Jason Keller Rivers

BACKGROUND: Botulinum neurotoxins in aesthetic medicine require reconstitution, which may cause administration errors. OBJECTIVE: To evaluate liquid nivobotulinumtoxinA treatment of lateral canthal lines (LCL) and glabellar lines (GL). MATERIALS AND METHODS: Participants with moderate-to-severe LCL with/without moderate-to-severe GL were enrolled in 2 double-blind randomized clinical trials. Study 002 participants received nivobotulinumtoxinA 24 U or placebo for LCL treatment. Study 006 participants received nivobotulinumtoxinA 24 U (LCL), nivobotulinumtoxinA 44 U (LCL+GL), or placebo. Each study allowed up to 2 additional doses. The composite primary end point was the proportion of participants achieving ≥2-grade improvement on the Facial Wrinkle Scale (FWS) by investigator and participant assessment at maximum smile; the coprimary end point was investigator- and participant-assessed FWS “none or mild” rating. RESULTS: At Day 30, significant responder rates versus placebo were observed for LCL in Study 002 (30.3% vs 2.6%, p < .001) and for LCL and LCL+GL in Study 006 (20.6% and 22.8% vs 0%, p < .001) for the composite end point. “None or mild” investigator/participant assessment of LCL (Study 002: 62.7%/56.5%; Study 006: 56.4%/43.6%) and LCL+GL (60.8%/47.3%) were significantly higher versus placebo ( p < .001). Headache was the most common adverse event. CONCLUSION: Liquid nivobotulinumtoxinA was effective and well-tolerated for treating moderate-to-severe LCL with/without GL.

BACKGROUND: Reduced bruising and swelling after aesthetic procedures accelerates recovery. Arnica montana is widely used by physicians and promoted on social media, although its efficacy in aesthetic medicine remains uncertain. OBJECTIVE: To evaluate the validity of social media claims regarding Arnica's therapeutic benefits, focusing on aesthetic injectable procedures. MATERIALS AND METHODS: Social media platforms, TikTok and Reddit, were searched on April 24, 2024, covering a 2-year period, using terms: “arnica montana,” “arnica,” “arnica filler,” “arnica botox,” and “arnica gel.” A literature review was conducted using OVID Medline and Embase databases with keywords “arnica” and “arnica montana.” RESULTS: A total of 48 TikTok posts and 305 Reddit entries were identified; with 91.7% and 58% of posts, respectively, endorsing Arnica use, primarily without scientific evidence. The literature review revealed limited and mixed evidence for Arnica's efficacy, with only 1 study addressing dermatologic injectable procedures. Systematic reviews indicated a small effect size for Arnica in surgical settings, with no specific focus on dermatologic applications. CONCLUSION: Despite its popularity on social media and frequent use by health care providers, scientific evidence supporting Arnica's efficacy in reducing bruising and swelling after aesthetic procedures remains inconclusive. Social media discussions predominantly supported Arnica use, with limited opposition noted.

Background: Panfacial treatment has the potential to positively impact psychosocial and emotional well-being. Objectives: The Canada HARMONY study evaluated the satisfaction and psychosocial impact of comprehensive, multimodal aesthetic treatment of the face and submental area from the patient perspective. Methods: Over 12 months, all patients (N = 58) sequentially received treatment with hyaluronic acid (HA) fillers, onabotulinumtoxinA, and medical-grade skincare products, and eligible patients (n = 13) also received ATX-101. The primary endpoint was the change from baseline on the FACE-Q Satisfaction with Facial Appearance Scale. Secondary endpoints included the following assessments: FACE-Q Expectations of Life Change, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales; Global Aesthetic Improvement Scale (GAIS); and the Periorbital Aesthetic Appearance Questionnaire (PAAQ). Safety was monitored throughout the study. Results: Baseline FACE-Q Expectations of Life Change scores indicated realistic treatment expectations. Significant improvements from baseline were observed on the FACE-Q Satisfaction with Facial Appearance, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales (P < .0001 for all endpoints). Most patients rated “much improved” on the GAIS. The mean PAAQ total score significantly improved from baseline by 32.6 (P < .0001). Most patients reported mild-to-moderate injection-site responses, which had a mean time to resolution of <14 days. Conclusions: Panfacial aesthetic treatment consisting of HA fillers, onabotulinumtoxinA, and ATX-101 improved patient-reported satisfaction, psychological function, social function, and aging appraisal across validated measures. Level of Evidence: 5 (Therapeutic):

BACKGROUND: RelabotulinumtoxinA (RelaBoNT-A) is a complex-free, ready-to-use, liquid botulinum toxin A. OBJECTIVE: Efficacy/safety of RelaBoNT-A treatment for lateral canthal lines (LCL). METHODS: Randomized adults received RelaBoNT-A (30 U/side; n = 230) or placebo (n = 73) during a 6-month, double-blind, Ph3 study (Relabotulinumtoxin Aesthetic Development Study-2 [READY-2]). Primary end points (Month 1, maximum smile) comprised: composite ≥2-grade responder rate using concurrent LCL severity investigator live assessment (LCL-ILA) and subject live assessment (LCL-SLA); LCL-ILA 0 (none)/1 (mild) responder rate. Subject satisfaction and adverse events were also reported. RESULTS: Month 1 composite ≥2-grade responder rates were 51.8% (RelaBoNT-A) and 1.4% (placebo; (p < .001). Month 1 none/mild LCL-ILA responder rates were 87.2% (RelaBoNT-A) and 11.9% (placebo; p < .001). Onset was reported Day 1 by 34%. At Month 6, LCL-ILA responder rates for RelaBoNT-A remained at 23.3% (none/mild) and 35.9% (≥1-grade improvement). Median return to baseline severity was 24.7 weeks; 64% (RelaBoNT-A group) had not returned to baseline at Month 6. RelaBoNT-A satisfaction was high through Month 6 (71%). Mild/moderate treatment-related adverse events occurred in 6.1% (RelaBoNT-A) and 5.5% (placebo). CONCLUSION: RelaBoNT-A (60 U) treatment provided statistically significant improvement of moderate-to-severe LCL. One-third of subjects reported onset within 1 day and improvements were maintained through Month 6. Treatment satisfaction was high. RelaBoNT-A was well tolerated.

Introduction: Fractional CO2 laser therapy is used to treat fibrosing conditions similar to Peyronie’s disease (PD). The aim of the study was to evaluate the safety and efficacy of using a fractional CO2 laser in the management of chronic phase PD. Methods: This was a single-site, non-randomized, open-label study using a fractional CO2 laser. Subjects underwent three treatment sessions every six weeks with a fractional CO2 device. Topical triamcinolone was applied immediately after each treatment. Between treatments, patients performed penile modeling three times daily. Penile curvature assessments, self-reported questionnaires, and adverse event screenings were completed at baseline, 24 weeks, and at 52 weeks. Results: Five patients were included in the study. The median baseline penile curvature was 37.0° (interquartile range [IQR] 33.0°, 53.0°), and at 52 weeks, this had reduced to a median curvature to 28.0° (IQR 17.50°, 44.0°, p=0.03), representing a median reduction in penile curvature by 24.3% (IQR 17.0%, 47.5%). The International Index of Erectile Function Overall scores were comparable at baseline and at 52 weeks (median: 59.0, IQR: 42.5, 66.5 vs. median: 60.0, IQR 53.5, 70.0 respectively, p=0.81). Patients did report significant improvement in overall Peyronies’ disease questionnaire (PDQ) scores from baseline to 52 weeks after laser treatment (median 26.0, IQR15.0, 29.5, vs. median: 14.0, IQR 7.0, 22.50, respectively, p=0.03). Four patients reported self-limiting side effects immediately after laser therapy that resolved spontaneously within two weeks. Conclusions: Fractional CO2 laser therapy may serve as a well-tolerated and minimally invasive therapy for PD in the future, with results at 52 weeks being encouraging.

Psychodermatology pertains to the relationship between the skin and brain. This review aims to summarize the evidence of the mind body connection in four psychophysiological conditions: rosacea, atopic dermatitis (AD), acne vulgaris (AV), and psoriasis. A literature search was conducted using several English language databases. All four conditions share similar psychiatric co-morbidities, including but not limited to anxiety, depression, and suicidality. In rosacea, the upregulation of transient receptor potential vanilloid type 1, Toll like receptor 2, and Th17 cells releases downstream products that are simultaneously implicated in mood disorders. Stress exacerbates AV through the hypothalamic-pituitary-adrenal (HPA) system, which alters functioning of sebocytes and Cutibacterium acnes. In AD and psoriasis, the HPA axis influences Th1, Th2, Th22, and Th1, Th17 immune mediated responses, respectively. This leads to the secretion of pro-inflammatory cytokines which are also involved in the pathogenesis of anxiety and depression. Neurotransmitters implicated in mental illness, such as gamma-aminobutyric acid and serotonin, may also play a role in the development of AD and psoriasis. The management of cutaneous disease may mitigate psychological distress, and future research may show the corollary to also be true.

Studies of predominantly White participants show that cryolipolysis reduces subcutaneous fat in the arms and inner thighs, but none have specifically tested for similar outcomes in participants of Chinese descent. This study assessed the safety and effectiveness of cryolipolysis treatment for noninvasive subcutaneous fat reduction of arms and inner thighs in participants of Chinese descent to assess equivalence to results seen in a prior study of White participants. Replicating a similar study design, participants of first- or second-generation Chinese descent underwent cryolipolysis treatment of arms and/or inner thighs. Effectiveness was assessed using pretreatment and posttreatment photographic review by blinded, independent experts, investigator-assessed caliper measurements, and participant satisfaction 12 weeks posttreatment. Safety was assessed throughout. Among 50 enrolled participants, 48 completed the study. The majority of participants (97.9%) were female, with a mean age of 36.0 years and mean BMI of 24.16 kg/m² (range 19.3-29.9 kg/m²). Overall, 76.4% and 70.0% of pretreatment photographs of arms and pairs of inner thighs, respectively, were correctly identified by at least 2 of 3 reviewers. The mean reduction from baseline in caliper-measured fat thickness was 6.5 mm for arms and 6.6 mm for inner thighs, and the majority of participants (>60%) were satisfied with the treatment. No adverse events were reported. Cryolipolysis is a well-tolerated, effective means of noninvasive fat reduction of arms and inner thighs in participants of Chinese descent. The results from this study show similar effectiveness and safety in Chinese participants compared with White participants treated in a prior study.

Background: Data suggest that hyaluronic acid (HA) fillers using VYC technology have a higher incidence of delayed‐onset nodule development at facial injection sites than earlier HA products.Objective: To assess the incidence of delayed‐onset nodules with VYC products based on a single experienced injector.Methods and Materials: Patients with delayed‐onset nodules after injections with VYC‐20L, VYC‐17.5L, and VYC‐15L were identified by retrospective chart review.Results: Since 2010, 2139 patients received injections from the same physician with combinations of VYC‐20L (57.6% of patients; 2.4 syringes/patient), VYC‐17.5L (23.9%; 1.5), or VYC‐15L (18.5%; 1.5). Seven female patients (mean age, 62 years) developed delayed‐onset nodules for an overall incidence of 0.33%. A potential inflammatory trigger (reported by 6 patients) occurred 1–168 days prior to nodule development. Nodule biopsy in 1 patient confirmed a foreign‐body granuloma. The most effective treatment incorporated prednisone with or without hyaluronidase, and in 2 patients, nodules resolved spontaneously. The incidence of delayed‐onset nodules was not associated with injection technique or amount of product used.Conclusion: VYC‐associated incidence of delayed‐onset nodules (0.33%) was lower than earlier estimates from previous studies. In the current analysis, VYC‐15L had a rate of delayed reactions comparable with non‐VYC products.