher than physician satisfaction in both treatment groups.

Article Source 

Microneedling with Tranexamic Acid as Effective as 4% Hydroquinone for Melasma | MedEsthetics (medestheticsmag.com)

Vertical Glabellar Line Fillers and the Supratrochlear and Supraorbital Arteries “The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected.”

 Source : research/injectables/news/21206867/understanding-the-location-of-vertical-glabellar-lines-and-the-supratrochlear-and-supraorbital-arteries

In an effort to reduce the risk of complications following glabellar soft tissue filler injections, researchers Sebastian Cotofana, MD, PhD, et al, used ultrasound imaging to identify the course of the superficial branch of the supratrochlear artery and of the deep branch of the supraorbital artery in relation to the ipsilateral vertical glabellar line. They measured the diameters, distance from skin surface, distance between the midline, distance between vertical glabella lines and the cutaneous projection of the supratrochlear/supraorbital arteries at rest and upon frowning.

After analyzing 41 healthy volunteers (mean age of 26.17 years and mean BMI of 23.09 kg/m2), they found that the mean depth of the supratrochlear artery was 3.34mm at rest and the mean depth of the supraorbital artery was 3.54mm.

The location of the arteries varied by gender: The mean distance between the superficial branch of the supratrochlear artery and the ipsilateral vertical glabellar line was 10.59mm in males and 8.21mm in females. The mean distance between the supraorbital artery and the ipsilateral vertical glabellar line was 22.38mm for in males and 20.73mm in females.

Upon frowning, there was a medial shift in the position of the supratrochlear arterial of 1.63mm in males and 1.84mm in females and a shift of 3.9mm in supraorbital arterial position for both genders .

The authors of the study, published in the Aesthetic Surgery Journal (December 2020), concluded, “The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected. Additionally, the glabella and the supraorbital region should be considered as an area of mobile, rather than static, soft tissues.”

FDA Issues More Sanitizer Warnings, Posts Microbe-related Recalls

 In the past few weeks, the U.S. Food and Drug Administration (FDA) has issued a warning letter and added five entries to its 'do not use' sanitizer list over product sub-potency. It also flagged four foaming hand soaps recalled for possible microbe contamination.

See related: 900+ Hand Sanitizer Poisonings, Mexican Imports Put on FDA Alert

Warning Letter: Insufficient (58%) Ethanol Content

A warning letter issued on Feb. 18, 2021, to Absaea Cosmetics, of Emiliano Zapata, Mexico, the FDA states, "Following an attempt to import Fragrance Free Vlanc + Plur Hand Sanitizer Rinse Free Formulated with 70% of Alcohol with Aloe Vera & Glycerin into the United States, it was detained and refused admission at the border. The results of the FDA laboratory testing of a batch of this product detained at the border demonstrate that this drug product labeled as manufactured at your facility is adulterated ... in that its strength, purity, or quality falls below that which it purports or is represented to possess."

See related: How NOT to Formulate Hand Sanitizers

The agency outlined that the product is labeled to contain 70% volume/volume (v/v) of the active ingredient alcohol (ethanol). However, FDA testing found that the drug product contained only 58% v/v ethanol. "This hand sanitizer drug product is adulterated under section 501(c) of the FD&C Act in that the active ingredient of ethanol is present at levels in the products lower than that which is declared on its labeling," the letter states.

The FDA concluded that all drugs and drug products manufactured by the firm remain listed on import alert until there is evidence establishing that the conditions that gave rise to the violation have been resolved.

Hand Sanitizer Additions to 'Do Not Use' List

Continuing its monitoring for hand sanitizer violations, the FDA added five listings to its hotlist of products consumers are warned not to use. The agency noted it currently has no evidence of these products being on the U.S. market, but all of the following were flagged for subpotent alcohol (ethanol) levels: two listings for Weper Clean Solutions, Kleengel Hand Sanitizer, CyroLab Q&T Antibacterial Gel and Kilvir Forte Virus Killer, all manufactured by Distribuidora Lagunera del Norte SA de CV, of Mexico.

Possible Burkholderia cepacia Contamination

Finally, four voluntary product recalls were made by Scent Theory Products for potential Burkholderia cepacia contamination. These included four foaming hand soaps made with essential oils: Lemon Citrus, Vanilla Coconut, Eucalyptus Mint and Fresh Lavender.

Source Article FDA Issues More Sanitizer Warnings, Posts Microbe-related Recalls | MedEsthetics (medestheticsmag.com)

Crisscross PDO Thread Pattern Improves Longevity

"In the crisscross implantation pattern, width and density of the fibrotic areas were five-fold greater than those of the fan-shaped areas. "

 A mouse study comparing the conventional fan-shaped pattern used in barbed thread lifts to a crisscross pattern found better longevity when polydioxanone (PDO)-barbed threads were implanted in the crisscross pattern. The study's findings were published in the Aesthetic Surgery Journal (March 2021). 

Researchers implanted three fragments of monofilament PDO-barbed lifting threads in the dorsal skin of 12 nude mice. The pattern of implantation was fan-shaped in the control group and crisscross in the experimental group. Tissue specimens containing tangential areas of threads were harvested, fixed and paraffin-embedded. Samples were histologically analyzed using hematoxylin and eosin, Massons' Trichrome and Sirius red staining. The researchers also analyzed fibrotic areas and the width of fibrosis from the thread. 

They found that the fibrous capsulations around the barbed area of the PDO-barbed lifting threads were three-fold greater than those around the barb-free areas of the threads. In the crisscross implantation pattern, width and density of the fibrotic areas were five-fold greater than those of the fan-shaped areas. In addition, induction of fibrous capsules around the PDO-barbed thread was markedly condensed in the crisscross areas. 

The authors concluded, "This study provides the basis for more logical implantation pattern in PDO-barbed lifting threads for facial rejuvenation. By generating controlled multiple crisscross patterns, we can create more intense fibrogenesis, reduce tension applied on each barbed thread and, as a result, extend the longevity of the result."

Credit 

Crisscross Vs. Fan-shaped Implantation of PDO Threads for Facial Rejuvenation | MedEsthetics (medestheticsmag.com)

Indications for Thermo-mechanical Fractional Therapy

Article Source: Tixel TMFI Therapy Effectively Improves Facial Skin Quality | MedEsthetics (medestheticsmag.com) 

Indications for Thermo-mechanical Fractional Therapy

Thermo-mechanical fractional injury (TMFI) therapy (Tixel, Novoxel) is effective for skin rejuvenation on skin types II-V, according to the results of a retrospective study published in Lasers in Surgery and Medicine (March 2021). 

TMFI involves the application of heated metal tips to the skin's surface in a fractional pattern. For this study, researchers performed a chart review of 24 patients with skin types II - V who received two or three Tixel treatments. Of the patients, 20 were women and four were men, and the average age of the patients was 56 years old. The treatments were delivered three to five weeks apart in two medical centers (12 from Israel and 12 from the United Kingdom).

Four experienced dermatologists compared standardized clinical photographs taken before each treatment and three months after the final treatment and rated outcomes based on seven parameters (blood vessels and erythema, skin complexion, periorbital wrinkles, pigmentation and toning, pore size, vitality, wrinkles and laxity) on a scale of -1 to 4. The authors also reviewed epidemiology, treatment data, satisfaction and adverse events. 

There was an overall improvement in all seven parameters with the greatest improvement demonstrated in skin complexion (2.1 ± 0.49) and periorbital wrinkling (2.09 ± 0.65) followed by vitality (1.7 ± 0.49). Adverse events were transient and included erythem and hyperpigmentation. The average downtime was 1.7 days.