Aesthetic Dermatology

Injection of botulinum toxin type A was the most popular type of minimally invasive cosmetic surgery in the United States in 2012, with more than 4.1 million procedures performed, according to a survey by the American Society for Aesthetic Plastic Surgery (ASPAS).

More than 20% (867,266) of the botulinum toxin type A (including Botox and Dysport) injections were performed by physician assistants and nurses, ASPAS estimated. The data were based on responses from 772 board-certified dermatologists, plastic surgeons, and otolaryngologists in active practice.

The second most popular type of minimally invasive surgery was injection of hyaluronic acid – including Juvederm, Perlane/Restylane, Belotero, Prevelle, and Elevess – with 1.8 million procedures in 2012, according to the ASPAS.

Almost 8.5 million minimally invasive cosmetic procedures were performed overall last year, an increase of more than 10% from 2011, according to the survey, which was compiled and analyzed by Industry Insights, an independent research firm.

rfranki@frontlinemedcom.com

Injection of botulinum toxin type A was the most popular type of minimally invasive cosmetic surgery in the United States in 2012, with more than 4.1 million procedures performed, according to a survey by the American Society for Aesthetic Plastic Surgery (ASPAS).

More than 20% (867,266) of the botulinum toxin type A (including Botox and Dysport) injections were performed by physician assistants and nurses, ASPAS estimated. The data were based on responses from 772 board-certified dermatologists, plastic surgeons, and otolaryngologists in active practice.

The second most popular type of minimally invasive surgery was injection of hyaluronic acid – including Juvederm, Perlane/Restylane, Belotero, Prevelle, and Elevess – with 1.8 million procedures in 2012, according to the ASPAS.

Almost 8.5 million minimally invasive cosmetic procedures were performed overall last year, an increase of more than 10% from 2011, according to the survey, which was compiled and analyzed by Industry Insights, an independent research firm.

rfranki@frontlinemedcom.com

Injection of botulinum toxin type A was the most popular type of minimally invasive cosmetic surgery in the United States in 2012, with more than 4.1 million procedures performed, according to a survey by the American Society for Aesthetic Plastic Surgery (ASPAS).

More than 20% (867,266) of the botulinum toxin type A (including Botox and Dysport) injections were performed by physician assistants and nurses, ASPAS estimated. The data were based on responses from 772 board-certified dermatologists, plastic surgeons, and otolaryngologists in active practice.

The second most popular type of minimally invasive surgery was injection of hyaluronic acid – including Juvederm, Perlane/Restylane, Belotero, Prevelle, and Elevess – with 1.8 million procedures in 2012, according to the ASPAS.

Almost 8.5 million minimally invasive cosmetic procedures were performed overall last year, an increase of more than 10% from 2011, according to the survey, which was compiled and analyzed by Industry Insights, an independent research firm.

rfranki@frontlinemedcom.com

The differences in facial structure, as well as differences in photoaging not discussed here, may be useful in the way we approach different aesthetic procedures sought by patients in different ethnic groups. Understanding these structural differences also may help us avoid a cookie-cutter approach and instead use aesthetic procedures to enhance each individual’s inherent beauty and what their ideals of beauty may be.

Beauty is subjective, but many have tried to measure beauty objectively by using anthropometry. Anthropometry is the quantitative measurement and ratio of facial features based on proportional relationships of the face known as the neoclassical canons. As proposed by Leonardo da Vinci, the ideal face can be divided into equal horizontal thirds: the distance from the frontal hairline to the top of the brow, from the brow to the base of the nose, and from the base of the nose to the inferior aspect of the chin. These mathematical facial proportions translate to a symmetrical oval or heart-shaped face, with prominent cheekbones, a tapered jaw line, a narrow nasal base, and thin lips.

Another method used to calculate beauty with mathematical proportions is the concept of "phi," the golden ratio. The ratio of 1:1.618 was described by ancient Greeks as a mathematical method to calculate optimal proportions for all structures in nature. Phi is the unique point on a line that divides the line into two lines in such a manner that the ratio of the smaller portion to the larger portion is the same as the ratio of the larger portion to the whole line.

Plastic surgeon Dr. Stephen Marquardt trademarked the "Phi mask," a facial mask of proportions that incorporates the 1:1.618 ratio to describe the mathematical ideal of an attractive face. The original Phi mask has been applied to persons of all races and ethnicities. However, Marquardt has modified it in recent years to apply to three different ethnic groups – Caucasian, Asian, and African – and he has noted the likelihood of more variations to come.

While phi proportions may be applied all ethnicities, baseline facial anatomic structural differences among different ethnicities exist. A study of facial analysis by Farkas et al. compared facial structure in African Americans with Caucasians (Aesthetic Plast. Surg. 2000;24:179-84). African Americans had a broader nasal base, decreased nasal projection, bimaxillary protrusion, orbital proptosis, increased soft tissue of the midface, prominent lips, and increased facial convexity. Given the interethnic variability in facial structure, other studies have identified two types of African-American nasal structure, one with a high dorsum and one with a low dorsum (Arch. Facial Plastic Surg. 2001;3:191-7).

Latino individuals reflect a range of ethnic backgrounds, but studies of Latina female facial structure generally have shown an increased bizygomatic distance, bimaxillary protrusion, a higher convexity angle, a broader nose, a broad rounded face, and a receding chin (Aesthetics and Cosmetic Surgery for Darker Skin Types, Lippincott Williams & Wilkins, 2007:10).

In persons of Mexican descent, studies show that the face is broader, with a prominent malar eminence, broad nose, widened alar base, short columella, horizontally oriented nostrils, and thick nasal skin (Clin. Plast. Surg. 1977;4:89-102; Aesthetic Plast. Surg. 1980;4:169-77). In Caribbean women, the anthropometric measurements are more similar to those of African American women than to those of Central and South American women, whose anthropometric measurements are closer to those of Caucasian women (Arch. Otolaryngol. Head Neck Surg. 1996;122:1079-86; Laryngoscope 1988;98:202-8).

Shirakabe et al. described the facial structure and soft tissue of persons of Asian descent as including a wider and rounder face, higher eyebrow, fuller upper lid, lower nasal bridge with horizontally placed flared ala, flatter malar prominence and midface, more protuberant lips, and more receded chin (Aesthetic Plast. Surg. 2003;27:397-402). The distance from the eyebrow to the upper-lid margin in Asians is much greater than in Caucasians due to the fuller upper eyelid and to the narrower palpebral fissure (Aesthetic Surg. J. 2003;23:170-76). There is also more malar fat in the midface of Asians, moderate premaxillary deficiency, and more prominent soft tissue in the lips compared with the thinner lips and more prominent chin often seen in Caucasians (Cosmetic Surgery of the Asian Face, Thieme Medical Publishers, New York, 1990).

Of course, such studies are limited by the use of one term to describe a large group of people encompassing many different countries and cultures that have different facial features and structures that distinguish them, but these are the data available thus far.

A recent study by Biller and Kim characterizing the ideal nasolabial angle, nasal tip width, and location of eyebrow apex for Asian and white women showed that neither the ethnicity of the model nor the ethnicity of the volunteer evaluating the model played a significant role in determining the ideal angle or position of the above parameters. The researchers found that, in general, a more lateral brow apex was preferable in younger faces, whereas a more medial apex was preferred in older faces. In addition, moderate nasolabial angles of 104 and 108 degrees and a nasal tip width of 35% of the alar base was most attractive in both ethnicities. The study supports some claims that beauty is considered to be innate and independent of ethnicity (Arch. Facial Plast. Surg. 2009;11:91-7). However, the study is limited by the small number of models (four), representing only two ethnicities. In addition, all of the volunteers evaluating the models were from the United States, which may represent a more "Westernized" ideal of beauty.

This column is adapted from "Evaluation of Beauty and the Aging Face," in Dermatology, 3rd ed., 2012, Elsevier Saunders, chapter 152; and from Semin. Cutan. Med. Surg. 2009;28:115-29.

Dr. Wesley practices dermatology in Beverly Hills, Calif. To read this column online, visit edermatologynews.com. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.

The differences in facial structure, as well as differences in photoaging not discussed here, may be useful in the way we approach different aesthetic procedures sought by patients in different ethnic groups. Understanding these structural differences also may help us avoid a cookie-cutter approach and instead use aesthetic procedures to enhance each individual’s inherent beauty and what their ideals of beauty may be.

Beauty is subjective, but many have tried to measure beauty objectively by using anthropometry. Anthropometry is the quantitative measurement and ratio of facial features based on proportional relationships of the face known as the neoclassical canons. As proposed by Leonardo da Vinci, the ideal face can be divided into equal horizontal thirds: the distance from the frontal hairline to the top of the brow, from the brow to the base of the nose, and from the base of the nose to the inferior aspect of the chin. These mathematical facial proportions translate to a symmetrical oval or heart-shaped face, with prominent cheekbones, a tapered jaw line, a narrow nasal base, and thin lips.

Another method used to calculate beauty with mathematical proportions is the concept of "phi," the golden ratio. The ratio of 1:1.618 was described by ancient Greeks as a mathematical method to calculate optimal proportions for all structures in nature. Phi is the unique point on a line that divides the line into two lines in such a manner that the ratio of the smaller portion to the larger portion is the same as the ratio of the larger portion to the whole line.

Plastic surgeon Dr. Stephen Marquardt trademarked the "Phi mask," a facial mask of proportions that incorporates the 1:1.618 ratio to describe the mathematical ideal of an attractive face. The original Phi mask has been applied to persons of all races and ethnicities. However, Marquardt has modified it in recent years to apply to three different ethnic groups – Caucasian, Asian, and African – and he has noted the likelihood of more variations to come.

While phi proportions may be applied all ethnicities, baseline facial anatomic structural differences among different ethnicities exist. A study of facial analysis by Farkas et al. compared facial structure in African Americans with Caucasians (Aesthetic Plast. Surg. 2000;24:179-84). African Americans had a broader nasal base, decreased nasal projection, bimaxillary protrusion, orbital proptosis, increased soft tissue of the midface, prominent lips, and increased facial convexity. Given the interethnic variability in facial structure, other studies have identified two types of African-American nasal structure, one with a high dorsum and one with a low dorsum (Arch. Facial Plastic Surg. 2001;3:191-7).

Latino individuals reflect a range of ethnic backgrounds, but studies of Latina female facial structure generally have shown an increased bizygomatic distance, bimaxillary protrusion, a higher convexity angle, a broader nose, a broad rounded face, and a receding chin (Aesthetics and Cosmetic Surgery for Darker Skin Types, Lippincott Williams & Wilkins, 2007:10).

In persons of Mexican descent, studies show that the face is broader, with a prominent malar eminence, broad nose, widened alar base, short columella, horizontally oriented nostrils, and thick nasal skin (Clin. Plast. Surg. 1977;4:89-102; Aesthetic Plast. Surg. 1980;4:169-77). In Caribbean women, the anthropometric measurements are more similar to those of African American women than to those of Central and South American women, whose anthropometric measurements are closer to those of Caucasian women (Arch. Otolaryngol. Head Neck Surg. 1996;122:1079-86; Laryngoscope 1988;98:202-8).

Shirakabe et al. described the facial structure and soft tissue of persons of Asian descent as including a wider and rounder face, higher eyebrow, fuller upper lid, lower nasal bridge with horizontally placed flared ala, flatter malar prominence and midface, more protuberant lips, and more receded chin (Aesthetic Plast. Surg. 2003;27:397-402). The distance from the eyebrow to the upper-lid margin in Asians is much greater than in Caucasians due to the fuller upper eyelid and to the narrower palpebral fissure (Aesthetic Surg. J. 2003;23:170-76). There is also more malar fat in the midface of Asians, moderate premaxillary deficiency, and more prominent soft tissue in the lips compared with the thinner lips and more prominent chin often seen in Caucasians (Cosmetic Surgery of the Asian Face, Thieme Medical Publishers, New York, 1990).

Of course, such studies are limited by the use of one term to describe a large group of people encompassing many different countries and cultures that have different facial features and structures that distinguish them, but these are the data available thus far.

A recent study by Biller and Kim characterizing the ideal nasolabial angle, nasal tip width, and location of eyebrow apex for Asian and white women showed that neither the ethnicity of the model nor the ethnicity of the volunteer evaluating the model played a significant role in determining the ideal angle or position of the above parameters. The researchers found that, in general, a more lateral brow apex was preferable in younger faces, whereas a more medial apex was preferred in older faces. In addition, moderate nasolabial angles of 104 and 108 degrees and a nasal tip width of 35% of the alar base was most attractive in both ethnicities. The study supports some claims that beauty is considered to be innate and independent of ethnicity (Arch. Facial Plast. Surg. 2009;11:91-7). However, the study is limited by the small number of models (four), representing only two ethnicities. In addition, all of the volunteers evaluating the models were from the United States, which may represent a more "Westernized" ideal of beauty.

This column is adapted from "Evaluation of Beauty and the Aging Face," in Dermatology, 3rd ed., 2012, Elsevier Saunders, chapter 152; and from Semin. Cutan. Med. Surg. 2009;28:115-29.

Dr. Wesley practices dermatology in Beverly Hills, Calif. To read this column online, visit edermatologynews.com. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.

The differences in facial structure, as well as differences in photoaging not discussed here, may be useful in the way we approach different aesthetic procedures sought by patients in different ethnic groups. Understanding these structural differences also may help us avoid a cookie-cutter approach and instead use aesthetic procedures to enhance each individual’s inherent beauty and what their ideals of beauty may be.

Beauty is subjective, but many have tried to measure beauty objectively by using anthropometry. Anthropometry is the quantitative measurement and ratio of facial features based on proportional relationships of the face known as the neoclassical canons. As proposed by Leonardo da Vinci, the ideal face can be divided into equal horizontal thirds: the distance from the frontal hairline to the top of the brow, from the brow to the base of the nose, and from the base of the nose to the inferior aspect of the chin. These mathematical facial proportions translate to a symmetrical oval or heart-shaped face, with prominent cheekbones, a tapered jaw line, a narrow nasal base, and thin lips.

Another method used to calculate beauty with mathematical proportions is the concept of "phi," the golden ratio. The ratio of 1:1.618 was described by ancient Greeks as a mathematical method to calculate optimal proportions for all structures in nature. Phi is the unique point on a line that divides the line into two lines in such a manner that the ratio of the smaller portion to the larger portion is the same as the ratio of the larger portion to the whole line.

Plastic surgeon Dr. Stephen Marquardt trademarked the "Phi mask," a facial mask of proportions that incorporates the 1:1.618 ratio to describe the mathematical ideal of an attractive face. The original Phi mask has been applied to persons of all races and ethnicities. However, Marquardt has modified it in recent years to apply to three different ethnic groups – Caucasian, Asian, and African – and he has noted the likelihood of more variations to come.

While phi proportions may be applied all ethnicities, baseline facial anatomic structural differences among different ethnicities exist. A study of facial analysis by Farkas et al. compared facial structure in African Americans with Caucasians (Aesthetic Plast. Surg. 2000;24:179-84). African Americans had a broader nasal base, decreased nasal projection, bimaxillary protrusion, orbital proptosis, increased soft tissue of the midface, prominent lips, and increased facial convexity. Given the interethnic variability in facial structure, other studies have identified two types of African-American nasal structure, one with a high dorsum and one with a low dorsum (Arch. Facial Plastic Surg. 2001;3:191-7).

Latino individuals reflect a range of ethnic backgrounds, but studies of Latina female facial structure generally have shown an increased bizygomatic distance, bimaxillary protrusion, a higher convexity angle, a broader nose, a broad rounded face, and a receding chin (Aesthetics and Cosmetic Surgery for Darker Skin Types, Lippincott Williams & Wilkins, 2007:10).

In persons of Mexican descent, studies show that the face is broader, with a prominent malar eminence, broad nose, widened alar base, short columella, horizontally oriented nostrils, and thick nasal skin (Clin. Plast. Surg. 1977;4:89-102; Aesthetic Plast. Surg. 1980;4:169-77). In Caribbean women, the anthropometric measurements are more similar to those of African American women than to those of Central and South American women, whose anthropometric measurements are closer to those of Caucasian women (Arch. Otolaryngol. Head Neck Surg. 1996;122:1079-86; Laryngoscope 1988;98:202-8).

Shirakabe et al. described the facial structure and soft tissue of persons of Asian descent as including a wider and rounder face, higher eyebrow, fuller upper lid, lower nasal bridge with horizontally placed flared ala, flatter malar prominence and midface, more protuberant lips, and more receded chin (Aesthetic Plast. Surg. 2003;27:397-402). The distance from the eyebrow to the upper-lid margin in Asians is much greater than in Caucasians due to the fuller upper eyelid and to the narrower palpebral fissure (Aesthetic Surg. J. 2003;23:170-76). There is also more malar fat in the midface of Asians, moderate premaxillary deficiency, and more prominent soft tissue in the lips compared with the thinner lips and more prominent chin often seen in Caucasians (Cosmetic Surgery of the Asian Face, Thieme Medical Publishers, New York, 1990).

Of course, such studies are limited by the use of one term to describe a large group of people encompassing many different countries and cultures that have different facial features and structures that distinguish them, but these are the data available thus far.

A recent study by Biller and Kim characterizing the ideal nasolabial angle, nasal tip width, and location of eyebrow apex for Asian and white women showed that neither the ethnicity of the model nor the ethnicity of the volunteer evaluating the model played a significant role in determining the ideal angle or position of the above parameters. The researchers found that, in general, a more lateral brow apex was preferable in younger faces, whereas a more medial apex was preferred in older faces. In addition, moderate nasolabial angles of 104 and 108 degrees and a nasal tip width of 35% of the alar base was most attractive in both ethnicities. The study supports some claims that beauty is considered to be innate and independent of ethnicity (Arch. Facial Plast. Surg. 2009;11:91-7). However, the study is limited by the small number of models (four), representing only two ethnicities. In addition, all of the volunteers evaluating the models were from the United States, which may represent a more "Westernized" ideal of beauty.

This column is adapted from "Evaluation of Beauty and the Aging Face," in Dermatology, 3rd ed., 2012, Elsevier Saunders, chapter 152; and from Semin. Cutan. Med. Surg. 2009;28:115-29.

Dr. Wesley practices dermatology in Beverly Hills, Calif. To read this column online, visit edermatologynews.com. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.

Discovered in nature in 1985 (Science 1992;257:215-7), fullerenes are novel, classically engineered chemical compounds composed only of carbon atoms. The stable form, a third carbon allotrope, is a molecule made up of 60 carbon atoms in a structure resembling a soccer ball or geodesic dome, although some fullerenes are ellipsoid or tube shaped. In fact, fullerene C(60), the first of the group of compounds to be discovered, is also known as buckminsterfullerene, based on Buckminster Fuller’s geodesic dome. The carbon nanotube structure, composed of thin carbon filaments (1-3 mcm in length and 1-3 nm in diameter) and possessing a wide range of mechanical characteristics, was discovered in 1991 (J. Nanosci. Nanotechnol. 2006;6:591-9).

The potential applications of C(60) and fullerene derivatives have been extensively studied, and recent data suggest that fullerenes exhibit potent antioxidant activity, even acting as a "free radical sponge" (Bioorg. Med. Chem. Lett. 2006;16:1590-5; Biomaterials 2008;29:3561-73). Therefore, fullerenes may be appropriate active ingredients for various skin care products, particularly rejuvenation products (Recent Pat. Biotechnol. 2011;5:67-73; Recent. Pat. Biotechnol. 2009;3:118-23).

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

Early studies

In one of the early studies of topical applications of fullerenes (C60), Nelson et al. examined the potential acute and subchronic toxic effects of fullerenes (200 mcg) applied in benzene on mouse skin. After 72 hours, they observed no effect on either DNA synthesis or ornithine decarboxylase activity. A skin tumor initiation model using 7,12-dimethylbenzanthracene (DMBA) failed to show benign or malignant skin tumor formation, but promotion using 12-O-tetradecanoyl-phorbol-13-acetate (TPA) resulted in benign skin tumors. The investigators concluded that fullerenes applied in benzene at a likely industrial exposure level did not cause acute toxic effects in mice (Toxicol. Ind. Health. 1993;9:623-30).

In 1997, Tabata et al., noted that fullerene C(60) efficiently generates singlet oxygen when irradiated with light, and found that polyethylene glycol (PEG)-modified C60 exhibits potential as an agent for photodynamic tumor therapy (Jpn. J. Cancer Res. 1997;88:1108-16).

Antiviral capacity

Fullerenes exhibit unique chemical and physical properties, including photodynamic characteristics and a hydrophobic spheroid and radical sponge quality. They also display antiviral activity, particularly in relation to HIV, and their potential commercial applications include use in patent-pending anticancer drug delivery systems employing photodynamic therapy (PDT), HIV drugs, and antiaging cosmetics (Int. J. Nanomedicine 2007;2:639-49).

Anti-inflammatory activity

An anti-inflammatory role has also been identified for fullerenes. Ryan et al. noted that preincubation with C(60) resulted in significant suppression of IgE-dependent mediator release in human mast cells and peripheral blood basophils. IgE-induced increases in cytoplasmic reactive oxygen species (ROS) levels was also hindered by preincubation with fullerenes. Using a mast cell–dependent anaphylaxis model, Ryan and colleagues also found that fullerenes prevented the in vivo release of histamine and fall in core body temperature. They concluded that fullerenes might suggest an innovative approach to managing mast cell–dependent conditions such as asthma, heart disease, inflammatory arthritis, and multiple sclerosis (J. Immunol. 2007;179(1):665-72).

Antimicrobial potential

In 2005, Tegos et al. compared the antimicrobial activity of six C(60) compounds functionalized with one, two, or three hydrophilic or cationic groups combined with white light against gram-positive and negative bacteria, and fungi. They found that following 10 minutes of incubation, bis- and tris-cationic fullerenes actively eliminated all tested microbes while leaving mammalian cells comparatively intact. The investigators also noted that the fullerene compounds were significantly more effective than a widely used antimicrobial photosensitizer, toluidine blue O. They concluded that the compounds warrant consideration as photosensitizers for antimicrobial use given their high selectivity and efficacy (Chem. Biol. 2005;12(10):1127-35).

Potent antioxidant

In 2006, Xiao et al. reported on their development of the Radical Sponge, a fullerene entrapped in polyvinylpyrrolidone to yield a water-soluble derivative with a mean particle diameter of about 688 nm and reactive oxygen species (ROS) scavenging abilities. The researchers repeatedly irradiated human skin keratinocytes (HaCaT) with visible light (400-2,000 nm) in the presence or absence of Radical Sponge, with no photocytotoxicity apparent in the Radical Sponge–exposed cells. In addition, the water-soluble fullerene derivative displayed a cytoprotective effect (10-40 mcM doses) against UVA exposure (30 J/cm²) when it was administered prior to exposure and rinsed out immediately before the irradiation, more so than when administered only during or after irradiation. The researchers concluded that this finding suggested more of a preventive as opposed to therapeutic effect conferred by Radical Sponge against UVA damage (Bioorg. Med. Chem. Lett. 2006;16:1590-5).

In a subsequent study, the researchers compared the Radical Sponge with two whitening agents and found the fullerene to have imparted stronger antimelanogenic activity, possibly due to down-regulation of the tyrosinase expression promoted by UVA-induced ROS generation (Arch. Dermatol. Res. 2007;299(5-6):245-57).

More recently, Kato et al. demonstrated the antioxidant activity of C(60) incorporated into liposomes, with persistent scavenging of hydroxyl radicals and cytoprotection of keratinocytes against UVA- and UVB-induced damage ascribed to the fullerene component (J. Nanosci. Nanotechnol. 2011;11(5):3814-23).

Safety

The first study establishing the safety of highly purified fullerenes (HPFs) as an additive in cosmeceuticals was conducted in 2009. Aoshima et al. performed in vivo tests in animals and in vitro examinations using human epidermal keratinocytes and fibroblasts. No primary or cumulative skin irritation, sensitization, photosensitization, or contact phototoxicity was observed. In the patch test on human skin, no reaction was noted. HPFs were deemed to be "minimally irritating" after the eye-irritation test in rabbits. The investigators concluded, based on their findings and in light of previously published data, that HPFs are safe for human skin as ingredients in cosmetic skin care formulations (J. Toxicol. Sci. 2009;34(5):555-62).

Hair regrowth

In 2009, Zhou et al. used shaved mice and SKH-1 hairless mice to study whether fullerene-based compounds could elicit hair growth. Fullerenes were found to significantly increase the hair growth rate compared with a placebo vehicle. Significantly increased numbers of hair follicles were also observed in SKH-1 hairless mice treated topically or subdermally with fullerenes. Cultured human skin treated with fullerenes also showed augmented hair growth. The data suggested implications for hair loss due to alopecia, chemotherapy, or other chemical reactions (Nanomedicine 2009;5:202-7).

Antiacne properties

In 2011, Inui et al. conducted an open trial of effects of fullerene gel on acne. Subjects used the gel twice daily, and significant reductions in the mean number of inflammatory lesions were noted at 4 and 8 weeks of treatment. In addition, the researchers conducted in vitro assays of sebum production in hamster sebocytes and found that 75 mcM polyvinylpyrrolidone-fullerene suppressed sebum production, suggesting that topical fullerenes inhibit acne by reducing neutrophil infiltration and sebum production (Nanomedicine 2011;7:238-41).

Water solubility and photodynamic activity

In 2007, Mroz et al. compared the photodynamic activity of six fullerenes functionalized to become soluble with 1, 2, or 3 hydrophilic or 1, 2, or 3 cationic groups in three mouse cancer cell lines (J774, LLC, and CT26) incubated for 24 hours with fullerenes and illuminated with white light. They found that some functionalized fullerenes (particularly monopyrrolidinium fullerene) induced apoptosis in all cancer lines (Free Radic. Biol. Med. 2007;43:711-9). In a subsequent study, Mroz et al. found that some fullerenes can be functionalized to photoinactivate pathogenic malignant cancer cells and/or microbial cells in a mechanism that involves superoxide anion and singlet oxygen. The researchers suggested that fullerenes have the potential to supersede photosensitizers in current clinical use in PDT for some conditions (Photochem. Photobiol. Sci. 2007;6:1139-49).

In 2009, Yin et al. showed that three different functionalized water-soluble fullerenes can intercept and protect cells against all of the primary physiologically important ROS and can efficiently suppress lipid peroxidation in vitro. The findings suggest the potential of fullerene derivatives as effective cytoprotective therapeutic agents (Biomaterials. 2009;30:611-21), the researchers wrote.

Conclusion

The discovery of the fullerene family has stimulated widespread research in chemistry and biology for a broad range of therapeutic applications. Anti-inflammatory, antioxidant, and antiviral activities have been linked to these compounds. In addition, fullerenes appear to be effective in drug and gene delivery and as an adjunct in acne therapy. The compounds have shown potential as photoprotectants as well as photosensitizers, which may be useful in photodynamic therapy. More research is needed, but the potential applications of fullerenes in dermatology are promising, particularly as potent antioxidants conferring skin protection.

Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

Discovered in nature in 1985 (Science 1992;257:215-7), fullerenes are novel, classically engineered chemical compounds composed only of carbon atoms. The stable form, a third carbon allotrope, is a molecule made up of 60 carbon atoms in a structure resembling a soccer ball or geodesic dome, although some fullerenes are ellipsoid or tube shaped. In fact, fullerene C(60), the first of the group of compounds to be discovered, is also known as buckminsterfullerene, based on Buckminster Fuller’s geodesic dome. The carbon nanotube structure, composed of thin carbon filaments (1-3 mcm in length and 1-3 nm in diameter) and possessing a wide range of mechanical characteristics, was discovered in 1991 (J. Nanosci. Nanotechnol. 2006;6:591-9).

The potential applications of C(60) and fullerene derivatives have been extensively studied, and recent data suggest that fullerenes exhibit potent antioxidant activity, even acting as a "free radical sponge" (Bioorg. Med. Chem. Lett. 2006;16:1590-5; Biomaterials 2008;29:3561-73). Therefore, fullerenes may be appropriate active ingredients for various skin care products, particularly rejuvenation products (Recent Pat. Biotechnol. 2011;5:67-73; Recent. Pat. Biotechnol. 2009;3:118-23).

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

Early studies

In one of the early studies of topical applications of fullerenes (C60), Nelson et al. examined the potential acute and subchronic toxic effects of fullerenes (200 mcg) applied in benzene on mouse skin. After 72 hours, they observed no effect on either DNA synthesis or ornithine decarboxylase activity. A skin tumor initiation model using 7,12-dimethylbenzanthracene (DMBA) failed to show benign or malignant skin tumor formation, but promotion using 12-O-tetradecanoyl-phorbol-13-acetate (TPA) resulted in benign skin tumors. The investigators concluded that fullerenes applied in benzene at a likely industrial exposure level did not cause acute toxic effects in mice (Toxicol. Ind. Health. 1993;9:623-30).

In 1997, Tabata et al., noted that fullerene C(60) efficiently generates singlet oxygen when irradiated with light, and found that polyethylene glycol (PEG)-modified C60 exhibits potential as an agent for photodynamic tumor therapy (Jpn. J. Cancer Res. 1997;88:1108-16).

Antiviral capacity

Fullerenes exhibit unique chemical and physical properties, including photodynamic characteristics and a hydrophobic spheroid and radical sponge quality. They also display antiviral activity, particularly in relation to HIV, and their potential commercial applications include use in patent-pending anticancer drug delivery systems employing photodynamic therapy (PDT), HIV drugs, and antiaging cosmetics (Int. J. Nanomedicine 2007;2:639-49).

Anti-inflammatory activity

An anti-inflammatory role has also been identified for fullerenes. Ryan et al. noted that preincubation with C(60) resulted in significant suppression of IgE-dependent mediator release in human mast cells and peripheral blood basophils. IgE-induced increases in cytoplasmic reactive oxygen species (ROS) levels was also hindered by preincubation with fullerenes. Using a mast cell–dependent anaphylaxis model, Ryan and colleagues also found that fullerenes prevented the in vivo release of histamine and fall in core body temperature. They concluded that fullerenes might suggest an innovative approach to managing mast cell–dependent conditions such as asthma, heart disease, inflammatory arthritis, and multiple sclerosis (J. Immunol. 2007;179(1):665-72).

Antimicrobial potential

In 2005, Tegos et al. compared the antimicrobial activity of six C(60) compounds functionalized with one, two, or three hydrophilic or cationic groups combined with white light against gram-positive and negative bacteria, and fungi. They found that following 10 minutes of incubation, bis- and tris-cationic fullerenes actively eliminated all tested microbes while leaving mammalian cells comparatively intact. The investigators also noted that the fullerene compounds were significantly more effective than a widely used antimicrobial photosensitizer, toluidine blue O. They concluded that the compounds warrant consideration as photosensitizers for antimicrobial use given their high selectivity and efficacy (Chem. Biol. 2005;12(10):1127-35).

Potent antioxidant

In 2006, Xiao et al. reported on their development of the Radical Sponge, a fullerene entrapped in polyvinylpyrrolidone to yield a water-soluble derivative with a mean particle diameter of about 688 nm and reactive oxygen species (ROS) scavenging abilities. The researchers repeatedly irradiated human skin keratinocytes (HaCaT) with visible light (400-2,000 nm) in the presence or absence of Radical Sponge, with no photocytotoxicity apparent in the Radical Sponge–exposed cells. In addition, the water-soluble fullerene derivative displayed a cytoprotective effect (10-40 mcM doses) against UVA exposure (30 J/cm²) when it was administered prior to exposure and rinsed out immediately before the irradiation, more so than when administered only during or after irradiation. The researchers concluded that this finding suggested more of a preventive as opposed to therapeutic effect conferred by Radical Sponge against UVA damage (Bioorg. Med. Chem. Lett. 2006;16:1590-5).

In a subsequent study, the researchers compared the Radical Sponge with two whitening agents and found the fullerene to have imparted stronger antimelanogenic activity, possibly due to down-regulation of the tyrosinase expression promoted by UVA-induced ROS generation (Arch. Dermatol. Res. 2007;299(5-6):245-57).

More recently, Kato et al. demonstrated the antioxidant activity of C(60) incorporated into liposomes, with persistent scavenging of hydroxyl radicals and cytoprotection of keratinocytes against UVA- and UVB-induced damage ascribed to the fullerene component (J. Nanosci. Nanotechnol. 2011;11(5):3814-23).

Safety

The first study establishing the safety of highly purified fullerenes (HPFs) as an additive in cosmeceuticals was conducted in 2009. Aoshima et al. performed in vivo tests in animals and in vitro examinations using human epidermal keratinocytes and fibroblasts. No primary or cumulative skin irritation, sensitization, photosensitization, or contact phototoxicity was observed. In the patch test on human skin, no reaction was noted. HPFs were deemed to be "minimally irritating" after the eye-irritation test in rabbits. The investigators concluded, based on their findings and in light of previously published data, that HPFs are safe for human skin as ingredients in cosmetic skin care formulations (J. Toxicol. Sci. 2009;34(5):555-62).

Hair regrowth

In 2009, Zhou et al. used shaved mice and SKH-1 hairless mice to study whether fullerene-based compounds could elicit hair growth. Fullerenes were found to significantly increase the hair growth rate compared with a placebo vehicle. Significantly increased numbers of hair follicles were also observed in SKH-1 hairless mice treated topically or subdermally with fullerenes. Cultured human skin treated with fullerenes also showed augmented hair growth. The data suggested implications for hair loss due to alopecia, chemotherapy, or other chemical reactions (Nanomedicine 2009;5:202-7).

Antiacne properties

In 2011, Inui et al. conducted an open trial of effects of fullerene gel on acne. Subjects used the gel twice daily, and significant reductions in the mean number of inflammatory lesions were noted at 4 and 8 weeks of treatment. In addition, the researchers conducted in vitro assays of sebum production in hamster sebocytes and found that 75 mcM polyvinylpyrrolidone-fullerene suppressed sebum production, suggesting that topical fullerenes inhibit acne by reducing neutrophil infiltration and sebum production (Nanomedicine 2011;7:238-41).

Water solubility and photodynamic activity

In 2007, Mroz et al. compared the photodynamic activity of six fullerenes functionalized to become soluble with 1, 2, or 3 hydrophilic or 1, 2, or 3 cationic groups in three mouse cancer cell lines (J774, LLC, and CT26) incubated for 24 hours with fullerenes and illuminated with white light. They found that some functionalized fullerenes (particularly monopyrrolidinium fullerene) induced apoptosis in all cancer lines (Free Radic. Biol. Med. 2007;43:711-9). In a subsequent study, Mroz et al. found that some fullerenes can be functionalized to photoinactivate pathogenic malignant cancer cells and/or microbial cells in a mechanism that involves superoxide anion and singlet oxygen. The researchers suggested that fullerenes have the potential to supersede photosensitizers in current clinical use in PDT for some conditions (Photochem. Photobiol. Sci. 2007;6:1139-49).

In 2009, Yin et al. showed that three different functionalized water-soluble fullerenes can intercept and protect cells against all of the primary physiologically important ROS and can efficiently suppress lipid peroxidation in vitro. The findings suggest the potential of fullerene derivatives as effective cytoprotective therapeutic agents (Biomaterials. 2009;30:611-21), the researchers wrote.

Conclusion

The discovery of the fullerene family has stimulated widespread research in chemistry and biology for a broad range of therapeutic applications. Anti-inflammatory, antioxidant, and antiviral activities have been linked to these compounds. In addition, fullerenes appear to be effective in drug and gene delivery and as an adjunct in acne therapy. The compounds have shown potential as photoprotectants as well as photosensitizers, which may be useful in photodynamic therapy. More research is needed, but the potential applications of fullerenes in dermatology are promising, particularly as potent antioxidants conferring skin protection.

Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

Discovered in nature in 1985 (Science 1992;257:215-7), fullerenes are novel, classically engineered chemical compounds composed only of carbon atoms. The stable form, a third carbon allotrope, is a molecule made up of 60 carbon atoms in a structure resembling a soccer ball or geodesic dome, although some fullerenes are ellipsoid or tube shaped. In fact, fullerene C(60), the first of the group of compounds to be discovered, is also known as buckminsterfullerene, based on Buckminster Fuller’s geodesic dome. The carbon nanotube structure, composed of thin carbon filaments (1-3 mcm in length and 1-3 nm in diameter) and possessing a wide range of mechanical characteristics, was discovered in 1991 (J. Nanosci. Nanotechnol. 2006;6:591-9).

The potential applications of C(60) and fullerene derivatives have been extensively studied, and recent data suggest that fullerenes exhibit potent antioxidant activity, even acting as a "free radical sponge" (Bioorg. Med. Chem. Lett. 2006;16:1590-5; Biomaterials 2008;29:3561-73). Therefore, fullerenes may be appropriate active ingredients for various skin care products, particularly rejuvenation products (Recent Pat. Biotechnol. 2011;5:67-73; Recent. Pat. Biotechnol. 2009;3:118-23).

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

Early studies

In one of the early studies of topical applications of fullerenes (C60), Nelson et al. examined the potential acute and subchronic toxic effects of fullerenes (200 mcg) applied in benzene on mouse skin. After 72 hours, they observed no effect on either DNA synthesis or ornithine decarboxylase activity. A skin tumor initiation model using 7,12-dimethylbenzanthracene (DMBA) failed to show benign or malignant skin tumor formation, but promotion using 12-O-tetradecanoyl-phorbol-13-acetate (TPA) resulted in benign skin tumors. The investigators concluded that fullerenes applied in benzene at a likely industrial exposure level did not cause acute toxic effects in mice (Toxicol. Ind. Health. 1993;9:623-30).

In 1997, Tabata et al., noted that fullerene C(60) efficiently generates singlet oxygen when irradiated with light, and found that polyethylene glycol (PEG)-modified C60 exhibits potential as an agent for photodynamic tumor therapy (Jpn. J. Cancer Res. 1997;88:1108-16).

Antiviral capacity

Fullerenes exhibit unique chemical and physical properties, including photodynamic characteristics and a hydrophobic spheroid and radical sponge quality. They also display antiviral activity, particularly in relation to HIV, and their potential commercial applications include use in patent-pending anticancer drug delivery systems employing photodynamic therapy (PDT), HIV drugs, and antiaging cosmetics (Int. J. Nanomedicine 2007;2:639-49).

Anti-inflammatory activity

An anti-inflammatory role has also been identified for fullerenes. Ryan et al. noted that preincubation with C(60) resulted in significant suppression of IgE-dependent mediator release in human mast cells and peripheral blood basophils. IgE-induced increases in cytoplasmic reactive oxygen species (ROS) levels was also hindered by preincubation with fullerenes. Using a mast cell–dependent anaphylaxis model, Ryan and colleagues also found that fullerenes prevented the in vivo release of histamine and fall in core body temperature. They concluded that fullerenes might suggest an innovative approach to managing mast cell–dependent conditions such as asthma, heart disease, inflammatory arthritis, and multiple sclerosis (J. Immunol. 2007;179(1):665-72).

Antimicrobial potential

In 2005, Tegos et al. compared the antimicrobial activity of six C(60) compounds functionalized with one, two, or three hydrophilic or cationic groups combined with white light against gram-positive and negative bacteria, and fungi. They found that following 10 minutes of incubation, bis- and tris-cationic fullerenes actively eliminated all tested microbes while leaving mammalian cells comparatively intact. The investigators also noted that the fullerene compounds were significantly more effective than a widely used antimicrobial photosensitizer, toluidine blue O. They concluded that the compounds warrant consideration as photosensitizers for antimicrobial use given their high selectivity and efficacy (Chem. Biol. 2005;12(10):1127-35).

Potent antioxidant

In 2006, Xiao et al. reported on their development of the Radical Sponge, a fullerene entrapped in polyvinylpyrrolidone to yield a water-soluble derivative with a mean particle diameter of about 688 nm and reactive oxygen species (ROS) scavenging abilities. The researchers repeatedly irradiated human skin keratinocytes (HaCaT) with visible light (400-2,000 nm) in the presence or absence of Radical Sponge, with no photocytotoxicity apparent in the Radical Sponge–exposed cells. In addition, the water-soluble fullerene derivative displayed a cytoprotective effect (10-40 mcM doses) against UVA exposure (30 J/cm²) when it was administered prior to exposure and rinsed out immediately before the irradiation, more so than when administered only during or after irradiation. The researchers concluded that this finding suggested more of a preventive as opposed to therapeutic effect conferred by Radical Sponge against UVA damage (Bioorg. Med. Chem. Lett. 2006;16:1590-5).

In a subsequent study, the researchers compared the Radical Sponge with two whitening agents and found the fullerene to have imparted stronger antimelanogenic activity, possibly due to down-regulation of the tyrosinase expression promoted by UVA-induced ROS generation (Arch. Dermatol. Res. 2007;299(5-6):245-57).

More recently, Kato et al. demonstrated the antioxidant activity of C(60) incorporated into liposomes, with persistent scavenging of hydroxyl radicals and cytoprotection of keratinocytes against UVA- and UVB-induced damage ascribed to the fullerene component (J. Nanosci. Nanotechnol. 2011;11(5):3814-23).

Safety

The first study establishing the safety of highly purified fullerenes (HPFs) as an additive in cosmeceuticals was conducted in 2009. Aoshima et al. performed in vivo tests in animals and in vitro examinations using human epidermal keratinocytes and fibroblasts. No primary or cumulative skin irritation, sensitization, photosensitization, or contact phototoxicity was observed. In the patch test on human skin, no reaction was noted. HPFs were deemed to be "minimally irritating" after the eye-irritation test in rabbits. The investigators concluded, based on their findings and in light of previously published data, that HPFs are safe for human skin as ingredients in cosmetic skin care formulations (J. Toxicol. Sci. 2009;34(5):555-62).

Hair regrowth

In 2009, Zhou et al. used shaved mice and SKH-1 hairless mice to study whether fullerene-based compounds could elicit hair growth. Fullerenes were found to significantly increase the hair growth rate compared with a placebo vehicle. Significantly increased numbers of hair follicles were also observed in SKH-1 hairless mice treated topically or subdermally with fullerenes. Cultured human skin treated with fullerenes also showed augmented hair growth. The data suggested implications for hair loss due to alopecia, chemotherapy, or other chemical reactions (Nanomedicine 2009;5:202-7).

Antiacne properties

In 2011, Inui et al. conducted an open trial of effects of fullerene gel on acne. Subjects used the gel twice daily, and significant reductions in the mean number of inflammatory lesions were noted at 4 and 8 weeks of treatment. In addition, the researchers conducted in vitro assays of sebum production in hamster sebocytes and found that 75 mcM polyvinylpyrrolidone-fullerene suppressed sebum production, suggesting that topical fullerenes inhibit acne by reducing neutrophil infiltration and sebum production (Nanomedicine 2011;7:238-41).

Water solubility and photodynamic activity

In 2007, Mroz et al. compared the photodynamic activity of six fullerenes functionalized to become soluble with 1, 2, or 3 hydrophilic or 1, 2, or 3 cationic groups in three mouse cancer cell lines (J774, LLC, and CT26) incubated for 24 hours with fullerenes and illuminated with white light. They found that some functionalized fullerenes (particularly monopyrrolidinium fullerene) induced apoptosis in all cancer lines (Free Radic. Biol. Med. 2007;43:711-9). In a subsequent study, Mroz et al. found that some fullerenes can be functionalized to photoinactivate pathogenic malignant cancer cells and/or microbial cells in a mechanism that involves superoxide anion and singlet oxygen. The researchers suggested that fullerenes have the potential to supersede photosensitizers in current clinical use in PDT for some conditions (Photochem. Photobiol. Sci. 2007;6:1139-49).

In 2009, Yin et al. showed that three different functionalized water-soluble fullerenes can intercept and protect cells against all of the primary physiologically important ROS and can efficiently suppress lipid peroxidation in vitro. The findings suggest the potential of fullerene derivatives as effective cytoprotective therapeutic agents (Biomaterials. 2009;30:611-21), the researchers wrote.

Conclusion

The discovery of the fullerene family has stimulated widespread research in chemistry and biology for a broad range of therapeutic applications. Anti-inflammatory, antioxidant, and antiviral activities have been linked to these compounds. In addition, fullerenes appear to be effective in drug and gene delivery and as an adjunct in acne therapy. The compounds have shown potential as photoprotectants as well as photosensitizers, which may be useful in photodynamic therapy. More research is needed, but the potential applications of fullerenes in dermatology are promising, particularly as potent antioxidants conferring skin protection.

Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.

Courtesy Wikimedia Commons/Jynto/Creative Commons Licesnse

MIAMI BEACH – ATX-101, an investigational injectable deoxycholic acid, is safe and effective for the non-surgical reduction of submental fat, according to interim findings from a 12-month phase IIIb open-label study.

At 3-month follow-up after their last treatment, 87% and 83% of 165 study participants achieved at least a 1-point improvement on the clinician and patient submental fat rating scales, respectively, Dr. Susan Weinkle reported during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology.

"That is major," Dr. Weinkle, a dermatologist in private practice in Bradenton, Fla., said of the patients’ rating scale scores.

Patients reported feeling less bothered by, and self-conscious about, their submental fat, and they also reported feeling younger. Most – about 96% – experienced unchanged or improved skin laxity in the treated area.

"Many, despite the fact that their body mass index stayed the same, actually felt like they looked like they had lost weight ... let me tell you, they were very, very happy," she said.

In fact, 94% reported being happy they had the procedure.

The study participants were men and women of varying ages, races, and Fitzpatrick skin types, who were dissatisfied with their appearance associated with the chin region. All had submental fat scale scores of 2 to 4 on both clinician and patient rating scales, had stable weight, and had received no prior treatments to the submental fat region. They received up to 6 treatments, at 4-week intervals, with ATX-101 at a dosage of 2 mg/cm². Injections were administered with a 30-gauge needle, and "little microinjections at 2 mm areas across the submental region," Dr. Weinkle said, noting that the number of injections was tailored as the fat decreased over time.

Treatments were provided at 21 sites across the United States.

Treatment-related adverse events occurred in more than 91% of patients, but these were mainly mild-to-moderate injection site hematomas, numbness, pain, edema, and erythema – and all were transient, she said

No changes in blood lipids occurred.

This "really exciting research" suggests that ATX-101, a synthetically derived product that has been shown to destroy and eliminate fat through adipocytolysis, "may very well provide, in the future, an approach to submental fat for our patients who are so unhappy with this part of their body," she said.

"This is an important thing to people, and it makes a huge difference ... if [ATX-101] has the opportunity to come to market, it will make a big impact for our patients," she added.

To date, between 2,000 and 3,000 patients have been studied, including 1,500 who have received active treatment, and 1,500 who received placebo. Patients in the current study will be followed out to 12 months, she said.

This study was funded by Kythera. Dr. Weinkle disclosed that she worked with Kythera as an investigator for the study.

MIAMI BEACH – ATX-101, an investigational injectable deoxycholic acid, is safe and effective for the non-surgical reduction of submental fat, according to interim findings from a 12-month phase IIIb open-label study.

At 3-month follow-up after their last treatment, 87% and 83% of 165 study participants achieved at least a 1-point improvement on the clinician and patient submental fat rating scales, respectively, Dr. Susan Weinkle reported during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology.

"That is major," Dr. Weinkle, a dermatologist in private practice in Bradenton, Fla., said of the patients’ rating scale scores.

Patients reported feeling less bothered by, and self-conscious about, their submental fat, and they also reported feeling younger. Most – about 96% – experienced unchanged or improved skin laxity in the treated area.

"Many, despite the fact that their body mass index stayed the same, actually felt like they looked like they had lost weight ... let me tell you, they were very, very happy," she said.

In fact, 94% reported being happy they had the procedure.

The study participants were men and women of varying ages, races, and Fitzpatrick skin types, who were dissatisfied with their appearance associated with the chin region. All had submental fat scale scores of 2 to 4 on both clinician and patient rating scales, had stable weight, and had received no prior treatments to the submental fat region. They received up to 6 treatments, at 4-week intervals, with ATX-101 at a dosage of 2 mg/cm². Injections were administered with a 30-gauge needle, and "little microinjections at 2 mm areas across the submental region," Dr. Weinkle said, noting that the number of injections was tailored as the fat decreased over time.

Treatments were provided at 21 sites across the United States.

Treatment-related adverse events occurred in more than 91% of patients, but these were mainly mild-to-moderate injection site hematomas, numbness, pain, edema, and erythema – and all were transient, she said

No changes in blood lipids occurred.

This "really exciting research" suggests that ATX-101, a synthetically derived product that has been shown to destroy and eliminate fat through adipocytolysis, "may very well provide, in the future, an approach to submental fat for our patients who are so unhappy with this part of their body," she said.

"This is an important thing to people, and it makes a huge difference ... if [ATX-101] has the opportunity to come to market, it will make a big impact for our patients," she added.

To date, between 2,000 and 3,000 patients have been studied, including 1,500 who have received active treatment, and 1,500 who received placebo. Patients in the current study will be followed out to 12 months, she said.

This study was funded by Kythera. Dr. Weinkle disclosed that she worked with Kythera as an investigator for the study.

MIAMI BEACH – ATX-101, an investigational injectable deoxycholic acid, is safe and effective for the non-surgical reduction of submental fat, according to interim findings from a 12-month phase IIIb open-label study.

At 3-month follow-up after their last treatment, 87% and 83% of 165 study participants achieved at least a 1-point improvement on the clinician and patient submental fat rating scales, respectively, Dr. Susan Weinkle reported during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology.

"That is major," Dr. Weinkle, a dermatologist in private practice in Bradenton, Fla., said of the patients’ rating scale scores.

Patients reported feeling less bothered by, and self-conscious about, their submental fat, and they also reported feeling younger. Most – about 96% – experienced unchanged or improved skin laxity in the treated area.

"Many, despite the fact that their body mass index stayed the same, actually felt like they looked like they had lost weight ... let me tell you, they were very, very happy," she said.

In fact, 94% reported being happy they had the procedure.

The study participants were men and women of varying ages, races, and Fitzpatrick skin types, who were dissatisfied with their appearance associated with the chin region. All had submental fat scale scores of 2 to 4 on both clinician and patient rating scales, had stable weight, and had received no prior treatments to the submental fat region. They received up to 6 treatments, at 4-week intervals, with ATX-101 at a dosage of 2 mg/cm². Injections were administered with a 30-gauge needle, and "little microinjections at 2 mm areas across the submental region," Dr. Weinkle said, noting that the number of injections was tailored as the fat decreased over time.

Treatments were provided at 21 sites across the United States.

Treatment-related adverse events occurred in more than 91% of patients, but these were mainly mild-to-moderate injection site hematomas, numbness, pain, edema, and erythema – and all were transient, she said

No changes in blood lipids occurred.

This "really exciting research" suggests that ATX-101, a synthetically derived product that has been shown to destroy and eliminate fat through adipocytolysis, "may very well provide, in the future, an approach to submental fat for our patients who are so unhappy with this part of their body," she said.

"This is an important thing to people, and it makes a huge difference ... if [ATX-101] has the opportunity to come to market, it will make a big impact for our patients," she added.

To date, between 2,000 and 3,000 patients have been studied, including 1,500 who have received active treatment, and 1,500 who received placebo. Patients in the current study will be followed out to 12 months, she said.

This study was funded by Kythera. Dr. Weinkle disclosed that she worked with Kythera as an investigator for the study.

Carolyn Jacob, MD

Hyperhidrosis is the production of sweat above and beyond normal physiological needs, regardless of the ambient temperature, and it affects >4% of the population. In addition, a poll showed up to 21% of the population is bothered on a daily basis by their amount of underarm sweating. Despite the large number of patients who suffer from hyperhidrosis, there are relatively few effective nonsurgical treatment options. A new, nonsurgical, lasting treatment for axillary hyperhidrosis has now been developed using microwave technology to eliminate sweat glands.

*For a PDF of the full article, click on the link to the left of this introduction.

Carolyn Jacob, MD

Hyperhidrosis is the production of sweat above and beyond normal physiological needs, regardless of the ambient temperature, and it affects >4% of the population. In addition, a poll showed up to 21% of the population is bothered on a daily basis by their amount of underarm sweating. Despite the large number of patients who suffer from hyperhidrosis, there are relatively few effective nonsurgical treatment options. A new, nonsurgical, lasting treatment for axillary hyperhidrosis has now been developed using microwave technology to eliminate sweat glands.

*For a PDF of the full article, click on the link to the left of this introduction.

Carolyn Jacob, MD

Hyperhidrosis is the production of sweat above and beyond normal physiological needs, regardless of the ambient temperature, and it affects >4% of the population. In addition, a poll showed up to 21% of the population is bothered on a daily basis by their amount of underarm sweating. Despite the large number of patients who suffer from hyperhidrosis, there are relatively few effective nonsurgical treatment options. A new, nonsurgical, lasting treatment for axillary hyperhidrosis has now been developed using microwave technology to eliminate sweat glands.

*For a PDF of the full article, click on the link to the left of this introduction.

Robert A. Weiss, MD, FAAD, FACPh

The medical use of radio frequency (RF) is based on an oscillating electrical current forcing collisions between charged molecules and ions, which are then transformed into heat. RF heating occurs irrespective of chromophore or skin type and is not dependent on selective photothermolysis. RF can be delivered using monopolar, bipolar, and unipolar devices, and each method has theoretical limits of depth penetration. A variant of bipolar delivery is fractional RF delivery. In monopolar configurations, RF will penetrate deeply and return via a grounding electrode. Multiple devices are available and are detailed later in the text. RF thermal stimulation is believed to result in a microinflammatory process that promotes new collagen. By manipulating skin cooling, RF can also be used for heating and reduction of fat. Currently, the most common uses of RF-based devices are to noninvasively manage and treat skin tightening of lax skin (including sagging jowls, abdomen, thighs, and arms), as well as wrinkle reduction, cellulite improvement, and body contouring.

*For a PDF of the full article, click on the link to the left of this introduction.

Robert A. Weiss, MD, FAAD, FACPh

The medical use of radio frequency (RF) is based on an oscillating electrical current forcing collisions between charged molecules and ions, which are then transformed into heat. RF heating occurs irrespective of chromophore or skin type and is not dependent on selective photothermolysis. RF can be delivered using monopolar, bipolar, and unipolar devices, and each method has theoretical limits of depth penetration. A variant of bipolar delivery is fractional RF delivery. In monopolar configurations, RF will penetrate deeply and return via a grounding electrode. Multiple devices are available and are detailed later in the text. RF thermal stimulation is believed to result in a microinflammatory process that promotes new collagen. By manipulating skin cooling, RF can also be used for heating and reduction of fat. Currently, the most common uses of RF-based devices are to noninvasively manage and treat skin tightening of lax skin (including sagging jowls, abdomen, thighs, and arms), as well as wrinkle reduction, cellulite improvement, and body contouring.

*For a PDF of the full article, click on the link to the left of this introduction.

Robert A. Weiss, MD, FAAD, FACPh

The medical use of radio frequency (RF) is based on an oscillating electrical current forcing collisions between charged molecules and ions, which are then transformed into heat. RF heating occurs irrespective of chromophore or skin type and is not dependent on selective photothermolysis. RF can be delivered using monopolar, bipolar, and unipolar devices, and each method has theoretical limits of depth penetration. A variant of bipolar delivery is fractional RF delivery. In monopolar configurations, RF will penetrate deeply and return via a grounding electrode. Multiple devices are available and are detailed later in the text. RF thermal stimulation is believed to result in a microinflammatory process that promotes new collagen. By manipulating skin cooling, RF can also be used for heating and reduction of fat. Currently, the most common uses of RF-based devices are to noninvasively manage and treat skin tightening of lax skin (including sagging jowls, abdomen, thighs, and arms), as well as wrinkle reduction, cellulite improvement, and body contouring.

*For a PDF of the full article, click on the link to the left of this introduction.

Jennifer L. MacGregor, MD, and Elizabeth L. Tanzi, MD

The demand for noninvasive skin tightening procedures is increasing as patients seek safe and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over the past decade, radiofrequency and infrared laser devices have been popularized owing to their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect modest tissue tightening with minimal recovery. However, these less invasive approaches are historically associated with inferior efficacy so that surgery still remains the treatment of choice to address moderate to severe tissue laxity. Microfocused ultrasound was recently introduced as a novel energy modality for transcutaneous heat delivery that reaches the deeper subdermal connective tissue in tightly focused zones at consistent programmed depths. The goal is to produce a deeper wound healing response at multiple levels with robust collagen remodeling and a more durable clinical response. The Ulthera device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been adapted specifically for skin tightening and lifting with little recovery or risk of complications since its introduction in 2009. As clinical parameters are studied and optimized, enhanced efficacy and consistency of clinical improvement is expected.

*For a PDF of the full article, click on the link to the left of this introduction.

Jennifer L. MacGregor, MD, and Elizabeth L. Tanzi, MD

The demand for noninvasive skin tightening procedures is increasing as patients seek safe and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over the past decade, radiofrequency and infrared laser devices have been popularized owing to their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect modest tissue tightening with minimal recovery. However, these less invasive approaches are historically associated with inferior efficacy so that surgery still remains the treatment of choice to address moderate to severe tissue laxity. Microfocused ultrasound was recently introduced as a novel energy modality for transcutaneous heat delivery that reaches the deeper subdermal connective tissue in tightly focused zones at consistent programmed depths. The goal is to produce a deeper wound healing response at multiple levels with robust collagen remodeling and a more durable clinical response. The Ulthera device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been adapted specifically for skin tightening and lifting with little recovery or risk of complications since its introduction in 2009. As clinical parameters are studied and optimized, enhanced efficacy and consistency of clinical improvement is expected.

*For a PDF of the full article, click on the link to the left of this introduction.

Jennifer L. MacGregor, MD, and Elizabeth L. Tanzi, MD

The demand for noninvasive skin tightening procedures is increasing as patients seek safe and effective alternatives to aesthetic surgical procedures of the face, neck, and body. Over the past decade, radiofrequency and infrared laser devices have been popularized owing to their ability to deliver controlled heat to the dermis, stimulate neocollagenesis, and effect modest tissue tightening with minimal recovery. However, these less invasive approaches are historically associated with inferior efficacy so that surgery still remains the treatment of choice to address moderate to severe tissue laxity. Microfocused ultrasound was recently introduced as a novel energy modality for transcutaneous heat delivery that reaches the deeper subdermal connective tissue in tightly focused zones at consistent programmed depths. The goal is to produce a deeper wound healing response at multiple levels with robust collagen remodeling and a more durable clinical response. The Ulthera device (Ulthera, Inc, Meza, AZ), with refined microfocused ultrasound technology, has been adapted specifically for skin tightening and lifting with little recovery or risk of complications since its introduction in 2009. As clinical parameters are studied and optimized, enhanced efficacy and consistency of clinical improvement is expected.

*For a PDF of the full article, click on the link to the left of this introduction.

Nazanin Saedi, MD, and Michael Kaminer, MD

With the rising demand for body contouring, noninvasive devices for fat reduction have become increasingly popular and have grown dramatically over the past decade. Highintensity focused ultrasound (HIFU) has been used for nearly half a century for the noninvasive treatment of tumors of various organs, but has only recently been evaluated as a method for the selective destruction of adipose tissue. HIFU works by ablating subcutaneous adipose tissue and causing molecular vibrations that increase the temperature of local tissue and induce rapid cell necrosis. Several studies reveal the safety and efficacy of HIFU for fat reduction in the abdomen and the flanks. These studies indicate consistent reduction in abdominal circumference >2 cm after a single treatment. The adverse events are limited to transient tenderness, bruising, and edema. Increased utility of HIFU for fat reduction will likely increase over time.

*For a PDF of the full article, click on the link to the left of this introduction.

Nazanin Saedi, MD, and Michael Kaminer, MD

With the rising demand for body contouring, noninvasive devices for fat reduction have become increasingly popular and have grown dramatically over the past decade. Highintensity focused ultrasound (HIFU) has been used for nearly half a century for the noninvasive treatment of tumors of various organs, but has only recently been evaluated as a method for the selective destruction of adipose tissue. HIFU works by ablating subcutaneous adipose tissue and causing molecular vibrations that increase the temperature of local tissue and induce rapid cell necrosis. Several studies reveal the safety and efficacy of HIFU for fat reduction in the abdomen and the flanks. These studies indicate consistent reduction in abdominal circumference >2 cm after a single treatment. The adverse events are limited to transient tenderness, bruising, and edema. Increased utility of HIFU for fat reduction will likely increase over time.

*For a PDF of the full article, click on the link to the left of this introduction.

Nazanin Saedi, MD, and Michael Kaminer, MD

With the rising demand for body contouring, noninvasive devices for fat reduction have become increasingly popular and have grown dramatically over the past decade. Highintensity focused ultrasound (HIFU) has been used for nearly half a century for the noninvasive treatment of tumors of various organs, but has only recently been evaluated as a method for the selective destruction of adipose tissue. HIFU works by ablating subcutaneous adipose tissue and causing molecular vibrations that increase the temperature of local tissue and induce rapid cell necrosis. Several studies reveal the safety and efficacy of HIFU for fat reduction in the abdomen and the flanks. These studies indicate consistent reduction in abdominal circumference >2 cm after a single treatment. The adverse events are limited to transient tenderness, bruising, and edema. Increased utility of HIFU for fat reduction will likely increase over time.

*For a PDF of the full article, click on the link to the left of this introduction.

H. Ray Jalian, MD, and Mathew M. Avram, MD, JD

Dermatologists have long used cold-based therapeutic approaches for a variety of applications. Based on the differences in chemical composition, it is possible to selectively target certain tissues rich with lipid, while sparing the surrounding tissue predominantly containing water. With historical observations of cold-induced panniculitis suggesting the feasibility of this strategy, cryolipolysis has emerged as a new methodology using controlled cooling to selectively target fat. Both preclinical and clinical studies have established the safety and efficacy of cryolipolysis for noninvasive body contouring. This review will focus on the evolution of cryolipolysis from initial case reports of cold-induced panniculitis, to preclinical and clinical studies, and the current clinical practice.

*For a PDF of the full article, click on the link to the left of this introduction.

H. Ray Jalian, MD, and Mathew M. Avram, MD, JD

Dermatologists have long used cold-based therapeutic approaches for a variety of applications. Based on the differences in chemical composition, it is possible to selectively target certain tissues rich with lipid, while sparing the surrounding tissue predominantly containing water. With historical observations of cold-induced panniculitis suggesting the feasibility of this strategy, cryolipolysis has emerged as a new methodology using controlled cooling to selectively target fat. Both preclinical and clinical studies have established the safety and efficacy of cryolipolysis for noninvasive body contouring. This review will focus on the evolution of cryolipolysis from initial case reports of cold-induced panniculitis, to preclinical and clinical studies, and the current clinical practice.

*For a PDF of the full article, click on the link to the left of this introduction.

H. Ray Jalian, MD, and Mathew M. Avram, MD, JD

Dermatologists have long used cold-based therapeutic approaches for a variety of applications. Based on the differences in chemical composition, it is possible to selectively target certain tissues rich with lipid, while sparing the surrounding tissue predominantly containing water. With historical observations of cold-induced panniculitis suggesting the feasibility of this strategy, cryolipolysis has emerged as a new methodology using controlled cooling to selectively target fat. Both preclinical and clinical studies have established the safety and efficacy of cryolipolysis for noninvasive body contouring. This review will focus on the evolution of cryolipolysis from initial case reports of cold-induced panniculitis, to preclinical and clinical studies, and the current clinical practice.

*For a PDF of the full article, click on the link to the left of this introduction.

Mark S. Nestor, MD, PhD, Jessica Newburger, DO, and Matthew B. Zarraga, DO

Noninvasive body contouring has become one of the fastest-growing areas of esthetic medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm lowlevel laser therapy (LLLT) has been used in the treatment of a variety of medical conditions and has been shown to improve wound healing, reduce edema, and relieve acute pain. Within the past decade, LLLT has also emerged as a new modality for noninvasive body contouring. Research has shown that LLLT is effective in reducing overall body circumference measurements of specifically treated regions, including the hips, waist, thighs, and upper arms, with recent studies demonstrating the long-term effectiveness of results. The treatment is painless, and there appears to be no adverse events associated with LLLT. The mechanism of action of LLLT in body contouring is believed to stem from photoactivation of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular secondary cascades, resulting in the formation of transitory pores within the adipocytes
membrane. The secondary cascades involved may include, but are not limited to, activation of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which are further metabolized. Future studies need to fully outline the cellular and systemic effects of LLLT as well as determine optimal treatment protocols.

*For a PDF of the full article, click on the link to the left of this introduction.

Mark S. Nestor, MD, PhD, Jessica Newburger, DO, and Matthew B. Zarraga, DO

Noninvasive body contouring has become one of the fastest-growing areas of esthetic medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm lowlevel laser therapy (LLLT) has been used in the treatment of a variety of medical conditions and has been shown to improve wound healing, reduce edema, and relieve acute pain. Within the past decade, LLLT has also emerged as a new modality for noninvasive body contouring. Research has shown that LLLT is effective in reducing overall body circumference measurements of specifically treated regions, including the hips, waist, thighs, and upper arms, with recent studies demonstrating the long-term effectiveness of results. The treatment is painless, and there appears to be no adverse events associated with LLLT. The mechanism of action of LLLT in body contouring is believed to stem from photoactivation of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular secondary cascades, resulting in the formation of transitory pores within the adipocytes
membrane. The secondary cascades involved may include, but are not limited to, activation of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which are further metabolized. Future studies need to fully outline the cellular and systemic effects of LLLT as well as determine optimal treatment protocols.

*For a PDF of the full article, click on the link to the left of this introduction.

Mark S. Nestor, MD, PhD, Jessica Newburger, DO, and Matthew B. Zarraga, DO

Noninvasive body contouring has become one of the fastest-growing areas of esthetic medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm lowlevel laser therapy (LLLT) has been used in the treatment of a variety of medical conditions and has been shown to improve wound healing, reduce edema, and relieve acute pain. Within the past decade, LLLT has also emerged as a new modality for noninvasive body contouring. Research has shown that LLLT is effective in reducing overall body circumference measurements of specifically treated regions, including the hips, waist, thighs, and upper arms, with recent studies demonstrating the long-term effectiveness of results. The treatment is painless, and there appears to be no adverse events associated with LLLT. The mechanism of action of LLLT in body contouring is believed to stem from photoactivation of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular secondary cascades, resulting in the formation of transitory pores within the adipocytes
membrane. The secondary cascades involved may include, but are not limited to, activation of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which are further metabolized. Future studies need to fully outline the cellular and systemic effects of LLLT as well as determine optimal treatment protocols.

*For a PDF of the full article, click on the link to the left of this introduction.