The periorbital area is a key wrinkle-prone region, where the first signs of aging usually appear.
AIMS:
To demonstrate the ability of new anti-aging moisturizing products to improve overall smoothness and wrinkle depth appearance in the periorbital region via the Fast Optical in vivo Topometry of Human Skin (FOITS).
METHODS:
Two double-blind, randomized, controlled, split-face studies (n = 42, Study 1; n = 35, Study 2) were conducted in women 30-70 years old with moderate to distinct periorbital wrinkles. Subjects applied 0.5 g of individual products to half their face twice daily for 4 weeks. Four test products containing niacinamide, the peptides Pal-KT and Pal-KTTKS, and carnosine were used and included a daytime SPF 30 lotion also containing antioxidants, a night cream, an eye cream also containing caffeine, and a wrinkle treatment containing retinyl propionate.
The wrinkle treatment was only tested in Study 2. The FOITS technique was used to measure changes in periorbital R(a) (mean roughness) and R(z) (average maximum roughness) at 2 and 4 weeks.
RESULTS:
In Study 1, the daytime SPF 30 lotion, night cream, and eye cream significantly improved crow's feet smoothness after 4 weeks relative to no treatment. After 4 weeks, the daytime SPF 30 lotion and night cream, but not the eye cream, were significantly better than no treatment at improving R(z).
In Study 2, the night cream, eye cream, and wrinkle treatment, but not the daytime SPF 30 lotion, significantly improved both R(a) and R(z) after 4 weeks. To increase power and precision of estimates, a meta-analysis was performed; the pooled data showed all three products were significantly better than no treatment at improving R(a) and R(z) after 4 weeks.
CONCLUSIONS:
Four weeks of treatment with these products was shown to improve the smoothness of periorbital skin and to reduce the apparent depth of larger wrinkles.
"Efficacy of anti-aging products for periorbital wrinkles as measured by 3-D imaging."
J Cosmet Dermatol. 2009 Sep; 8(3): 228-33Kaczvinsky JR, Griffiths CE, Schnicker MS, Li J
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Constipation is a common problem in children, and when it becomes chronic fecal impaction, overflow soiling and megarectum may develop. Children with chronic idiopathic constipation (IC) may not respond to conventional treatments of laxatives, enemas, and toilet training. The aims of the study were to evaluate the long-term outcome of transcutaneous needle-free injection of botulinum toxin (TNFBT) into the external anal sphincter (EAS) and to assess the extent of the toxin penetration into the sphincter.
METHOD:
Children were recruited if symptomatic with chronic constipation, soiling, painful defecation, and withholding behavior requiring disimpaction of stool and rectal biopsy under general anesthesia. A total dose of 200 U of botulinum toxin (BT) (Dysport; Ipsen Limited, Slough, United Kingdom) was injected transcutaneously into the EAS at 3 and 9-o'clock positions using J-tip needle-free syringes (National Medical Products Inc, Irvine, Calif).
The depth and width of toxin penetration was assessed by endosonography. Outcome was measured by a validated symptom severity (SS) score questionnaire. The total SS score ranged between 0 (best) and 65 (worst). The outcome was compared with 31 children in a comparable historical control group at 3 and 12-month follow-up.
RESULTS:
Sixteen children were recruited with median age of 6.11 (range, 3-14.85) years and median duration of symptoms of 3.9 years (1.6-11.5). On endosonography, the median depth and width of BT penetration was 8 (7-10) mm and 8 (6-10) mm, respectively. At 3-month follow-up, the median SS score improved in all children after TNFBT from 32.50 (5-57) to 7.50 (0-26) (Wilcoxon's P < .0001). There were significant improvements in symptoms of constipation, soiling, painful defecation, general health and behavior, and fecal impaction of rectum (P < .05). Anal fissures healed in all 4 children. The SS score in the control group improved from 33 (12-49) to 15 (0-40) (P < .0001). At 12-month follow-up, the improvement of SS score in TNFBT group was significantly more than the control group as follows: 4 (0-25) vs 15 (0-51), respectively (Mann-Whitney U P < .002).
Three patients had a second TNFBT injection for relapsed symptoms. There were no complications. The transcutaneous needle-free injection of botulinum toxin eliminates the risk of intravascular injection or needlestick injury. The transcutaneous needle-free injection of botulinum toxin also has other therapeutic applications including an alternative therapy to biofeedback training for dyssynergia of the EAS, treatment of muscle limb spasticity in cerebral palsy, and cosmetic treatment of overactive facial muscles and wrinkles and hyperhydrosis.
CONCLUSION:
Transcutaneous needle-free injection of botulinum toxin into the external anal sphincter is a novel and safe new treatment of chronic idiopathic constipation and anal fissure in children. A second injection may be required in 20% of patients.
"Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure"
J Pediatr Surg. 2009 Sep; 44(9): 1791-8Keshtgar AS, Ward HC, Clayden GS (Hubmed.org)
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Infraorbital dark circles refer to the conditions that present with darkness of the infraorbital eyelids. Although it is not a medical concern, it can be a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes have not been elucidated.
OBJECTIVE:
To review the possible causes and treatment options for infraorbital dark circles.
METHODS:
The article is based on a review of the medical literature and the author's clinical experience in treating infraorbital dark circles.
CONCLUSION:
Possible causative factors of infraorbital dark circles include excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough, but because multiple factors cause infraorbital dark circles in the majority of patients, it is essential to identify the cause and choose the appropriate treatment according to the cause.
"Infraorbital dark circles: definition, causes, and treatment options"
Dermatol Surg. 2009 Aug; 35(8): 1163-71Roh MR, Chung KY (Hubmed.org)
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Primary human aging may be associated with augmented Rho-kinase (ROCK)-mediated contraction of vascular smooth muscle and ROCK-mediated inhibition of nitric oxide synthase (NOS). We hypothesized that the contribution of ROCK to reflex vasoconstriction (VC) is greater in aged skin.
Cutaneous VC was elicited by 1) whole-body cooling (Tsk=30.5 degrees C) and 2) local norepinephrine (NE) infusion (1x10(-6)M). Four microdialysis fibers were placed in the forearm skin of 8 young (Y) and 8 older (O) subjects for infusion of 1) Ringers solution (control), 2) 3 mM fasudil (ROCK inhibition), 3) 20 mM L-NAME (NOS inhibition), and 4) both ROCK + NOS inhibitors.
Red cell flux was measured by laser Doppler flowmetry (LDF) over each site. Cutaneous vascular conductance was calculated (CVC = LDF/MAP) and normalized to baseline CVC (%DeltaCVCbaseline). VC was reduced at the control site in O during cooling (Y: -34 +/- 3, O: -18 +/- 3 %DeltaCVCbaseline; P
"Reflex vasoconstriction in aged human skin increasingly relies on rho-kinase dependent mechanisms during whole-body cooling"
Am J Physiol Heart Circ Physiol. 2009 Aug 28; Lang JA, Jennings JD, Holowatz LA, Kenney WL (Hubmed.org)
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Massively parallel pyrosequencing of the small subunit (16S) ribosomal RNA gene has revealed that the extent of rare microbial populations in several environments, the 'rare biosphere', is orders of magnitude higher than previously thought.
One important caveat with this method is that sequencing error could artificially inflate diversity estimates. Although the per-base error of 16S rDNA amplicon pyrosequencing has been shown to be as good as or lower than Sanger sequencing, no direct assessments of pyrosequencing errors on diversity estimates have been reported.
Using only Escherichia coli MG1655 as a reference template, we find that 16S rDNA diversity is grossly overestimated unless relatively stringent read quality filtering and low clustering thresholds are applied. In particular, the common practice of removing reads with unresolved bases and anomalous read lengths is insufficient to ensure accurate estimates of microbial diversity.
Furthermore, common and reproducible homopolymer length errors can result in relatively abundant spurious phylotypes further confounding data interpretation. Thus, stringent quality-based trimming of 16S pyrotags and clustering thresholds no greater than 97% identity should be used to avoid overestimates of the rare biosphere.
"Wrinkles in the rare biosphere: pyrosequencing errors lead to artificial inflation of diversity estimates"
Environ Microbiol. 2009 Aug 27; Kunin V, Engelbrektson A, Ochman H, Hugenholtz P (Hubmed.org)
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The dermal degeneration accompanying photoaging is considered to promote skin roughness features such as wrinkles. Our previous study demonstrated that polarization-sensitive spectral domain optical coherence tomography (PS-SD-OCT) enabled noninvasive three-dimensional evaluation of the dermal degeneration of photoaged skin as a change in dermal birefringence, mainly due to collagenous structures.
Our purpose is to examine the relationship between dermal birefringence and elasticity and the skin morphology in the eye corner area using PS-SD-OCT. Nineteen healthy male subjects in their seventees were recruited as subjects. A transverse dermal birefringence map, automatically produced by the algorithm, did not show localized changes in the dermal birefringence in the part of the main horizontal wrinkle.
The averaged upper dermal birefringence, however, showed depth-dependent correlation with the parameters of skin roughness significantly, suggesting that solar elastosis is a major factor for the progress of wrinkles. Age-dependent parameters of skin elasticity measured with Cutometer did not correlate with the parameters.
These results suggest that the analysis of dermal birefringence using PS-SD-OCT enables the evaluation of photoaging-dependent upper dermal degeneration related to the change of skin roughness.
"Relationship between dermal birefringence and the skin surface roughness of photoaged human skin"
J Biomed Opt. 2009 Jul-Aug; 14(4): 044032Sakai S, Nakagawa N, Yamanari M, Miyazawa A, Yasuno Y, Matsumoto M (Hubmed.org)
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Int J Cosmet Sci. 2009 Sep 1; Dumont S, Cattuzzato L, Trouvé G, Chevrot N, Stoltz CSynopsis The mode of action of two cosmetic active ingredients (AIs), palmitoyl glycine (PG) and cocoyl alanine (CA) was studied with cDNA array experiments and quantitative PCR confirmations, which were performed on experimentally aged human fibroblasts. These preliminary studies revealed complementary profiles. Thus, specific supplementary investigations were then carried out for each AI. Protocols used were based either on in vitro models: (i) biochemical assays, (ii) monolayer cell culture (primary human fibroblasts and keratinocytes) and (iii) the model of capillary-like tube formation by human endothelial cells or on ex vivo models, i.e. topically treated skin explants and both immunohistochemical and Chromameter(TM) investigations. New prospects are proposed to fight out against skin aging. Indeed, PG and CA showed complementary properties and thus enabled a regulation or a restoration effect on main aging-associated disorders. Thus, they can not only act on tissue architecture, cell-cell interactions and extracellular matrix protection but also on inflammation, cell longevity, skin immune system protection, skin radiance and stem cell survey. Finally, a clinical trial performed on Caucasian women confirmed AI anti-wrinkle efficacy, which was superior to that of a market reference ingredient. In the future, complementary experiments enabling a better understanding of the aging-induced decline of epidermal stem cells would be of a great interest.
Plast Reconstr Surg. 2009 Sep; 124(3): 826-35McCluskey PD, Constantine FC, Thornton JFBACKGROUND: A full-thickness skin graft is generally not considered the ideal replacement for the thick, sebaceous skin of the nasal tip, ala, lower sidewalls, or dorsum. Instead, many clinicians prefer to reconstruct these defects with local or axial composite flaps that incorporate skin, subcutaneous tissue, and fat. METHODS: The authors conducted a retrospective analysis of 55 consecutive patients who underwent reconstruction of lower third nasal defects with full-thickness skin grafts between 2002 and 2007 performed by the senior author (J.F.T.). All of the patients in this review underwent skin cancer ablation by means of Mohs' micrographic surgery. RESULTS: Good aesthetic results, based on preoperative and postoperative photographic analysis of contour and pigmentation, have been achieved in both the recipient and donor sites in 52 of 55 patients. Three patients, all of whom were smokers, experienced loss of the skin graft requiring alternative reconstructive techniques. CONCLUSIONS: Under certain conditions, skin grafting of defects of the caudal third of the nose offers a viable reconstructive option that yields good contour and color match. Careful analysis of defect size, location, and depth and consideration of donor-site skin thickness and pigmentation are vital for accurate replacement of the thick, pitted, sebaceous skin of the caudal nose. An evolution in technique has revealed that the forehead donor skin often provides a more consistent color and contour match in such reconstructions. Secondary dermabrasion of the graft provides a critical step for obtaining final aesthetic contour and color.
J Cell Mol Med. 2009 Sep 1; Mimeault M, Batra SKRecent advances in skin-resident adult stem/progenitor cell research have revealed that these immature and regenerative cells with a high longevity provide critical functions in maintaining skin homeostasis and repair after severe injuries along the lifespan of individuals. The establishment of the functional properties of distinct adult stem/progenitor cells found in skin epidermis and hair follicles and extrinsic signals from their niches, which are deregulated during their aging and malignant transformation, has significantly improved our understanding on the etiopathogenesis of diverse human skin disorders and cancers. Particularly, enhanced ultraviolet radiation exposure, inflammation and oxidative stress and telomere attrition during chronological aging may induce severe DNA damages and genomic instability in the skin-resident stem/progenitor cells and their progenies. These molecular events may result in the alterations in key signaling components controlling their self-renewal and/or regenerative capacities as well as the activation of tumor suppressor gene products that trigger their growth arrest and senescence or apoptotic death. The progressive decline in the regenerative functions and/or number of skin-resident adult stem/progenitor cells may cause diverse skin diseases with advancing age. Moreover, the photoaging, telomerase re-activation and occurrence of different oncogenic events in skin-resident adult stem/progenitor cells may also culminate in their malignant transformation into cancer stem/progenitor cells and skin cancer initiation and progression. Therefore, the anti-inflammatory and anti-oxidant treatments and stem cell-replacement and gene therapies as well as the molecular targeting of their malignant counterpart, skin cancer-initiating cells offer great promise to treat diverse skin disorders and cancers.
Aesthet Surg J. 2009 Jul-Aug; 29(4): 264-71Man DBACKGROUND: The telltale signs associated with facelift procedures, including tightening of the lower face (lateral sweep), visible scars, a distorted hairline, and the "pixie ear" deformity are grounds for concern among both patients and aesthetic surgeons. It is the author's belief that facelift results can be improved with correct positioning of the ears, so that these signs are reduced or eliminated altogether. OBJECTIVE: The purpose of this paper is to study the causes of ear deformity and describe the advantages of the author's technique for the prevention of ear deformities in facelift surgeries. METHODS: Between January 2005 and November 2007, the author performed facelifts on 106 patients using a technique that included autologous fat injections to improve facial volume, hidden incisions in and around the ear, and absorbable bidirectional barbed sutures. Patient charts and photographs were reviewed retrospectively. Pre- and postoperative angles were measured with respect to the ear and face and were documented to determine the degree of improvement or deformity. RESULTS: Significant improvement of the specified angles was noted in 70% of cases following facelift surgery; in these cases, the ear position was elevated. No change in ear position occurred in 10% of cases. Some distortion and lowering of the ear was seen in the remaining cases. CONCLUSIONS: Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures can aid in achieving improved aesthetic results. The advantages of the author's technique include shorter incisions, a diminished need to remove redundant skin, ear elevation, and a smoother repair with improved contour. Further investigation of long-term results is necessary.
