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Background: Facial dyspigmentation is a challenging concern which cannot easily be corrected. Although the application of topical exosomes has shown some efficacy, there is still scarce data addressing the role of plant-derived exosomes for skin hyperpigmentation. Objectives: This study using rose stem-cell-derived exosomes (RSCE) was performed as a proof-of-concept case series to evaluate the efficacy and safety of microneedling and topical RSCE, for the reduction of pigmentation and photoaging in adult volunteers. Methods: Twelve female volunteers were recruited, with a mean age of 46.64 years and a moderate-to-severe facial pigmentation, due to solar lentigines, melasma, postinflammatory hyperpigmentation, and periorbital hyperpigmentation. Three treatments were performed at 3 weeks intervals. These consisted of the topical application of RSCE with microneedling and a 20 min LED light with an RSCE-infused mask. A 3D facial analyzer was used to quantify improvement in superficial, deep pigmentation, skin redness, and wrinkles at baseline, Weeks 3, 6, and 12. Global Aesthetic Improvement Scale (GAIS), Dermatology Life and Quality Index (DLQI), and Melasma Quality of Life Scale (MELASQoL) scores were noted at the same time points. Results: GAIS scores improved by at least 1 scale point. Superficial pigmentation and spots decreased by 12.95% and deep pigmentation improved by 15.9%, by Week 12. Skin redness was reduced by 7.34% at the same time point. The measured wrinkle reduction was 6.34%. DLQI scores were reduced by 10 points, and MELASQoL scores had a mean reduction of 30 points at Week 12. Conclusions: Improvement of facial pigmentation is possible when combining nonthermal microneedling and the use of topical RSCE.

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BACKGROUND: Inevitable signs of aging are especially noticeable in middle to elder age when stretch marks, loose skin, cellulite, and body-contour changes naturally appear. AIMS: To verify efficacy of high-intensity focused electromagnetic field (HIFEM), radiofrequency (RF), and Targeted Pressure Energy (TPE) combination treatment to address unfavorable changes in skin, fat, and muscle tissue. METHODS: The device simultaneously emitting monopolar RF and TPE energies was consecutively combined with simultaneous HIFEM+RF procedure in 32 subjects (21-64 years, 17.4-33.5 kg/m2 ) for treatment of thighs (N = 15; back, inner, or front), buttocks/saddlebags (N = 7), abdomen (N = 8), and upper arms (N = 2). All patients underwent four weekly, combined treatments of 30-min HIFEM+RF procedure followed by 15-30 min RF+TPE, depending on treatment area. Circumferential measurements, digital photographs, subject satisfaction, and comfort questionnaires were assessed up to 3-months post-treatment. RESULTS: Majority of participants found treatments comfortable, no adverse events occurred. Subjects showed substantial improvement in all treated areas from 1-month follow-up. Combination of HIFEM+RF, monopolar RF, and TPE resulted in significant circumference decrease. Generally, more pronounced results were seen at 3 months when subjects showed -5.2 cm on abdomen, -3.0 cm on thighs, and -5.5 cm on saddlebags, respectively. Ninety-four percent of subjects were satisfied with treatment results, most noticed improvement in cellulite, skin laxity, and muscle definition. CONCLUSIONS: Results showed high patient satisfaction and efficacy in improving body contour and skin quality. Combining simultaneous HIFEM+RF procedure with simultaneous monopolar RF+TPE treatments considerably enhanced body contour and skin tissue. The procedure proved versatile and may effectively treat multiple body parts.

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Background: High-intensity focused electromagnetic field (HIFEM) and radiofrequency (RF) are established stand-alone techniques used in body contouring. However, data on the simultaneous combination and effects of these modalities for inner thigh treatment is lacking. Objective: To investigate the efficacy and safety of the HIFEM+RF procedure for non-invasive fat reduction in the inner thigh, as well as toning and strengthening of the inner thigh muscles. Methods: Sixteen women with an average age of 47.31±12.51 years were recruited. Each patient received four 30-minute bilateral treatments on the inner thighs once a week. Magnetic resonance imaging (MRI) scans of the treated area were evaluated at baseline, one-, and three-month follow-up visits for subcutaneous fat and muscle thickness changes. Anthropometric data and digital photographs were collected. Subject satisfaction and therapy comfort were evaluated. Results: The results peaked at three months, showing significant changes in both treated tissues. On average, the fat thickness was reduced by 27.4 percent (p<0.001), while muscle tissue showed an average increase of 23.2 percent. Thigh circumference was reduced on average by 1.52cm, with a maximum change of -1.8cm, observed at 5cm below the gluteal crease. The treatment was considered comfortable with high patient satisfaction. Conclusion: Analysis of magnetic resonance images and thigh circumference showed that therapy combining HIFEM and RF is highly effective for subcutaneous fat reduction and increased muscle thickness in inner thighs.

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BACKGROUND: High-intensity electromagnetic field procedure (HIFEM) is an effective tool for body shaping and muscle toning. Radiofrequency (RF) combined with targeted pressure energy (TPE) provides the solution for skin laxity and cellulite. AIMS: To document the effect of consecutive use of HIFEM, RF, and TPE for treatment of abdomen and buttocks. METHODS: Fifteen subjects (44.3 ± 14.2 years, 22.3 ± 2.3 kg/m2 ) finished treatments and consequent follow-ups. They were treated over the abdomen (Group 1, N = 7) or buttocks (Group 2, N = 8), receiving four treatment procedures consisting of HIFEM treatment administered first, immediately followed by the simultaneous RF & TPE treatment. Each session took approximately 50 min (30 min of HIFEM; up to 20 min of RF & TPE) depending on the treated area. Study outcomes were assessed by the circumference measurement, satisfaction and comfort questionnaires, and digital photographs. RESULTS: Combined treatments were safe and comfortable. At 1 month, the abdominal circumference significantly decreased by 4.4 cm, while buttocks showed a significant increase by 1.0 cm. The abdomen (-4.1 cm) and buttocks (+1.2 cm) circumference results were sustained for three months without a significant decline. Satisfaction was high in both groups (93.3%) since most subjects noted that the appearance of the treated area has been improved, referring to both body sculpting and skin appearance. CONCLUSIONS: The consecutive application of HIFEM, RF, and TPE treatments noticeably improved the appearance of the abdomen and buttocks. Subjects showed enhancement of abdominal body contour, buttock lifting, and improved skin quality manifested by reduced skin laxity and cellulite.

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Microneedling is a popular and cost-effective treatment with little down time. The application of topical agents to enhance outcomes is common practice. Microchannels created with nonthermal needling close at 4 hours to 6 hours due to fibrin plugs. Channels created with thermal needling or fractional laser stay open longer and enhance drug or biological uptake more due to the dermal sponge injury pattern that is created. Nonthermal microneedling devices may need Food and Drug Administration clearance, which also notes that dermaceuticals should be considered drugs in many cases.

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BACKGROUND: Fractional radiofrequency (RF) technology is often the preferable skin resurfacing treatment, especially among Asian patients. Second generation fractional RF technology has exclusive capability to produce separate biological responses (ablation, coagulation, or a combination of both) with 3 distinguished penetration depth programs. AIMS: The aim of this study was to evaluate the efficacy and safety of a fractional RF handpiece such as this, on the Thai population. METHODS: Fifty-five Thai patients were treated with a fractional RF handpiece. The clinical assessment included a pain score, satisfaction survey, physician assessment, a combined patient and physician's assessment of skin condition, and clinical photographic assessments. The wound healing response was evaluated according to 5-time points: immediately after applying a pulse, post 24 hours, post 7 days, post 1 month and post 8 weeks. RESULTS: The obtained patient satisfaction score was "very satisfied" among 74% of the patients, post 3 sessions. Positive correlation was found between patient satisfaction and the physician's assessment. The skin condition assessment showed an increase from an average of 4.2 to 7.9. All treated symptoms improved after each treatment and the clinical outcome lasted at least up to 3-5 months. No significant adverse events were recorded. The in vivo prospective study showed a dose-related response in the deepness of the coagulation injury. In addition, there was evidence for a progressive healing process beginning shortly after exposure and completed within a week. CONCLUSIONS: This study clinically and histologically supports the efficacy of fractional RF handpiece in question with a high safety profile.

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To date, there have been no objective measurements of subcutaneous volume loss following treatments with a noninvasive radiofrequency (RF)-based device. Twenty female patients were treated with a suction-coupled bipolar RF device using external RF energy combined with pulsed electromagnetic RF energy for subcutaneous fat reduction. Parameters followed included weight, Vectra measurements of abdominal circumference and torso volume, and high-definition ultrasound measurements of fat thickness. Measurements were taken before treatment and three times following treatment. Analysis of the measured parameters showed that mean circumference reduction of 2.30 cm was noted at three months post-treatment. Independent volumetric analysis showed a mean subcutaneous volume reduction of 428 cc three months following RF treatment. High-resolution ultrasound fat thickness was reduced by a mean of 39.6% three months following the final BodyFX treatment. Independent and paired-sample t-tests showed a p value of < 0.05. Repeated measures of analysis of covariance (ANCOVA) adjusted for differences in age, as well as height and weight (proxy for body mass index) to minimize individual differences and control for extraneous variables that may affect the pre- and post-treatment results were analyzed. No confounding variables were found. All analyses were conducted using IBM SPSS 21.0.

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Noninvasive fat reduction is claimed by many device manufacturers, but proof of efficacy has been difficult to establish. This prospective study was designed to measure the reduction of fat thickness and actual volume reduction in 20 female patients treated with an external radiofrequency (RF) device. This device combines RF heat, suction coupled vacuum, and oscillating electrical pulses that induce adipocyte death over time. Patients underwent pre- and post-treatment and intercurrent measurements of weight, body mass index, ultrasonic transcutaneous fat thickness, and 2D and 3D Vectra photography with independent calculation of circumferential and volumetric change. Mean transcutaneous ultrasound thickness at reproducible points was 2.78 cm; at 1-month post-treatment, the mean fat thickness was 1.71 cm. At 3-month post-treatment, the mean fat thickness reduction was 39.6%. Vectra circumference measurements were taken at 10-mm intervals, with postural and breathing cycle control. Independent analysis of serial measurements from + 60 to - 70 mm showed mean abdominal circumference measurement of 2.3 cm. Mean abdominal volume loss was 202.4 and 428.5 cc at 1- and 3-month post-treatment, respectively. Scanning electron microscopy confirmed that permanent cell destruction was caused by irreversible electroporation. Pyroptosis appears to be the mechanism of action.

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BACKGROUND: Brachioplasty is frequently recommended for patients with more skin laxity than subcutaneous fat. However, many patients are reluctant to accept a visible scar that will affect the activity of the upper arm or clothing choices. Traditional liposuction is effective when minimal skin laxity is present, but the dual problems of postoperative residual skin laxity and unsatisfactory contour irregularities are common when upper arm skin laxity is the chief complaint. OBJECTIVES: The author investigates the degree of skin contraction resulting from treatment with radiofrequency-assisted liposuction (RFAL) and attempts to determine whether, after long-term follow-up, the classification of upper arm deformities and their corresponding treatment protocols can be refined to offer patients with prominent skin laxity an alternative to traditional brachioplasty. METHODS: A prospective, institutional review board-approved pilot study was planned with 12 consecutive patients who presented to the author's private clinic for treatment of upper arm laxity. Patients were included only if they were categorized as Stage 2b, 3, or 4 according to the El Khatib and Teimourian system. Based on the "pinch" test and the vertical measurement of skin distal to the bicipital groove as described by El Khatib, a novel caliper was devised to quantify the shortening of the pendulous volar skin. Treatment regions were tattooed prior to surgery and measurements from a Vectra system (Canfield Scientific, Inc., Fairfield, New Jersey) confirmed the preoperative surface area. All patients were treated with the BodyTite device (Invasix, Inc., Yokneam, Israel). No patient underwent skin resection in the volar treatment region. Skin contraction was measured at one year posttreatment. Statistical analysis was conducted with a paired t-test. RESULTS One year after treatment with RFAL, the mean surface area reduction in the volar upper arm region was 33.5% bilaterally. The mean degree of pendulous vertical "hang" shortening was 50% bilaterally. Statistical analysis showed a P value of >.001 for both measurements. CONCLUSIONS: Treatment with RFAL achieved statistically significant skin contraction in the upper arm region. Patients in categories 2b and 4 were successfully treated with RFAL instead of traditional brachioplasty (which is recommended by the current classification system). Category 3 patients, however, did require a short-scar brachioplasty procedure to obtain satisfactory results.

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The practice of injecting phosphatidylcholine/sodium deoxycholate compounds into subcutaneous fat is growing rapidly. As with any new procedure, a standard of practice should be developed so that practitioners maintain patient safety as the primary goal. Efficacy and predictability of outcome are another priority. As injection lipolysis, also known as "lipodissolve," becomes more accepted, many standards are being set, such as indications, contraindications, acceptable postinjection sequelae, best regions to treat, regions to avoid, and expected outcomes. This article establishes a basis of practice for the practitioner interested in adding this procedure to his or her repertoire.

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There is increasing interest in injection lipolysis as a technique for reducing small, localized fat deposits. While many articles have been published about injection lipolysis, none specifically address safety issues. A clinical safety data survey was sent to physicians practicing injection lipolysis. Seventy-five physicians from 17 countries responded. Data from the treatment of 17,376 patients who underwent a total of 56,320 injection sessions were analyzed. Among the topics reviewed in the survey were indications and contraindications for treatment, best and worst areas for treatment, and additives to the formula and their efficacy. Expected sequelae were differentiated from unexpected complications. The safety data collected here indicate that, when practiced by licensed and certified physicians, the safety record for injection lipolysis is excellent. There were no deaths or hospitalizations resulting from treatment. There were also no bacterial or atypical mycobacterial infections, no reports of skin loss or ulceration, and no episodes of dermatitis or chronic skin irritation. Among the 17,376 patients treated, 0.0021% experienced transient hyperpigmentation, 0.015% had persistent pain beyond 2 weeks posttreatment, 0.0003% had a late allergic reaction, and 0.00006% had a contour irregularity requiring additional injection treatment. Disappointment at a less-than-expected aesthetic result was expressed by 12.34% of patients. There was consensus among responding physicians on the need for pretreatment patient education regarding realistic expectations. This survey is a representative, not definitive, survey of treatment results that is intended to serve as a starting point for further development and improvement of injection lipolysis technique.

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According to the authors, Lipodissolve injections reduce the size of localized fat deposits and cause skin retraction in body regions containing small deposits of localized fat, cellulite, or postlipoplasty deformities. It will not replace traditional lipoplasty techniques, but is an excellent adjunct or alternative for those patients seeking minimally invasive treatment. Successful outcomes are highly dependent on the correct formula and injection technique, as well as proper patient selection.