Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination

Background: Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications. Material and Methods: We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used. Results: TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046). Conclusions: Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

The Outcomes Assessment of the Plasma Blade Technology in Upper Blepharoplasties: A Prospective Study on a Series of 25 Patients

Background: The Dermo Ablation Surgery (DAS) Medical® (Technolux, Italy) device is a plasma blade which induces a plasma voltaic arc causing a retraction in the epidermis and superficial dermis. Objective: The aim of our study is to prove the efficacy and safety of the DAS Medical® device in dermatochalasis size reduction. Methods: Our prospective study included 25 adult patients presenting with upper eyelid dermatochalasis undergoing a two-session treatment protocol with the DAS Medical® device (with a month treatment-free interval). The primary end point was the reduction in the size of the dermatochalasis. The secondary end points were patient satisfaction, and a blinded assessment of the outcomes was carried out by 15 plastic surgery specialists on post-procedural pictures. Results: The mean reduction in the size of the dermatochalasis was estimated at 2.47 mm on a 6-month follow-up (13.5 mm at T0 vs. 11.03 mm at 6 months, p = 0.0002) and 1.97 mm on a 12-month follow-up ((13.5 mm at T0 vs. 11.53 mm at 12 months, p = 0.0055). Eighty per cent of the patients and 78% of the assessing clinicians were globally satisfied with the results on a 12-month follow-up. The mean visual analogue pain score reported during the treatment was 4.5/10; MEOPA® was used in 23% of cases. No irreversible post-procedural sequelae (complications) were observed. Conclusion: Voltaic plasma arc treatment with DAS Medical® is an effective technique for non-invasive blepharoplasty on moderate dermatochalasis patients not suffering from palpebral lipoptosis and is very well tolerated. It can be usefully and successfully associated with surgery. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Use of platelet-rich plasma (PRP) in microsurgery

Platelet-rich plasma (PRP) is currently used for its property to improve tissue regeneration and wound healing. Platelet derived growth factors are involved in tissue regeneration and new vessels formation that could improve a free flap survival. Nevertheless to validate the use of regenerative medicine in microsurgery further large and robust human clinical trials are needed

High-Intensity Focused Ultrasound: A Satisfactory Noninvasive Procedure for Neck Rejuvenation

Background: High-intensity focused ultrasound (HIFU) is an advanced technology that has been developed in response to the growing demand for noninvasive face rejuvenation. Objectives: The aim of this study was to evaluate the rejuvenation effects, patient satisfaction, and safety of HIFU treatment of the neck in a European population. Methods: This was a prospective study of 20 patients. The patients were treated with HIFU, and the outcomes were investigated. The modified FACE-Objective Assessment Scale, developed by our team, and the subjective Investigator Global Improvement Assessment Scale (IGIAS;-1 to 3) were used to judge the results of HIFU. Five blinded evaluators scored the procedure outcomes based on photographs taken before and 6 months after the procedure. Side effects were reported and pain was evaluated on a visual analog scale of 0 to 10. Results: Clinical results, such as better definition of the cervicomental angle, were observed in the treated areas. The pretreatment and posttreatment evaluation scores for double chin and skin laxity were evaluated by 4 of 5 evaluators as significantly improved. The IGIAS score was between 1 and 5 in 2 patients, between 6 and 10 in 7 patients, and between 11 and 15 in 11 patients. No patients had a score between-5 and 0. No major complications were reported. The mean pain scores for the D4, M7, and S7 transducer treatments were 5.6 (range, 4.5-6.7), 4.2 (range, 2.5-5.9), and 2.05 (range, 1.05-3.05), respectively. Conclusions: HIFU may be considered a satisfactory, simple, reproducible, rapid, and safe procedure for neck rejuvenation. Level of Evidence:

Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients

Background and Objective: Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD. Study Design/Materials and Methods: This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm 2 , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported. Results: Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported. Conclusion: Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230–238, 2019. © 2018 Wiley Periodicals, Inc

Efficacy of autologous platelet-rich plasma glue in weight loss sequelae surgery and breast reduction: A prospective study

Background: Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes. Methods: Fifty-four patients were included in this study. They underwent breast reduction surgery, abdominoplasty, or limb lifting with A-PRP glue application on the entire surface of the subcutaneous tissue at the time of suture. Retrospective data were used for the control group. The primary endpoint was the incidence of postoperative seroma or hematoma. The secondary endpoint was the Patient and Observer Scar Assessment Scale score. Results: Demographics and clinical characteristics were not statistically different between the A-PRP glue group and the control group regarding age, sex ratio, and body mass index. After abdominoplasty, 37.5% of patients (3/8) in the control group experienced seroma and hematoma complications versus 12.5% of patients (2/16) in the A-PRP glue group (P = 0.55 and P = 0.25, respectively). After limb lifting, 50% of patients experienced postoperative complications in the control group versus no patient in the A-PRP glue group (P = 0.03*; * indicates that the P value is significant). After breast reduction, no patient experienced complication in the A-PRP glue group versus 25% of patients in the control group who experienced hematoma (P = 0.04*). The scar quality assessed 12 months after surgery showed no statistical differences between the groups. Conclusions: A-PRP glue seems effective to prevent seroma formation after limb lifting and hematoma formation after breast reduction. Wound-healing quality did not seem to be improved

Labia Majora Augmentation Combined with Minimal Labia Minora Resection: A Safe and Global Approach to the External Female Genitalia

Background All the labia minora reduction techniques fail to treat the other component of the abnormally increased labia minora to majora ratio: the labia majora atrophy. The purpose of this study is to describe a technique of female genitalia beautification, which combines labia majora augmentation and conservative labia minora reduction. Methods The hypertrophied labia minora were first treated by a conservative inferior wedge excision with a superior flap. The conservative excision was done to obtain labia minora that would still protrude beyond the labia majora because it will be masked by the augmentation of the labia majora. Labia majora augmentation was done by autologous fat transplantation. The newly augmented labia majora completely masked the conservatively reduced labia minora. Results Twenty-one patients underwent surgery for labia majora augmentation and labia minora reduction. One patient (4.7%) had a small separation of the labial edge postoperatively that resolved with no additional interventions. There was no flap necrosis or infections. No patient reported pain or sexual dysfunction. Seventeen patients (81%) were satisfied or very satisfied with their results. Conclusions Labia majora augmentation combined with a conservative labia minora reduction is an appealing procedure because it enhances the global aspect of the female genitalia while reducing the labioplasty complications

Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial

International audienceBackground and objective: Quality of life preservation after anti-cancer therapy is a major challenge for breast cancer survivors. Approximately 42-70% of patients who receive systemic therapy for breast cancer, including endocrine therapy, will develop vulvovaginal atrophy (VVA). For these patients, the commonly proposed gel-based treatments for topical applications are restrictive. Recently, innovative, non-hormonal therapeutic approaches, such as laser therapy, have emerged. The purpose of this feasibility study is to investigate the safety and efficacy of CO2 laser therapy in women with a history of breast cancer.Material and methods: This prospective monocentric study included 20 patients with vulvovaginal atrophy who were treated at Henri Mondor University Hospital between 2017 and 2018. We included patients with a vaginal health index (VHI) score11, and at M6, only 15% had a female sexual distress score>11. No side effects were reported during follow-up.Conclusion: This pilot feasibility study showed that carbon dioxide laser treatment appears to be an effective and safe method to improve the trophicity and decrease vaginal mucosal dryness in women with vulvovaginal atrophy that developed after systemic breast cancer therapy