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Jan/Feb 2022 ❙ Volume 12 ❙ Issue 1

Jan/Feb 2022
❙
Volume 12 Issue 1

INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE

INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE

CORRECTING
THE GLUTEAL
REGION
WITH THREADS
AND FILLERS

CHIN FILLER
TREATMENTS
DIFFERENCES BETWEEN
MEN AND WOMEN

Treating post-inflammatory
hyperpigmentation
WITH A TYROSINASE-
INHIBITOR
prime-journal.com
 2022

AESTHETIC & ANTI-AGING MEDICINE WORLD CONGRESS

CELEBRATING THE

EDITION OF
AMWC MONACO
March 31 • April 1-2
Under the High
Patronage of H.S.H.
Prince Albert II
of Monaco

MONTE-CARLO,
MONACO
GRIMALDI FORUM

REGISTRATION CONTACT US

Following the success of our last edition, AMWC 2022 is back at the
Grimaldi Forum, Monaco and will be broadcasted live, worldwide.
Join us on March 31 to April 2, 2022 to celebrate the 20th edition of this
world leading aesthetic & anti-aging medicine congress.

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 ARTICLE | LIP ENHANCEMENTS | | EDITORIAL

W
ELCOME TO THE FIRST ISSUE OF 2022. USUALLY, IT IS THE TIME OF
year we would have attended IMCAS Paris to kick-off the conference
calendar but it seems Covid-19 has claimed another scalp and the event
has been postponed. However, it’s not all bad news; the Omicron wave
appears to be in decline across Europe and the US, while countries are
looking to continue with some semblance of normality and ditch
lockdowns and restrictions on movement. This is a huge boost for AMWC 2022, which will take
place in Monaco on March 31st and April 2nd, 2022. I attended the last conference in September
and can’t wait to return.
While the world looks to be returning to a new normal, it’s become clear how important
online tools and educational resources have become to almost every industry, particularly
aesthetic medicine. At PRIME Journal, we recognise this shift to online communities is here to
stay and have taken the opportunity to partner with the Aesthetic Multispecialty Society
(AMS), a new medical society providing an online platform full of features designed to
improve techniques and good practice in the field of Aesthetic Dermatology and Surgery.
Membership to the AMS is currently free and brings with it many benefits,

Aesthetic
including the ability to message and connect with other members, access to
scientific webinars and live demonstration videos, 20% off relevant books
from CRC Press and Routledge, collaboration tools, jobs and classified ads,
Multispecialty Society and discussion forums.
You can visit the website for more information or to become a free

Premium Members member: multispecialtysociety.com.

Turning to our current issue, we have some great aesthetic features for

will receive 20% off you to enjoy. Dr Grasiela Cássia Monteiro evaluates the changing
requirements and treatment strategies when searching for the ideal chin in
male and female patients. You can read all about it on page 16.
their delegate pass to Next, we look at the gluteal region as Natalia Markova, Svetlana Pervykh,
Eliska Kubiková, and colleagues discuss their novel non-surgical technique

AMWC 2022. for addressing this problem area. Find out more on page 20.
Looking to skin concerns and hyperpigmentation is certainly one of the
most common and all practitioners need a reliable, safe, and effective
Affiliated partners: remedy for their patients. Agneta Troilius Rubin, Zoi Tsaknakis, Adel
Sammain, and Laura Schmidt evaluate an isobutylamido thiazolyl resorcinol-containing
regimen’s efficacy and safety to improve melasma or PIH due to ablative laser treatments,
acne or sunburn. You can read the full article on page 28.
If you would like to attend AMWC Monaco in person this year, and I highly recommend
you do, be sure to book your place at euromedicom.com. Aesthetic Multispecialty Society
Premium Members will receive 20% off their delegate pass to AMWC 2022 as well as further
enhanced benefits, and you can sign up here: multispecialtysociety.com.
Delicious Flickr Twitter Retweet

Balraj Juttla
Editor, PRIME
[email protected]
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ing RENÉE
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Gels

AMWC 2022 ❚
Practice Man
agement Adv
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Jan/Feb 2022

FIND US ON TWITTER, FACEBOOK & LINKEDIN

❙
Volume 12 Issue
1

DIC INE
Cover image Stock.Adobe.com Retouching Linda Duong

GE ING ME
STH ETI C AN D AN TI-A
RNAL OF AE
IONAL JOU
INT ERNAT

Join PRIME’s editorial team for the latest updates in aesthetic and
Slash Dot anti-ageing
Mixx medicine, debates, and interaction withFlickr
Delicious
Skype your peers and
Technorati Twitter
TING
CORRECUT EAL
colleagues, conference information and special offers
THE GL
REGION S
WITH THREAD
AND FILLERS

CHIN FILLER

Follow usFollow us
TREATM ENTS

Search for Search for

CES BETWEEN
DIFFEREN EN
MEN AND WOM

flammat
post-inen
ory @PrimeJournal
@PrimeJournal Prime Journal Prime Journal
Treatinpger m tati o n
hy pig OSINASE-
s WITH A T Y R OR
Flickr Twitter Retweet
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4 January/February 2022 | prime-journal.com
EDITORIAL |

F
OLLOWING THE SUCCESS OF AMWC 2021, WE WILL BE HOSTING AMWC 2022
from March 31 to April 2 in a hybrid format to allow delegates from across the world
to join us on-site for the 20th edition of our world leading aesthetic & anti-ageing
International Journal of Aesthetic medicine congress or attend live-streamed sessions from wherever you are.
and Anti-Ageing Medicine Held under the High Patronage of H.S.H. Prince Albert II of Monaco, AMWC is proud
Informa, Floor 2, to be the world’s leading conference specializing in aesthetic and anti-ageing
5 Howick Place, London,
medicine and will celebrate its 20th anniversary.
SW1P 1WG, UK
ISSN 2159-8908 (print) Under the scientific supervision of the Aesthetic Multispecialty Society (AMS), AMWC features a
ISSN 2159-8916 (online) highly interactive, stimulating, and multidisciplinary programme tailored to entice the exchange of
ideas and expertise, discuss new experiences, educate and facilitate networking opportunities.
Editor Balraj Juttla Our Scientific Committee is composed of eminent, internationally recognized experts in plastic
[email protected]
surgery, aesthetic dermatology, and anti-ageing medicine. By attending, you will gain access to
Art Director David ‘Spike’ McCormack
[email protected] highly practical training and educational sessions on a diverse range of disciplines, including
Global Sales Manager Serena Allegrini aesthetic and functional dermatology, minimally invasive aesthetics, lasers and EBD’s, anti-ageing
[email protected] / +33 682 039 840
Digital Marketing Manager Pluto Luong
medicine and more. Additionally, you will get the chance to reinforce your understanding with
[email protected] countless live demonstrations and workshops.
Production & Ads Department Five reasons why you should attend:
[email protected]
■ AMWC is the world’s leading aesthetic & anti-ageing congress
Please send your manuscripts and press releases to:
[email protected] ■ The congress’s highly-quality programme is delivered by top KOLS and has been created under
All submitted manuscripts are evaluated on the basis the scientific supervision of the Aesthetic Multispecialty Society (AMS)
of scientific quality, originality, appropriateness,
contribution to the field and style. Suitable ■ AMWC is ideal for aesthetic medicine doctors looking to expand their practice and offer
manuscripts are subject to peer-review. Manuscripts patients a wider range of aesthetic treatment options
and accompanying files should be prepared in
accordance with our Author Guidelines, which are ■ Discover hundreds of innovative international companies showcasing their products and
available via www.prime-journal.com.
hosting workshops across our 5-floor exhibition area
All content © 2019 Informa UK Ltd
Images © Stock.adobe.com, unless otherwise stated
■ Keep up-to-date on the latest products technological advancements in the industry.
Typically, this highly anticipated annual event attracts over 12,000 participants from more
than 120 countries and hundreds of worldwide exhibitors to Monaco.
We look forward to welcoming you on-site in Monaco, or online via our digital platform from
wherever you are!

SUBSCRIPTION RATES
UK: £295
Europe: €370 AMWC Scientific and Organizing Committee
Rest of world: US$490
Paris, France

PRIME JOURNAL EDITORIAL BOARD

BOARD MEMBER SPECIALISM COUNTRY BOARD MEMBER SPECIALISM COUNTRY
Dr Claude Dalle Anti-ageing & aesth. medicine France Dr Gustavo Leibaschoff Cosmetic Surgery USA
Dr Wilmar Accursio Endocrinology Brazil Dr Sohail Mansoor Dermatology UK
Dr Firas Al-Niaimi Dermatology & laser surgery UK Prof Leonardo Marini Dermatology Italy
Dr Ashraf Badawi Dermatology Egypt & Canada Dr Sly Nedic Aesthetic & anti-ageing medicine South Africa
Dr Janethy Balakrishnan Aesthetic & anti-ageing medicine Malaysia Prof Daniel Pella Cardiology Slovakia
Dr Lakhdar Belhaouari Plastic surgery France Dr Chariya Petchngaovilai Dermatology Thailand
Dr Anthony Benedetto Cosmetic Dermatology USA Prof Ascanio Polimeni Neuro-endocrinology Italy
Dr Philippe Berros Oculoplastic surgery Monaco Dr Herve Raspaldo Facial plastic surgery France
Dr Dario Bertossi Maxillofacial surgery Italy Dr Christopher Rowland-Payne Dermatology UK
Dr Pierre Bouhanna Dermatology – Hair surgery France Dr Neil Sadick Dermatology USA
Dr Fahd Benslimane Plastic Surgery Morocco Dr Hema Sundaram Dermatology USA
Dr Claude Chauchard Anti-ageing medicine France Dr Pakpilai Thavisin Dermatology & Anti-ageing medicine Thailand
Dr Christophe de Jaeger Geriatrics France Dr Patrick Treacy Aesthetic surgery Ireland
Dr Gerd Gauglitz Aesthetic Dermatology Germany Dr Mario Trelles Plastic surgery Spain
Prof Ilaria Ghersetich Dermatology Italy Dr Ines Verner Dermatology Israel
Dr Michael H. Gold Dermatology USA Dr Octavio Viera Anti-ageing medicine Spain
Dr Kate Goldie Aesthetic Physician UK Dr Jean-Luc Vigneron Aesthetic dermatology France
Prof Eckart Haneke Dermatology Germany Prof Bernard Weber Genetics Luxembourg
Dr Steven Hopping Plastic surgery USA Dr Sabine Zenker Dermatology Germany
Prof Andreas Katsambas Dermatology Greece Catherine Decuyper Industry expert & consultant France
Dr Mario Krause Anti-ageing medicine Germany Wendy Lewis Industry expert USA
Dr Marina Landau Dermatology Israel Christophe Luino Industry expert & consultant France

6 January/February 2022 | prime-journal.com

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January/February 2022 | CONTENTS

NEWS
10 Annual ISAPS Global Survey reveals impact of COVID
pandemic on aesthetic procedures
12 RealSelf unveils most-loved aesthetic procedures
of 2022

EVENT PREVIEW
14 AMWC 2022: Marketing mistakes to avoid
An international panel of aesthetic practitioners will
share their biggest marketing blunders at AMWC
Monaco

AESTHETIC FEATURES

16 Chin filler treatments: differences between male

and female patients
Grasiela Cássia Monteiro evaluates the changing
requirements and treatment strategies when searching
28 for the ideal chin in male and female patients
20 Correcting the gluteal region using threads and

34 polylactic acid fillers

Natalia Markova MD, Svetlana Pervykh MD,
Eliska Kubiková MD, Chuan-yuan Lin, MD, and
Hsu Nai‑Jen, MD discuss their novel non-surgical
technique for addressing this problem area
28 Treating post-inflammatory hyperpigmentation
with a tyrosinase-inhibitor
Agneta Troilius Rubin, Zoi Tsaknakis, Adel Sammain,
and Laura Schmidt evaluate the efficacy and safety of
an isobutylamido thiazolyl resorcinol-containing
regimen to improve melasma or PIH due to ablative
laser treatments, acne or sunburn

PRACTICE MANAGEMENT

Just say no to content chaos

34 
20 10 Wendy Lewis offers guidelines to defining an effective
content strategy

16 PRIME PROMOTIONS
38 Advanced superficial resurfacing with a novel
fractional handpiece: FRAX 1940
RENÉE [BIONIC-HA] ® Gels for facial aesthetics: Why
40 
bionic design matters

EVENTS
42  round-up of the major industry events happening
A
around the world over the next 12 months

prime-journal.com | January/February 2022 9

 |

news
NEWS

A round-up of news stories in

the aesthetic and anti-ageing
medicine industry

ANNUAL ISAPS GLOBAL SURVEY REVEALS IMPACT

OF COVID PANDEMIC ON AESTHETIC PROCEDURES
COVID-19 PRACTICE CLOSURES LEAD TO A 10.9% DECREASE IN SURGICAL PROCEDURES

T
he International Society of nonsurgical procedures), hyaluronic acid (28.1%),
Aesthetic Plastic Surgery (ISAPS) hair removal (12.8%), nonsurgical fat reduction
released the results of its annual (3.9%), and photo rejuvenation (3.6%). Around
Global Survey on Aesthetic/ 85% of nonsurgical procedures were performed
Cosmetic Procedures, which on women.
showcased the impact of the COVID-19 pandemic In spite of the overall reduction in surgeries,
on aesthetic plastic surgery procedures rhinoplasty and brow lift surgeries continued to
worldwide throughout 2020. increase, and nonsurgical facial rejuvenation
showed a 13.9% increase compared to a decrease
Highlights in both 2019 and 2018.
Plastic surgery procedures for aesthetic purposes Overall, nonsurgical procedures increased,
decreased by 10.9% overall in 2020, with 77.8% of except for botulinum toxin, hyaluronic acid, and
surgeons globally experiencing temporary increase in demand due to patients’ increased micro- ablative resurfacing (decreasing by 0.9%,
practice closures during the COVID-19 pandemic. flexibility, the opportunity for a more private 6.1% and 11.3%, respectively).
Nonsurgical procedures (primarily fillers and hair recovery and, particularly for facial procedures, The most common surgical procedures in
removal treatments) continued to increase, but the so-called ‘zoom effect’. This has limited the men continue to be eyelid surgery, liposuction,
by lower proportions than seen in previous years impact of COVID-19 on overall procedures.’ gynecomastia, rhinoplasty and ear surgery.
(5.7% in 2020, compared to 7.6% in 2019). This At the time of this survey, only 45% of
resulted in an overall decrease of 1.8% for all Aesthetic Procedures surgeons had seen a return to pre-pandemic
procedures. The most common surgical procedures patient volume. Dr. Ramirez-Montañana said,
Dr. Arturo Ramirez-Montañana, Chair of ISAPS’ worldwide remained the same during 2020, with ‘Despite the terrible pandemic we are living
Global Survey Committee said, ‘This downward breast augmentation making up 16% of all through, it seems that most aesthetic plastic
trend is in line with our survey findings of lower procedures, liposuction 15.1%, eyelid surgery 12.1%, surgeons are getting back to near-normal
patient demand due to safety and financial rhinoplasty 8.4%, and abdominoplasty 7.6%. practice and I am optimistic about 2021, both for
concerns during the COVID-19 pandemic. At the The top five nonsurgical procedures also the plastic surgery industry and for surgical and
same time, many of us have also experienced an remained consistent: botulinum toxin (43.2% of all nonsurgical procedures.’

FDA APPROVAL FOR GALDERMA’S NEW SCULPTRA® LABEL

Galderma has announced the new new injection techniques and the and volume loss,’ said Dr. Melanie appearance of wrinkles up to
label for SCULPTRA® (injectable optional addition of lidocaine. Palm, MD. ‘Aesthetic injectors will 2 years after last treatment
poly-L-lactic acid (PLLA)), the first These changes provide aesthetic find that the higher reconstitution according to investigator
and only FDA-approved PLLA injectors with even more options volume with optional lidocaine evaluation.
facial injectable treatment that to administer SCULPTRA safely can help increase patient comfort, The new label approval is
helps stimulate the skin’s own and effectively. and the immediate use protocol based on new data from
collagen production, to smooth ‘I’ve been using SCULPTRA with provides greater convenience.’ physiochemical studies, as well as
facial wrinkles, such as smile my patients for over 10 years and SCULPTRA delivers gradual, results from a randomised,
lines. The new label approved by it is my go-to product for collagen natural-looking results over an evaluator-blinded, parallel-group,
the U.S. Food and Drug stimulation, with natural-looking, average of three treatments multi-centre study, which
Administration (FDA) includes long-lasting results that address a spaced at least 3 weeks apart. In a evaluated the safety and
higher dilution, the addition of number of underlying ageing clinical study, 100% of patients effectiveness of two different
immediate use reconstitution, concerns, such as facial wrinkles still showed improvement in the dilutions of SCULPTRA.

10 January/February 2022 | prime-journal.com

NEWS |

REALSELF UNVEILS MOST-LOVED PREVENT AGEING

AESTHETIC PROCEDURES OF 2022 BY TARGETING
HONOREES CHOSEN ACCORDING TO THEIR CONSUMER WORTH IT RATINGS ‘OLD’ CELLS
Scientists have developed a vaccine to

R
ealSelf, a medical aesthetic ‘gave me my confidence back’ also achieved a target a protein expressed exclusively by
community and marketplace, 98% Worth It Rating. A mini tummy-tuck is less certain ‘senescent’ cells, paving the way
announced the 2022 Most Worth It extensive than a full tummy-tuck and the surgery for anti-ageing therapies
Honorees — the year’s most-loved happens below the belly button—the navel is not The accumulation of senescent cells
aesthetic procedures for every body touched or moved as it is with a full tummy-tuck leads to age-related impairments and
area and concern, according to the RealSelf procedure. diseases. So far, there have been no
community. The comprehensive list of the Most treatments that can exclusively target
Worth It Honorees is determined by Worth It Breast surgeries continue to deliver high these senescent cells. Now, researchers
Ratings from real patients on RealSelf from January consumer satisfaction year over year have developed a vaccine specific to a
1, 2021, to December 31, 2021. The RealSelf Worth It ■ RealSelf saw more than 5,000 Worth It reviews protein found in senescent cells, thereby
Rating is a proprietary consumer satisfaction score of breast related procedures in 2021 allowing their targeted elimination. The
based on reviews from consumers on RealSelf who, ■ Reported satisfaction of breast augmentation discovery paves the way towards a
after undergoing a treatment, rated it as ‘Worth It’ or continued to be very high — with more than strategy to combat ageing and age-
‘Not Worth It.’ 2,700 Worth It reviews, the procedure earned a related diseases.
‘Back for the fifth year in a row, our 2022 Most 97% Worth It Rating Ageing is primarily caused by the
Worth It Honorees are truly consumers’ vote and ■ Motiva breast implants (96% Worth It) and accumulation of poorly functional
are based solely on their Mentor breast ‘senescent’ cells (old cells that no longer
input and feedback,’ said Our RealSelf community implants (96% Worth proliferate) in various tissues and organs.
Hailey Sullivan, RealSelf continues to tell us that the Most It) were the top-rated As such, the elimination of senescent cells
Chief Marketing Officer. implant brands can prevent ageing and age-related
‘Our RealSelf community Worth It Rating is an important among RealSelf disorders, including atherosclerosis,
continues to tell us that the signal when deciding whether to community dementia, and glaucoma. However,
Most Worth It Rating is an invest their money and time in a members treatments that target these cells could
important signal when ■ Breast implant potentially damage other cells too.
deciding whether to invest
procedure. removal took home In a new study published in Nature
their money and time in a procedure. Additionally, a Most Worth It ranking of 97%. Breast implant Aging, researchers in Japan developed a
the thousands of real, unbiased reviews on RealSelf safety remained on the minds of RealSelf vaccine against senescent cells using a
provide notable value to our doctors and specialists, community members and breast implant protein that is only expressed by these
and our brand partners.’ removal was also an overarching celebrity plastic cells. Then, they used this vaccine to
Facial rejuvenation, body tightening and breast surgery trend of 2021— common reasons breast eliminate senescent cells in mice and
procedures are among the highest-rated cosmetic implants are removed include a desire to address observed significant improvements in
procedures. health concerns, implant failure, or complications, both the normal and disease-causing
though some women are just ready for a smaller effects of ageing. According to
Two surgical facial procedures breast size. corresponding author Professor Tohru
top the annual list Minamino of the Juntendo University
■ Deep plane facelift, designed to treat drooping Nonsurgical options for smooth, Graduate School of Medicine, who has
cheeks, along with the lower face, jawline, and radiant skin consistently rank high studied cellular senescence for over two
neck, is a clear favorite earning a 100% Worth It ■ Injectable neuromodulators that smooth fine decades, ‘With age and metabolic stress,
Rating lines and wrinkles were among the most popular cells become senescent and lose function.
■ Forehead reduction surgery, a newcomer to procedures in this category. This year Botox We wanted to find an effective and
RealSelf’s Most Worth It honoree list, also (96% Worth It) slightly outranked Dysport (95% efficient way to get rid of these cells and
achieved a 100% Worth It Rating. Designed to Worth It). improve overall tissue function.’
create a more balanced facial proportion, the ■ Dermal fillers work in an entirely different way According to Prof. Minamino, ‘Our study
procedure has been hailed as ‘a dream come than injectable neuromodulators and are a has demonstrated the possibility of a new
true’ by one RealSelf member. RealSelf community favorite with a 93% Worth It anti-senescence strategy. We speculate
Rating. that there are many more seno-antigens
Two body tightening procedures that are produced by other kinds of
also garner high votes Methodology senescent cells. With more research we
■ Body lift surgery, considered the gold standard To be recognized as a 2022 Most Worth It honoree, will be able to provide individualized
of body-tightening procedures that RealSelf a treatment must meet the minimum requirement anti-senescence therapy for patients
members ‘can’t say enough positive things of 50 reviews between January 1, 2021, and depending on the prevalence of different
about,’ earned a 98% Worth It Rating December 31, 2021, and have earned a cumulative types of senescent cells in their body.’
■ The mini tummy-tuck one RealSelf member says Worth It Rating of 90% or higher during 2021.

12 January/February 2022 | prime-journal.com

MEETING PREVIEW |

AMWC 2022
MARKETING MISTAKES TO AVOID
An international panel of aesthetic practitioners will share their biggest
marketing blunders at AMWC Monaco

A
ESTHETIC CLINIC digital marketing trends to be sure too many platforms and areas to
marketing to they are attracting a steady stream focus on to do it all yourself
consumers has of new patients, and managing the anymore, which is why more
emerged as a clinic experience from the first practitioners are hiring managers
critical success point of contact so patients will with business degrees and
factor for keep coming back. There are just extensive training to handle it all.’
practitioners who are entering the Here are ten of the most common
vast field of aesthetic medicine. Practitioners must be errors practitioners often fall victim
‘No matter how adept you may nimble to stay on top of the to, according to Ms. Lewis:
be at promoting your aesthetic shifts in technology, social ■ Not doing enough research or
practice, not every strategy works platforms, and digital testing
well every time. Even the most ■ Straying away from your brand’s
marketing trends to be sure
experienced and clever marketers unique selling proposition (USP)
they are attracting a steady
take a wrong turn at least some of ■ Failing to keep patients in the
the time,’ said Wendy Lewis, stream of new patients, and practice for the long term
President of Wendy Lewis & Co. Ltd managing the clinic ■ Lack of focus on your patient
in New York City. ‘Practitioners must experience from the first demographic’s wants and needs
be nimble to stay on top of the shifts point of contact so patients ■ Not setting aside a sufficient
in technology, social platforms, and will keep coming back. budget to be effective

14 January/February 2022 | prime-journal.com

 | MEETING PREVIEW

■ Choosing to work with the

wrong or inexperienced
consultants and advisors
■ Hiring staff who are not people
persons, or failing to train them
properly
■ Neglecting to measure results
and return on investments (ROI)
from each marketing program
■ Hanging on to staff for too long
that need to go
■ Trying to do it all on your own
without engaging with reputable
experts for guidance.
Plastic surgeon Nikolaos
Metaxotos MD, PhD, Founder of
Symmetria, an international
consortium of plastic and aesthetic
surgery centres, has transitioned
from managing a thriving cosmetic
surgery practice combined with
aesthetic treatments, to expanding
his Symmetria brand to London
and in the Middle East. ‘Aesthetic
medicine is always evolving and
what may have worked last year to
grow your practice, may not be
nearly as effective this year. Looking Rivkin of Westside Aesthetics in Los our time and money.’
back to when I first started in private Angeles, CA, ‘We have all spent This panel shall include a
practice, I wish I knew then what I many years learning medicine, but diverse faculty of practitioners
have learned to date. We started out marketing has never been part of across specialties hailing from the
with a robust website and the curriculum. We must be able to USA, UK, France, Austria, Greece,
traditional marketing, but word of market effectively to compete in Czech Republic, and Russia. Ms.
mouth was what drove new clients the crowded aesthetics industry, Lewis will moderate the
to our clinic. and we have all been taken programme, and they will be
Facebook and Instagram did not advantage of by unscrupulous taking questions from the
exist, and no one was blogging or consultants at one time or another. audience. Wendy Lewis
sharing videos. Most doctors did Aesthetic practitioners need to ‘Panels like this featured at
not have websites or even business learn from each other and share global congresses are key to
cards. Only a fraction of large our experiences about what works, making sure that you do not make
practices in big cities did any what doesn’t, and what is a waste of the same mistakes I did early on in
marketing at all. For those few, my practice. There is so much we
printed brochures, direct mailings, can learn from each other,’ says Dr.
advertising in glossy magazines, Rivkin.
and public relations were the gold 2022 This is sure to be a very popular
standard,’ he says. session that will cover a wide
‘In 2022, there has been a sea AESTHETIC & ANTI-AGING MEDICINE WORLD CONGRESS range of current topics of interest
change in the way we approach CELEBRATING THE to attendees. Nikolaos Metaxotos
marketing our clinics that is EDITION OF
AMWC MONACO
multifactorial. There is no one March 31 • April 1-2
To register:
perfect strategy or tactic that will Under the High
My Worst Marketing Mistakes
work for every location, specialty, or Ever Panel
Patronage of H.S.H.
Prince Albert II
of Monaco

demographic of patients. The MONTE-CARLO,

31 March 2022, 2pm–4pm CEST
options that are open to aesthetic MONACO
GRIMALDI FORUM Grimaldi Forum, Monaco
practices today are plentiful and [email protected]
many physicians and clinic
managers do not have the skills or REGISTRATION CONTACT US

time to manage the marketing on Following the success of our last edition, AMWC 2022 is back at the
Grimaldi Forum, Monaco and will be broadcasted live, worldwide.
Join us on March 31 to April 2, 2022 to celebrate the 20th edition of this
world leading aesthetic & anti-aging medicine congress.

their own,’ says Dr. Metaxotos.

According to Dr. Alexander Z.
WWW.EUROMEDICOM.COM
Alexander Z. Rivkin

prime-journal.com | January/February 2022 15

AESTHETIC FEATURE | INJECTABLES |

The chin is of
great importance for
a beautiful face in both
male and female
patients.

CHIN FILLER
TREATMENTS
DIFFERENCES BETWEEN MALE
AND FEMALE PATIENTS
Grasiela Cássia Monteiro evaluates the changing requirements and treatment
strategies when searching for the ideal chin in male and female patients
ABSTRACT a wider and larger chin and broader jawbones compared before filler treatments in the chin area to avoid undesired
The use of injectables in the chin area has grown in with females. The male face, in general, is squarer compared masculinization or feminization of the face. In this paper, the
popularity in recent years. This minimally invasive facial to the heart-shaped face of a woman. The male chin is also author offers a review of the anatomy of the chin, special
aesthetic treatment is more popular than surgery in many squarer compared to the female, which is more pointed. gender considerations for assessment and filler treatments,
recessed cases. Gender differences in the male face include It is crucial for the correct assessment to be carried out and special tips to use cannula in the mental area.

16 January/February 2022 | prime-journal.com

 | INJECTABLES | AESTHETIC FEATURE

Anatomy of the chin

Bone
The main structural component is the mandible in the
sagittal midline and the mandibular symphysis. Other
points include:
■ Menton (Me): lowest point on the contour of the
mandibular symphysis
■ Gnathion (Gn): most anteroinferior point along the
contour of the mandibular symphysis
■ Pogonion (Pg): most anterior point along the contour
of the mandibular symphysis.

Soft tissues
Anterior to the labiomandibular sulcus, from superficial
to deep, there is skin, subcutaneous fat, muscles of facial
expression (depressor anguli oris, platysma, depressor
labia inferioris, and mentalis), deep labiomandibular fat,
and deep mental fat in the chin, and periosteum. The
inferior margin of the labiomandibular sulcus is formed
by the mandibular ligament, anterior to the jowls4.
Inferior to the chin, there are insertions of the muscles
platysma, genioglossus, and geniohyoid1.

Vasculature
The primary blood supply to the chin are the mental
arteries, which exit the mental foramen on the lateral
chin, in line with the vertical axis of the second inferior
premolar teeth5. The mental veins also exit from the
mental foramen. The mental arteries are terminal
branches of the inferior alveolar arteries, which are
branches of the maxillary artery. The inferior labial artery

A
and labiomental artery provide further blood supply to
BEAUTIFUL FACE, IN GENERAL, the region. The submental artery is a cervical branch of
requires harmonious proportions of the facial artery. It runs from the exit of the submandibular
the facial horizontal thirds and gland over the mylohyoid and crosses the mandible near
vertical fifths. The chin is of great the mandibular symphysis2.
importance for a beautiful face in
both male and female patients. Nerves
Abnormal proportions between the chin, nose, and the The mental nerve, a branch of the trigeminal nerve, exits
rest of the face are features for the diagnosis of short or the mental foramen and provides sensory innervation.
long face patterns and micrognathia. To achieve In the lower face, the motor innervation is given by the
balance in a short face the chin should be elongated, for branches of the facial nerve, the buccal and marginal
example, and in a recessed chin, it should be projected. mandibular nerves.
GRASIELA CÁSSIA
In mild and moderate cases of a recessed chin, MONTEIRO, MD, MSC,
injectable fillers can be used, such as hyaluronic acid, Professor of Cosmetic Chin assessment
calcium hydroxyapatite, and a new option with both Dermatology at Ambulatory of The chin is of great importance for facial attractiveness in
Sanitary Dermatology–Porto
substances in the same syringe is also available on the Alegre (RS), Brazil men and also in women. The injector should identify
market. Chin deformities are the most common bony chin projection, length and width, dental occlusion, and
email: gcmonteiro@hotmail.
abnormality in the face1 and the majority can be treated com
nasal relationship. It is essential to analyze the
with fillers. Fillers to the chin can be used for labiomental sulcus, mandible angle, pre-jowl sulcus, and
beautification and/or rejuvenation. cervicomental angle.
In the face, the ageing process leads to skin atrophy, the The chin should be assessed via horizontal, vertical,
redistribution of subcutaneous fat, and bone remodelling and oblique measurements. It is important to identify
and resorption. In the lower face, the mandible undergoes facial patterns and ascertain whether facial width and
anterior and inferior resorption, which the loss of teeth length are balanced or whether the patient can be
can worsen. The chin becomes more anterior and classed as either dolichofacial (long face) or brachyfacial
shorter with ageing2, resulting in loss of jawline definition (short face). The subjective facial analysis includes the
and facial contour, and modifies the facial proportions. relationship between maxillae and mandible and the
KEYWORDS
The ageing process modifies all layers of the facial soft Chin, dermal filler, face, male dental occlusion. It is also important to diagnose if the
tissue as well as the skeleton3. patient, female patient patient is orthognathic, prognathic, or retrognathic. On

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AESTHETIC FEATURE | INJECTABLES |

average, the prognathic profile is more acceptable in

men, whereas the retrognathic is preferable in women5.
Rickett’s E-line (a line between the nose tip to the
pogonion) assesses the overall alignment of the nose, lip,
and chin. The Rickett’s E-line serves as a reference for the
protrusion of the lips and should fall 4 and 2 mm from the
upper and lower lips, respectively. This line is necessary
to identify a malpositioned chin1. Besides that, the true
vertical line (TVL) is also important to analyze the chin
position in the profile. This TLV is a vertical line dropped
to the subnasal point and perpendicular to the Frankfort
horizontal plane (FH). The TLV is used to verify the chin
position concerning the pogonion point and its projection
of the TLV6.
A straightforward way to diagnose micrognathia is to
evaluate the measurements of the mandibular arch with
the maxillary arch, while if diagnosing retrognathia, one
needs to look to evaluate the alveolar overjet. Both
micrognathia and retrognathia involve abnormal,
arrested development of the mandible. Although it is
difficult to distinguish between these conditions,
micrognathia refers to the size of the mandible, whereas

The lower face in men is, in general,

marked by a sharper and more defined
Figure 1 Female patient; the ideal width of the chin is the jawline and a wider and larger chin
intercanthal distance, the chin area is more pointed compared area. The female chin is more pointed
with male patient.
and rounded.

retrognathia refers to the posterior mandibular

positioning in relation to the maxilla7. The Jaw Index can
be used to identify micrognathia and it is defined by =
Aleveolar overjet x (Maxillary arch/Mandibular arch) in
millimetres. The Jaw index measures the maxillary-
mandibular discrepancy by quantifying the
micrognathic and retrognathic jaw through its alveolar
relationship with the maxillary development7.
In general, the mental index (MI) is higher in men than
in women; it is measured by the superior border of the
foramen mental and the lower mandibular border. In
men, the mean of MI was 3.50, while in women, it was
2.968.
It is crucial to identify skeletal abnormalities in the
chin as well as soft tissue characteristics.
A system of chin deformities classification was
developed by Guyuron and included1:
■ Class I: macrogenia— horizontal, vertical, or a
combination of both
■ Class II: microgenia — horizontal, vertical, or a
combination of both
■ Class III: combined — horizontal macrogenia with
vertical microgenia or horizontal microgenia with
vertical macrogenia
■ Class IV: asymmetric chin
■ Class V: chin-soft tissue ptosis
Figure 2 Male patient; the chin is squarer compared with the ■ Class VI: pseudomacrogenia (normal bony volume
female and the ideal width of the chin is the width of the mouth with excessive soft tissue)

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 | INJECTABLES | AESTHETIC FEATURE

■ Class VII: pseudomicrogenia (normal bony volume

with retrogenia secondary to excessive maxillary
growth and associated mandibular clockwise
autorotation).
In dentoalveolar abnormalities, the injector should
consider orthognathic treatment and consider surgical
therapy, such as genioplasty and alloplastic chin
implants, in severe cases of chin deformities1.
Bertossi and colleagues in 2015 proposed that
microgenia with sagittal chin deficiency less than 4 mm
from the true vertical line (or profile line, a vertical line in
the subnasale perpendicular to the Frankfort horizontal
plane) or with mild asymmetry, with normal soft-tissue
chin thickness (mean 8–10 mm) can be treated with
injectable fillers. Furthermore, patients aged over 50
years affected by sagittal chin deficiency of more than Figure 3 (A) Female patient in profile view before the filler injection, and (B) after filler injection
4 mm with a reduction of soft-tissue chin thickness
(mean 6.5 mm) have been corrected with the use of sessions can be performed. To restore or create an
fillers6. anterior projection to the chin, the filler should be placed
in the pogonion and submuscular below the mentalis
Treatment planning muscles. If the injector wishes to augment the length of
In the male patient, the ideal width of the chin is equal to the chin, the filler should be placed in the submental
the width of the mouth, and the ideal projection is area.
approximately as far as the lower lip. Whereas in the
female patient, the ideal width of the chin is equivalent to Conclusion
the medial intercanthal distance and in women, the The use of filler treatments in the chin area while
lower lip should be 1 to 2 mm beyond the chin2 respecting gender differences is a suitable option for
(Figures 1–2). Besides that, the lower face in men is, in recessed cases, correction of small defects, and
general, marked by a sharper and more defined jawline asymmetries. More severe cases should be managed
and a wider and larger chin area9, 10. The female chin is with surgery and genioplasty, especially when the patient
more pointed and rounded. If the bellies of mentalis Key points presents with respiratory difficulties. Injectors can use a
muscle are visible in a woman, consider filler to create a cannula to place filler in the chin area in both female and
Chin deformities are
more feminine appearance. To mark the chin area, the male patients in an easy method with the Braz-Monteiro
the most common
injector should mark a semicircle in the mental area abnormality to the face manoeuvre.
respecting the intercanthal or the mouth width according and the majority of them
to the desired female or male chin. The inferior border of can be treated with fillers Declaration of interest None
this semicircle is the mandible bone and the superior is injections
the labiomental sulcus. To treat the chin area, the injector The chin becomes Figures 1-3 © Grasiela Cássia Monteiro
more anterior and
should choose fillers with very high G prime with
shorter with ageing
hyaluronic acid, calcium hydroxyapatite, or both
Abnormal proportions
products in the same syringe. If the injector prefers a between the chin, nose,
needle, it is necessary to touch the bone in the and the rest of the face
supraperiosteal plane and aspirate before injecting to are features for the
avoid any vascular occlusion. The author recommends diagnosis of short or long
the use of 22 or 23 G 40- or 50 mm cannulas to treat the
face patterns and References
micrognathia
chin. A tip to treat the chin in men with cannula is the use
In the male patient, 1. Ward J, Podda S, Garri JI, Wolfe SA, 2015;39(5):651-8.
of a manoeuvre which we call Braz-Monteiro (described the chin is more
Thaller SR. Chin deformities. J Craniofac
Surg. 2007;18(4):887-94.
7. Mermans JF, Ghasemi SM,
Lissenberg-Witte BI, Don Griot JPW. The
with Dr. André Braz in the scientific literature). This projected and stronger 2. Braz A, Eduardo CCP. Reshaping the Reproducibility of the Jaw Index in the
Lower Face Using Injectable Fillers.
manoeuvre was created because the mentalis muscles and the ideal width of the Indian J Plast Surg. 2020;53(2):207-18. Measurement of Healthy Newborns.
Cleft Palate Craniofac J. 2020;57(5):574-
in males are stronger and have more muscle mass than chin is equal to the width 3. Wong CH, Mendelson B. Newer
Understanding of Specific Anatomic 80.
of the mouth, whereas in Targets in the Aging Face as Applied to 8. Sghaireen MG, Alam MK, Patil SR,
in females making it difficult to use the cannula. Outside the female it is equivalent Injectables: Aging Changes in the Rahman SA, Alhabib S, Lynch CD, et al.
Craniofacial Skeleton and Facial
the semicircle, we use an injection point of lidocaine to to the medial Ligaments. Plast Reconstr Surg.
Morphometric analysis of panoramic
mandibular index, mental index, and
2015;136(5 Suppl):44s-8s.
anaesthetise and relax the mentalis muscles. Using the intercanthal distance 4. Vazirnia A, Braz A, Fabi SG.
antegonial index. J Int Med Res.
Nonsurgical jawline rejuvenation using 2020;48(3):300060520912138.
entry point, we introduce the cannula, pinching the A tip to treat the chin injectable fillers. J Cosmet Dermatol. 9. Rossi AM, Fitzgerald R, Humphrey S.
mentalis muscle with the non-dominant hand and in men with cannula is 2020;19(8):1940-7. Facial Soft Tissue Augmentation in
5. Braz A, Sakuma T. Atlas de Anatomia Males: An Anatomical and Practical
displacing anteriorly and superiorly, creating a space the use of a Braz- e Preenchimento Global da Face. 1 Approach. Dermatol Surg. 2017;43 Suppl
Monteiro maneuver edição ed. Rio de Janeiro,Brazil: 2:S131-s9.
behind the mentalis muscles. The technique is which creates a space
Guanabara Koogan; 2019.
10. Braz A, Eduardo CCP. The Facial
6. Bertossi D, Galzignato PF, Albanese
retroinjection with 80% of the total amount in the behind the mentalis M, Botti C, Botti G, Nocini PF. Chin Shapes in Planning the Treatment with
Microgenia: A Clinical Comparative Injectable Fillers. Indian J Plast Surg.
supraperiosteal plane and 20% of it in the subcutaneous. muscle Study. Aesthetic Plast Surg. 2020;53(2):230-43.
The amount to use in each session is 0.5–1.0 cc. Many

prime-journal.com | January/February 2022 19

AESTHETIC FEATURES | THREADS AND FILLER |

CORRECTING THE
GLUTEAL REGION
USING THREADS
AND POLYLACTIC
ACID FILLERS
Natalia Markova MD, Svetlana Pervykh MD, Eliska Kubiková
MD, Chuan-yuan Lin, MD, and Hsu Nai-Jen, MD discuss their
novel non-surgical technique for addressing this problem area
ABSTRACT ease of use, lack of intervention in the long-term In our article, we would like to discuss
Loss of elasticity, volume, and ptosis of soft post-procedural period and reduced surgical the correction of the gluteal zone using the
tissue in the gluteal region due to involutional risks, the ability to perform them under local combination of thread lifting and reinforcing
changes lead patients to search for minimally anaesthesia, and quick rehabilitation. In addition methods and soft tissue polylactic acid fillers.
invasive aesthetic solutions with short to filling with hyaluronic acid, thread lifting and In our clinical cases, we used threads made of
rehabilitation periods, such as correction reinforcing thread methods, soft tissue fillers polymer consisting of polycaprolactone (75%),
with threads and soft tissue fillers. However, based on collagen-stimulating substances from polylactic acid (25%), and soft tissue polylactic
the use of minimally invasive methods also polycaprolactone and polylactic acid deserve acid filler (1000 mg).
requires confirmation of the anatomical safety close attention. Such drugs, depending on the The purpose of using thread lifting methods
and clinical effectiveness of the proposed volume of the active substance, are sometimes is to move soft tissue and fix them to a new
correction methods. called tissue substitutes. position3.
Improving the quality of the skin and non- Buttocks are considered aesthetically ideal The purpose of using thread reinforcing
surgically increasing the volume in the gluteal when the gluteal sulcus is short and does not methods is to strengthen the subcutaneous
area has recently gained popularity among reach the midline of the posterior surface of the fat layer due to the collagen-stimulating
patients. The most common complaints thigh; the transition of the back/buttocks in the composition of the reinforcing threads and
are reduced turgor in the gluteal zone, skin lateral projection is S-shaped, the maximum slight lifting of soft tissues in the direction
flabbiness, ptosis, and insufficient volume projection point of the buttocks is in its central opposite to the ageing vectors due to the fixing
of soft tissues in the upper inner and zone. device (barbs) on the threads.
outer quadrants of the gluteal area due to The purpose of the use of collagen-stimulating
lipodystrophy. OBJECTIVE and tissue-replacing methods is to achieve, by
NATALIA MARKOVA MD,
For the correction of the gluteal zone, The purpose of this article is to describe administration of the drug based on polylactic Dermatovenerologist,
classical surgical techniques are currently a minimally invasive method of aesthetic acid, an increase in volume and skin elasticity, MedicalEsthetic,
used: liposuction and lipofilling1, buttock correction of the gluteal zone using lifting, followed by the secondary replacement of the Prague, Czech Republic;
endoprosthesis2, and surgical lifting. reinforcing threads, and soft tissue polylactic administered volume with the patient’s own SVETLANA PERVYKH MD,
Additionally, minimally invasive techniques are acid fillers, to demonstrate their anatomical tissue without the use of permanent or non- Ophthalmologist, Gwangju city,
also becoming popular in this area due to their safety and clinical efficacy. absorbable implants or fillers. Republic of Korea;
ELISKA KUBIKOVÁ MD,

T
Surgeon, Anatomický ústav
Univerzita Komenského v
O UNDERSTAND AND PREDICT THE anatomical base and the main anatomical landmarks Bratislavě; CHUAN-YUAN
results of procedures and the safety of are always bones. LIN, MD, Head of ToBeauty
Aesthetic clinic, Chief of
their performance, it is necessary to In the gluteal region, there are two deep cellular spaces Plastic and reconstructive
understand the functional and layer-by- (deep gluteal and supratrochanteric). It is in the deep division, Taipei Veteran General
layer anatomy of the gluteal region4. It is cellular space between the gluteus medius and minimus Hospital, Taiwan; HSU NAI-JEN,
MD, Director, Hsu Nai-Jen
bounded from above by the iliac crest, muscles that the branches of the lower gluteal vessels Dermatologic clinic, Tainan city,
from below by the gluteal fold, from the inside by the and nerves pass, and the fascial sheath of the sciatic Taiwan
sacrum and the coccyx (medial line — intergluteal cleft, nerve is located. Due to the presence of these important email: [email protected]
the median ridge of the sacrum and coccyx), laterally — a anatomical structures, it is undesirable to work in deep
line drawn from the anterior-superior iliac spine, cellular gluteal spaces without using direct visualization
anterior superior to the greater trochanter (trochanter of the above structures, which limits the work with KEYWORDS
Absorbable Threads, Aptos,
NA). In the case of two gluteal folds, the lower fold is minimally invasive technologies in this zone. thread lifting, polylactic acid
considered the border of the gluteal region. The However, we are more interested in the superficial filler

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 | THREADS AND FILLER | AESTHETIC FEATURE

In the second stage,

treatments were conducted
on 35 women aged 35 to 53
years, with complaints of soft
tissue flabbiness in the gluteal
region, seeking skin
strengthening and an increase
in volume in the gluteal
region.

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AESTHETIC FEATURES | THREADS AND FILLER |

technique developed by the authors of this article.

Women without inflammatory processes and post-
traumatic changes in the correction area, healthy, without
permanent implants in the correction area, having no
contraindications for correction, were allowed to
undergo the procedure. No combined correction
techniques were used in the area of correction. All
patients gave their informed consent to the procedure
and to the use of photo and video materials. Samples
were taken from the patients for histologic examination
prior to the procedure, and 5 randomly selected patients
were re-sampled from the correction area (gluteal region,
outer-upper quadrant) 3 months after the procedure.
This technique includes simultaneous lifting and
restoration of the volume of the gluteal region, while
reinforcing the gluteal region and the area of the posterior
surface of the thigh, using self-fixing thread lifting and
reinforcing materials as well as the administration of a
collagen-stimulating polylactic acid filler.
For the lifting action5, absorbable threads with
bidirectional barbs were used. As a fixing device, the
Light Lift NEEDLE METHOD (manufactured by Aptos)
cellular space since this is the zone of impact of the Figure 1 Layer of was used: UPS 2/06; chemical composition
studied technique. The subcutaneous tissue is well subcutaneous fat for polycaprolactone 75%, polylactic acid 25%; P (LA/CL); USP
manipulation
developed and penetrated by vertical fibrous cords 2/0; 500 mm, 2 pcs; on needles 1.1x120 mm, 4 pcs, attached
connecting the skin and fascia. It has a honeycomb to the middle of the guide-needle7.
structure. To the borders of the gluteal region, the For their reinforcing action, absorbable threads with
subcutaneous tissue becomes thinner and the fascial multidirectional barbs were used. Excellence Body
layer disappears. In women, unlike men, the layer of fatty Method (manufactured by Aptos), UPS 2/0; chemical
tissue, which is located under the skin, is more developed. composition polycaprolactone 75%, polylactic acid 25%;
Fatty tissue in this area is usually elastic because it is P (LA/CL); length 240 mm; 15 pcs; cannula 19G x 200mm;
penetrated by thin strips of dense connective tissue that 2 pcs.
go from the skin to the muscles; along the edges they are The result of the reinforcement is not immediately
spliced with one another, forming cells that provide visible. To visualize the result, it is necessary to wait for
stability for the fatty tissue. the results of the cellular response to the implanted
thread. The procedure will stimulate the production of
Materials and methods the patient’s own collagen. This usually takes more than
Study population 1 month and intensifies by 3 months after implantation.
In the first part of the study, anatomical dissections were The technique for implanting reinforcing threads is
performed (8 female bodies) — age range from 54 to 83 different from the technique for lifting threads. When
years. The average age is 60 years. Dissections were choosing the depth of implantation, the diameter of the
performed at the Anatomical Institute of the Faculty of threads, barbs, their direction and size, as well as the
Medicine of the Comenius University in purpose of implantation, are taken into account.
Bratislava (Slovakia) and the Faculty of To stimulate collagen production, PLDA — PowerFill
Medicine of the University of Rijeka 1000 mg, polylactic acid 1000 mg / 24 ml was used.
(Croatia). The research was permitted by This technique includes
the Ethics Committee of the Faculty of simultaneous lifting and Inclusion criteria
Medicine of the Comenius University in restoration of the volume of For the purposes of the procedures, it is necessary to
Bratislava and the Faculty of Medicine of select patients without excess weight and with an initial
the University of Rijeka. All rights to the gluteal region while degree of soft tissue ptosis or in a pre-ptotic state. The
research and its results are reserved reinforcing the gluteal region degree of ptosis of the buttocks was assessed according
(Figure 1). and the area of the posterior to the classification proposed by R. Gonzalez in 2006 by
In the second stage, treatments were the excess of soft tissues of the gluteal region, descending
conducted on 35 women aged 35 to 53
surface of the thigh, using below the sub gluteal sulcus8.
years, with complaints of soft tissue self-fixing thread lifting and The study included clinically healthy patients without
flabbiness in the gluteal region, seeking reinforcing materials as well significant chronic diseases and mental abnormalities.
skin strengthening and an increase in All patients underwent a standard medical
as the administration of a
volume in the gluteal region (Beautis examination and collection of medical history to identify
Malgeun Dermatology Clinic, Gwangju collagen-stimulating contraindications to thread lifting and the administration
city, Republic of Korea) using a combined polylactic acid filler. of collagen-stimulating drugs or the use of anaesthetic

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 | THREADS AND FILLER | AESTHETIC FEATURE

solutions, according to their instructions for use. The

patients also signed an Informed Consent for the
procedure to be performed and the use of their
photographic materials for scientific purposes.
All patients underwent sampling of biological material
from the area of impact by punch biopsy up to 3 mm in
diameter before performing the procedures to form a
control group and perform subsequent histologic
examination (morphological assessment). Repeated
sampling in a similar way was performed in five
randomly selected patients 3 months after the
procedures.
The material collected by punch biopsy for subsequent
light optical examination was subjected to standard
preparation:
■ Fixation in 10% solution of buffered neutral formalin
■ Dehydration in the alcohol series (increasing
concentration)
■ Exposure to xylol solution
■ Embedding in paraffin with preparation blocks
■ Making slices on a sledge microtome
■ Staining with routine dyes
■ Embedding in a stabilizing balm on slides. Figure 2 An example of disinfected, materials and instruments for conducting
The cellular/non-cellular component around the marking the gluteal zone the procedure are prepared.
during the operation
implanted materials was studied after scanning the The polylactic acid solution is reconstituted from the
slides using a Leica Apero AT2 scanner and random dry suspension with sterile water for injection at least
selection in sections of five random high power fields in 30 minutes before the start of the procedure.
the preparation. Anaesthesia is performed before the implants are
A morphometric assessment of the following inserted and the punch biopsy is performed. The
parameters was performed: anaesthetic solution for infiltration is chosen depending
■ the specific area of the vessels of the capillary bed on the experience of the attending physician. First,
■ the mean diameter of collagen fibres separate injections of the anaesthetic solution are given
■ the ratio in the profile of inflammatory cells. at the cannula insertion sites. Next, infiltration
Refined measurements and comparative analysis with anaesthesia of the implantation zone is performed.
the exposure group were made. Puncture sites for cannula insertion are selected
according to the length of the infiltration cannula.
Procedure After a short exposure of 5–10 minutes, before the start
To satisfy the main complaints of patients (reduced of the procedure, all patients underwent sampling of
turgor and flabby skin of the gluteal region and the area biological material from the area of impact by punch
of the posterior surface of the thigh, lipodystrophy and biopsy up to 3 mm in diameter to form a control group
ptosis), the technique includes three successive stages: and perform subsequent histologic examination
■ implantation of lifting threads (morphological assessment). Repeated sampling in a
■ implantation of reinforcing threads similar way was performed in 5 randomly selected
■ administration of a collagen-stimulating polylactic patients 3 months after the procedures.
acid filler.
For this, the zone of each buttock is tentatively divided Procedure stages
into four quadrants: two upper — lateral and medial, and For the first stage, the barbed lifting thread is used to
two lower — lateral and medial. The horizontal line move and form volume in the upper lateral quadrant of
dividing the gluteal zone in half is the ‘sitting zone’. the gluteal zone (Figure 3).
Above the ‘sitting zone’ in the upper part, according to The existing volume is moved with the soft tissue
the investigational technique, volume can be created or lifting thread, forming it in an aesthetically more
moved to improve the contour of the buttocks and significant place (upper lateral and medial quadrants of
visually lift the tissues upward. The lower lateral and the gluteal zone), which entails secondary improvements
medial quadrants are reinforced (Figure 2). in tissue sagging in the lower quadrants of the gluteal
Before starting the procedure, preliminary zone. The gluteal region is lifted, the contours become
photographic documentation of the impacted area is more attractive. The result of the correction is maintained
performed. Markings are made in three main stages: for up to 1 year.
implantation of lifting threads, reinforcing threads, and The implantation of lifting threads is performed in a
the administration of a solution of polylactic acid. layer of deep subcutaneous fat. The injection is carried
The implantation zone is cleaned and preliminary out in the upper lateral zone. We insert both needles in

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AESTHETIC FEATURES | THREADS AND FILLER |

dermis and used to reinforce the lower lateral and medial

quadrants of the buttocks and the upper posterior
surface of the thigh (Figure 2). The injection entry points
are in the area of the upper outer quadrant. The insertion
trajectory is a radial distribution in the lateral and lower
Insertion sides going into the lower lateral and medial quadrants of
point the gluteal zone and the area of the upper posterior
1st vector surface of the thigh to reinforce them.
3rd vector It is recommended to use the reverse (returned)
technique of one-step reinforcement and soft tissue
lifting. After implantation of the first thread along the first
2nd vector vector, the thread is pulled with the right hand and,
holding it with the left hand, the tissues are brought to the
desired position, lifting and supporting them. In the same
hole into which the thread has already been inserted, the
thread is implanted in a reciprocating motion along the
next vector. Throughout the manipulation with the
Figure 3 Insertion point and vectors for barbed thread placement thread, the tissue is held in the left hand in the desired
lifted position. This creates the angle of the
one puncture and then implant the thread, creating multidirectional vectors of the thread tension from the
volume. By implanting the thread with the right hand, two halves of the implanted thread, where a lifting and
with the left hand, we simultaneously collect and reinforcing structure is held at the puncture site at the
maintain the volume of tissues that we want to move and angular joint of the two halves of the thread, which,
fix; with a radial spreading towards the thanks to the barbs, maintains the tissues in the desired
lower quadrants, pull the muscle tissues of position.
the buttocks into the upper lateral quadrant
For stage three, Threads implanted in order to reinforce and strengthen
of the gluteal zone, while simultaneously administer a collagen- the skin in the required zone should be implanted with as
tightening and reducing the sagging of the stimulating drug based on a many reversals and decussations as possible since at the
muscle tissues in the lower lateral and intersection of the implanted threads, as well as between
polylactic acid solution to
medial gluteal quadrant. the barbs and the thread, fibroblasts create colonies to a
For the second stage, reinforcing threads replenish soft tissue greater extent than merely around the implanted thread.
are implanted into the reticular layer of the volume. Fibroblasts produce collagen, which creates a collagen

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 | THREADS AND FILLER | AESTHETIC FEATURE

skeleton, supporting the skin and the walls of fat cells and
strengthening the skin. Hence stimulating them is very
important for the reinforcement technique.
Table 1 Morphometry of collagen fibre results
The depth of implantation of reinforcing threads
PARAMETER CONTROL GROUP IMPACT GROUP
differs from the depth of implantation of lifting threads.
Implanting threads with the reinforcing technique, they Mean diameter of
12.3 —
+ 0.4 15.4 —
+ 0.2
strive to strengthen and improve the quality of the skin. collagen fibers, m
Based on our histologic examinations, the best results in
stimulating neocollagenesis were obtained when the
thread was implanted into the reticular layer of the
dermis. Stimulation of the process of neocollagenesis is
the goal of the reinforcing technique of thread
implantation.
For stage three, administer a collagen-stimulating drug
based on a polylactic acid solution to replenish soft tissue
volume.
PowerFill 1000 diluted with 24 ml water for injection
was used. The total volume of the finished administered
filler was 24 ml: 12 ml on each side in the area of the upper
outer quadrant.
An 18 G cannula with a length of 90 mm was used to
administer the drug. The drug is administered in a fan-
shaped manner in different vectors and layers of
subcutaneous fat. We avoid bolus injections because of
the risk of overcorrection and the possible development Figure 4 Gluteal region, outer-upper quadrant: epidermis, dermis, hypodermis of the exposure
of granulomatous adverse reactions. Such reactions are group: the predominance of collagen fibre bundles. Hematoxylin-eosin staining. Magnification 1:40.
very rare but can occur due to improper dilution of the
drug and non-compliance with the administration
technique (overdose in a locally limited place). The drug Treatment of skin punctures with alcohol-based
is administered into the deep subcutaneous fat layer at disinfectants during the first 3 days after the procedure and
the level of the hypodermis.
In addition, the required clinical result is achieved by
increased hygiene requirements are highly recommended.
the fact that, for the implantation of lifting and reinforcing
threads for each gluteal zone, three threads of each type
are used with a triple radial distribution for each of them. Table 2 Morphometry of capillary bed parameter results
Recommendations after PARAMETER CONTROL GROUP IMPACT GROUP
the procedure Specific density of
Antibiotic therapy with drugs, usually of penicillin or the vessels of the 9.3 —
+ 0.6 12.6 —
+ 0.2
cephalosporin groups, for prophylactic purposes. The
capillary bed
patient is advised to exclude active sports, muscle
exertion in the implantation area, swimming pools,
saunas, taking baths, and injury to the impacted area for
14 days.
When the drug is implanted in the gluteal region,
sleeping on the abdomen is recommended for the first
4-5 days after the procedure. The patient is recommended
to wear compression underwear for at least 21 days after
the procedure.
Treatment of skin punctures with alcohol-based
disinfectants during the first 3 days after the procedure
and increased hygiene requirements are highly
recommended. Do not wet the puncture sites for 3 days
after the procedure.

Methods of evaluation
Clinical evaluation of the results was performed by the
doctor and the patient.
The changes in the skin and subcutaneous fat in the Figure 5 Gluteal region, outer-upper quadrant: dermis and hypodermis of the exposure group: the
area of impact were also assessed by comparing the formation of a capillary network in the paravasal space. Hematoxylin-eosin staining. Magnification 1: 225.

prime-journal.com | January/February 2022 25

AESTHETIC FEATURES | THREADS AND FILLER |

histological changes in the control group (before

Table 3 Profile of inflammatory cells ratio implantation) and the comparison group, which was
comprised of the biomaterial taken from patients
PARAMETER CONTROL GROUP IMPACT GROUP 3 months after the intervention.
The cellular/non-cellular component around the
Count of foreign body
implanted materials was studied after scanning the
giant cells in 1mm2/ slides using a Leica Apero AT2 scanner and random
active macrophages 0/2.3 —
+ 0.2/9.6 —
+ 0.2 1.3 —
+ 0.6/3.1 —
+ 0.2/10 selection in sections of 5 high power fields in the
in 1mm / lymphocytes
2 preparation.
in 1mm2
Statistical analysis
Statistical processing was performed using the Statistica
8.0 software package. The Shapiro-Wilk test was used to
assess the normal distribution of data. In the case of the
normal distribution of data, the measure of the central
trend was the mean (M), and the measure of dispersion
was the interval between 25 and 75% of the data in the
sample. The nonparametric Mann-Whitney U test was
used to identify differences between groups. The
parametric Student’s t-test was used to compare groups
with a distribution of values that did not differ from
normal. Differences were considered statistically
significant at p≤0.05.

Results
The clinical results were assessed positively by both the
doctor and the patient. The above-mentioned results
Figure 6 Gluteal region, outer-upper quadrant: dermis and hypodermis of the exposure group: were demonstrated in the creation of a visual increase in
predominance of cells of the lymphohistiocytic series. Hematoxylin-eosin staining. Magnification 1: 100 the volume of the upper gluteal quadrants, lifting the
lower gluteal quadrants, reducing the degree of ptosis,
and strengthening and aligning the skin surface of the
The proposed method of buttocks and the posterior surface of the thigh, which
improved the aesthetic appearance of the gluteal region
correcting the gluteal zone, which and the upper third of the posterior surface of the thigh
consists of the combined use of lifting as a whole.
and reinforcing threads and polylactic
acid filler, satisfies the requirements of Results of microscopic examination
Figure 7 Photos of the
female patient before the
of biopsy specimens
gluteal region correction
procedure — lateral and
patients for skin-strengthening and an In the zone of the procedures, as a natural response to
front view increase of gluteal volume. the implanted materials, both the cellular to non-cellular
ratio and the quantitative indicators of the vascular
density changed. The process of neoangiogenesis and
neovasculogenesis is a significant indicator of the
process of reorganization and tissue remodeling. There
was a large presence of small capillaries in the paravasal
region in the exposure group, which indicates a sufficient
development of the anastomotic-capillary network.
The number of giant cells of a foreign body, active
macrophages and lymphocytes were counted to assess
lymphohistiocytic infiltration and calculate the ratio in
the profile of inflammatory cells.
An increase in the mean diameter of the collagen fibre,
as well as a change in the composition of the
lymphohistiocytic series towards the predominance of
cells of macrophage-monocytic representation, turned
out to be significant in the exposure group. The revealed
change in the parameters of the capillary bed and the
change in the types of grouping of vessels require further
study in order to clarify the stability and impact of these
changes.

26 January/February 2022 | prime-journal.com

 | THREADS AND FILLER | AESTHETIC FEATURE

In the procedure area, as a natural response to the

implanted materials, there was an increase in collagen
fibre production and an increase in the mean diameter of
collagen fibres. There was a change in both the cellular to
non-cellular ratio and the quantitative indicators of the
vascular density. The process of neoangiogenesis and
neovasculogenesis was revealed, which is a significant
indicator of the process of reorganization and tissue
remodeling. In the exposure group, there was a large
presence of small capillaries in the paravasal region,
which indicates a sufficient development of the
anastomotic-capillary network.
The predominance of cells of the lymphohistiocytic
series was observed in the exposure group. In addition,
there was a change in the composition of the
lymphohistiocytic series towards the predominance of
cells of macrophage-monocyte representation.
The above-mentioned data, which we obtained,
confirm the clinical efficacy of the chosen approach of
combining lifting and reinforcing methods with
polylactic acid filler for correcting the gluteal region.

Figure 8 Photos of the

Conclusion female patient 21 days
The proposed method of correcting the gluteal zone, after the gluteal region
which consists of the combined use of lifting and correction
reinforcing threads and polylactic acid filler, satisfies the procedure — lateral and
front view
requirements of patients for skin-strengthening and an
increase of gluteal volume. Anatomical studies and
experiments have shown the safety of the proposed
method. Histopathology reports confirmed the clinical
efficacy of the method, implying the histological
confirmation of an increase in collagen fibres in the area Figure 9 Photo of the
female patient 90
and an increase of blood supply to tissues; which, in turn, days after the gluteal
confirms an increase in the reparative capacity of soft region correction
tissues and the authors’ statement about the collagen- procedure
stimulating effect of substances that make up reinforcing
absorbable threads (polycaprolactone and polylactic
Key points
acid) and polylactic acid filler.
Therefore, in the proposed method of correcting the Knowledge of the
gluteal zone, the result of strengthening the skin and anatomy of the gluteal
increasing the gluteal volume is achieved, which implies area will help in choosing
expanding the arsenal of techniques used in the field of the correct method of
correction and choosing
dermatology and aesthetic medicine, and ensuring an
the depth of implantation
improvement in the skin quality and non-surgical for an ideal result
volume increase of the gluteal zone while maintaining The combination of
reliability and the preservation of results.. methods will provide the
long-lasting result
Declaration of interest None The combination of
threads from References
polycaprolactone and
Figures 1–9 © Dr Markova
polylactic acid and 1. Mills D., Rubin JP., Saltz R. Multi Paikidze T.G., Sulamanidze G.M. Removal
– Society Gluteal Fat Grafting Task Force of facial soft tissue ptosis with special
polylactic acid-based issues safety advisory urging threads // Dermatol. Surg. — May 2002.
Tables 1–3 © Dr Markova fillers work well thanks to practitioners to reevaluate technique. — V. 28 (5). — P. 367–371.
ISAPS News 2018; 12: 8-9.
similar biodegradation 2. Mendieta CG., Gluteal reshaping.
6. Sulamanidze M., Sulamanidze G.,
Aptos suture lifting methods: 10 years
processes Aesth. Surgery J., 2007; 27: 641-655.
experience. Clin. Plast. Surg., 2009; 36:
3. Sulamanidze M.A., Fournier P.F., 281-306.
Bioresorption and Paikidze T.G., Sulamanidze G.M. Removal
7. Sulamanidze M., Sulamanidze G.,
of facial soft tissue ptosis with special
biodegradation of threads // Dermatol. Surg. — May 2002. Aptos suture lifting methods: 10 years
experience. Clin. Plast. Surg., 2009; 36:
polylactic acid are — V. 28 (5). — P. 367–371.
281-306.
4. Melvin A. Shiffman, Alberto Di
different from hyaluronic Giuseppe (Eds.), Body Contouring, Art, 8. Gonzalez, Raul. “Etiology, definition,
acid. In output results of Science, and Clinical Practice /
Springer-Verlag Berlin Heidelberg 2010.
and classification of gluteal ptosis.”
Aesthetic plastic surgery 30.3 (2006):
correction are various 5. Sulamanidze M.A., Fournier P.F., 320-326.

prime-journal.com | January/February 2022 27

AESTHETIC FEATURE | HYPERPIGMENTATION |

ITR has,
according to
pre-existing data,
shown to be an
effective inhibitor
with superior
efficacy over
conventional
hydroquinone,
kojic acid, and
arbutin in an in
vitro study.
 | HYPERPIGMENTATION | AESTHETIC FEATURE

TREATING
POST-INFLAMMATORY
HYPERPIGMENTATION
WITH A TYROSINASE-
INHIBITOR
Agneta Troilius Rubin, Zoi Tsaknakis, Adel Sammain, and Laura Schmidt
evaluate the efficacy and safety of an isobutylamido thiazolyl resorcinol-
containing regimen to improve melasma or PIH due to ablative
laser treatments, acne or sunburn

ABSTRACT MATERIALS AND METHODS RESULTS

Post-inflammatory hyperpigmentation A single centre post-laser study was 30 patients were included in this study
(PIH) is a common side-effect after ablative performed to evaluate the reduction of PIH and 3 patients were lost to follow up. In
treatments of the skin, especially in Skin type and Melasma in healthy participants by the remaining 27 patients, a statistically
III-IV but also after sunburn or inflammatory using two formulations containing ITR in the significant improvement on both brown spot
acne. Isobutylamido thiazolyl resorcinol (ITR, morning (Eucerin® AntiPigment Day Care SPF count and intensity, as well as UV-spot count
Thiamidol®) has been proposed as a potent 30 and Eucerin® AntiPigment Dual Serum) and intensity, was noted after 4 and 12 weeks
tyrosinase inhibitor to improve PIH. and two formulations containing ITR in the of treatment (p-value <0,001).
evening (Eucerin® AntiPigment Night Care
OBJECTIVES and Eucerin® AntiPigment Dual Serum) for CONCLUSION
This study aimed to evaluate the efficacy and 12 consecutive weeks. Clinical photography Thiamidol demonstrated effective
safety of an ITR-containing regimen (Eucerin (Canfield Visia Skin Analysis system of brown improvement of epidermal PIH without
AntiPigment Range) to improve melasma or spot and UV spot count and intensity) and severe side-effects as well as a high
PIH due to ablative laser treatment, acne or patient self-assessment were performed at patient satisfaction rate after 1 month of AGNETA TROILIUS RUBIN, MD,
sunburns. 0, 4, and 12 weeks. treatment. PHD, is an Associate Professor
in Dermatology, Malmö, Sweden;

P
ZOI TSAKNAKIS, is a Licensed
Pharmacist, Medical Advisor
IGMENTATION DISORDERS SUCH AS effective. Pursuing alternative options for and Medical Coach, Eucerin,
post-inflammatory hyperpigmentation hyperpigmentation remains challenging, particularly Sweden; ADEL SAMMAIN, MD,
is a German Board certified
(PIH), melasma, solar lentigos and diffuse among patients with skin of colour, e.g. skin type III-IV Dermatologist & Allergist,
mottled pigmentation are common who tend to experience undesirable complications such International Medical Advisor
concerns for which patients seek as discolouration and scarring after aggressive topical Eucerin; LAURA SCHMIDT, is
a Licensed Pharmacist, Global
cosmetic consultations. Available topical treatments or application of medical devices such as Medical Manager Eucerin
treatments contain active ingredients targeting different ablative lasers, micro-needling and chemical peels.
email: agneta.troiliusrubin@
steps of melanin synthesis and distribution, as well as Isobutylamido thiazolyl resorcinol (ITR) is a recently
skane.se
expediting the turnover rate of pigmented keratinocytes. developed inhibitor of human tyrosinase. ITR has,
Tyrosinase is a rate-limiting step of melanin biosynthesis; according to pre-existing data, shown to be an effective
therefore, its inhibition has become the key treatment inhibitor with superior efficacy over conventional
for various hyperpigmentary conditions. A well- hydroquinone, kojic acid, and arbutin in an in vitro study2.
known agent in this group is hydroquinone, but In vivo, a formulation containing 0.2% ITR achieved
studies have shown that frequent application of visible improvement in the appearance of age spots over COVER
hydroquinone causes side-effects, including a 12-week treatment with a statistically significant STORY
skin irritation and ochronosis1. Various difference compared to other solutions2. It also showed KEYWORDS
agents inhibiting tyrosinase activity have that a melasma-reducing efficacy was evident as early as Melasma, chloasma,
hyperpigmentation, tyrosinase,
been previously examined to substitute 4 weeks and demonstrated a significant decrease in the pigmentation disorder, ablative
hydroquinone but have not always been modified Melasma Area and Severity Index (mMASI) laser

prime-journal.com | January/February 2022 29

AESTHETIC FEATURE | HYPERPIGMENTATION |

score compared with controls. In addition, the efficacy

of the ITR containing product was significantly superior
to 2% hydroquinone in the treatment of melasma3.
Our study aims to investigate the reduction of PIH
when using an ITR-containing product.

Material and methods

We conducted a single centre, uncontrolled post-laser
study in Sweden between January and March 2021 to
evaluate the reduction of PIH by using a formulation
containing the active ingredient Thiamidol (Eucerin®
Anti Pigment Regimen). The patients applied Eucerin®
Anti pigment day cream including an SPF 30 and
Antipigment Dual Serum in the morning and Antipigment
Night Cream and Antipigment Dual Serum in the evening
over a period of 12 weeks. Patients with actinic keratoses
were advised to use SPF 100.
Subjects were also instructed to avoid extreme sun
Figure 1 Sundamaged skin and PIH after Erbium vaporization of lentigo solaris causing PIH. (A) exposure, topical medications, and other cosmetic
Before thiamidol and (B) 12 weeks after treatment with thiamidol products during the study period. Clinical evaluation,
patient self-assessment, and Canfield Visia skin analysis
evaluation were performed at 0, 4, and 12 weeks.
The Canfield system differentiates between brown
spots and UV spots. Brown spots are lesions on the skin,
such as hyperpigmentation, lentigo and melasma that
occur from an excess of melanin. UV spots are flat brown
spots in the epidermis that develop on the skin after sun
exposure (during which UV radiation causes
melanocytes to multiply). The VISIA image analysis
system uses multispectral imaging to scan the skin and
capture key information of surface and subsurface facial
skin conditions. A designed capture module rotates
around the subject simplifying the imaging process and
providing three images of each subject4 (left, front, and
right side). Analysis to detect statistically significant
improvements in the Canfield skin images assessment
was completed using Poisson regression and
independent t-tests.

Results
Thirty participants started the study, and 27 subjects
were evaluated at the end of the study (26 females and 1
male, 30 to 78 years old, median age 51 years). Three
subjects were lost to follow up, one due to an undefined
skin reaction at the treatment site that persisted for a
number of days; however, it was not possible to retrieve
further information in order to assess a causal
relationship to the product application. Two patients
were excluded due to violation of the study protocol
(PDT treatment and extreme UV exposure). All
participants had Fitzpatrick skin type III or IV and 20 of
30 patients underwent an ablative or abrasive aesthetical
skin treatment such as CO2-, Erbium or fractionated laser,
microneedling, nitrogen treatment, chemical peelings or
curettage within 2 years but not closer than 6 months
before the start of the study. Four patients had PIH after
acne, five patients had melasma, and 19 patients suffered
from sun-damaged skin. Several of the patients exhibited
Figure 2 Severely sun damaged skin treated with CO2 vaporisation causing PIH. (A) and (C) before more than one of the diagnoses above at the same time.
treatment. (B) and (D) 12 weeks after treatment with thiamidol The results of the patient self-assessment

30 January/February 2022 | prime-journal.com

 | HYPERPIGMENTATION | AESTHETIC FEATURE

The automated
VISIA image analysis
demonstrated significant
improvement of UV and
Brown spot count as well
as intensity compared to
the baseline visit after
4 and 12 weeks of
treatment.

demonstrated a 100%
agreement rate on
efficacy in reducing
their skin
pigmentation, and
all patients felt that
the products were
comfortable to
their skin,
nourishing their
skin and absorbing
quickly. 96.3% felt
that the texture was
pleasant and 92.6%
said that the
products improved
their skin condition
and they will continue
to use the products after
completion of the study.
The automated VISIA
image analysis
demonstrated significant
improvement of UV and Brown
spot count as well as intensity
compared to the baseline visit after
4 and 12 weeks of treatment.

Discussion
After 1 month of treatment with the regime, we
were able to show a significant decrease in PIH
and melasma skin pigmentation. Three out of five
melasma patients underwent an Intense Pulsed Light
(IPL) treatment before entering the study. However, all
five melasma patients still showed a decrease in
superficial skin pigmentation during the study period.
One patient suffered from dermal melasma but
demonstrated a clinical improvement. Dermal energy-based device (EBD) interventions, such as IPL, to
pigmentation is hard to treat and will remain a topic of increase the penetration of EBD light and thereby also
further investigation on the efficacy of Thiamidol. We reach the dermal components of melasma. Acne patients
also recommend a pretreatment with Thiamidol before who used the Thiamidol regimen reported that they

prime-journal.com | January/February 2022 31

AESTHETIC FEATURE | HYPERPIGMENTATION |

Figure 3 Melasma and acne exhibited far less postinflammatory hyperpigmentation Conclusion
excoriée, treated with upon the healing of inflammatory skin lesions. It seemed Thiamidol demonstrated effective improvement of
microneedling, Dermapen
and IPL causing PIH. (A)
that those patients who did not use any skincare products epidermal PIH without severe side-effects as well as a high
Before thiamidol, (B) after 4 before entering the study demonstrated a more dramatic patient satisfaction rate after 1 month of treatment.
weeks, (C) after 12 weeks. clinical improvement as well as a superior objective However, dermal PIH seems more difficult to treat with
assessment by VISIA image analysis. One patient with topical formulations. Therefore, we suggest treatment with
Asian skin type did not a Thiamidol containing formulation 1
respond at all to the to 4 weeks before, and for up to 3
Thiamidol demonstrated
intervention, probably months after EBD treatments and
due to a condition referred effective improvement of other abrasive therapies, in order to
to as Hori’s nevus, which is epidermal PIH without severe reduce the risk of developing PIH as
extremely difficult to treat. side-effects as well as a high well as to provide better penetration
Patients 70 years and and thus better efficacy of EBD
older exhibiting a lot of patient satisfaction rate after treatments in dermal
seborrheic keratosis and 1 month of treatment. hyperpigmentation, which is more
sun-damaged skin with challenging to treat. However, more
actinic keratoses and lentigines did not respond as well data is needed to quantify the beneficial effect of the
as younger patients. This could be explained by a less application of formulations containing Thiamidol for up to
active cell renewal process or the reduced influence of 1 to 4 weeks prior to EBD based interventions.
melanocytes on pigment production. No effect of the
Key points regimen containing Thiamidol was seen on Poikiloderma Declaration of interest None
Civatte5 on the neck. As expected, brown spots, which are
Post inflammatory deeper than UV spots, such as lentigo, improved only Figures 1-3 © Agneta Troilius Rubin
hyperpigmentation (PIH) slightly. In most patients, mottled pigmentation was
is a common side effect improved, especially in the younger patients and in those
after abrasive treatments
of the skin who had been using sunscreens before entering the
study, as they did not have as much sun-damaged skin.
Thiamidol® has been
The exception was a 77-year-old woman who
shown to improve PIH
demonstrated a significant decrease of both superficial
References
This study confirmes
previous results on PIH, and dermal pigmentation, but she had never been sun 1. Grimes PE. Management of
hyperpigmentation in darker racial
improvement of mild to moderate
melasma. J Invest Dermatol.
Melasma and UV tanning because she grew up in the northern part of ethnic groups. Semin Cutan Med Surg.
2009;28(2):77-85.
2019;139(8):1691-1698.
induced 4. Canfield Scientific, Inc. VISIA
Sweden. Post-inflammatory hyperpigmentation (PIH) is a 2. T, Gerwat W, Batzer J, et al. Inhibition Imaging Systems. Available at: https://
hyperpigmentation of human tyrosinase molecular motifs www.canfieldsci.com/imaging-systems/
severe problem, especially for darker skin types; distinctively different from mushroom
visia-complexion-analysis/ [last
We hypothesise that a therefore, our recommendation is to also investigate the
tyrosinase. J Invest Dermatol.
2018;138(7):1601-1608 accessed 14 January 2022]
pre-treatment with 3. Arrowitz C, Schoelermann AM, 5. Dermnet NZ. Poikiloderma of
Thiamidol® could be beneficial effect of a pretreatment with Thiamidol 1 Mann T, Jiang LI, Weber T, Kolbe L. Civatte. Available at: https://dermnetnz.
Effective tyrosinase inhibition by org/topics/poikiloderma-of-civatte/
even more beneficial month before undergoing EBD treatments to achieve a thiamidol results insignificant [last accessed 14 January 2022]
better and deeper penetration of the EBD light.

32 January/February 2022 | prime-journal.com

 Differentiate
your practice,
add shallow skin
resurfacing and
treatment of actinic
keratosis* to your
offerings with the
new Frax 1940™
applicator today.
Available on the NordlysTM system.
* Fitzpatrick Skin Type 1-3 only

Visit
candelamedical.com
© 2022 Candela Corporation. This material contains registered and unregistered trademarks, trade-names, service marks
and brand names of Candela Corporation and its affiliates. All other trademarks are the property of their respective owners.
All rights reserved. PU02198EN, Rev. A
PRACTICE MANAGEMENT | CONTENT STRATEGY |

JUST SAY NO TO
CONTENT CHAOS!
Wendy Lewis offers guidelines for defining an effective content strategy

A
RE YOU DROWNING IN CONTENT awareness, and keeping your business top of mind when
but not sure what to do with it all? Do customers are seeking what you have on offer.
you often find yourself endlessly It requires more than just a better way to organize your
staring at your various screens, trying content; rather, it needs a universal strategy to quickly
to figure out where to post what and determine how to optimize the best content for the right
when? Having intermittent moments channel at the right time. Content chaos creates
of feeling clueless about what will work for growing your unnecessary diversions that can keep key stakeholders in
digital brand? the practice too busy sorting through it all to use it in a
You may be suffering from a chronic condition timely manner.
sometimes called ‘Content Chaos,’ and it’s all too common.
It can be overwhelming to sort through the best strategy Content creation
for content that delivers the right result, especially since the Each marketing channel you may be active on tends to
WENDY LEWIS is President of
Wendy Lewis & Co Ltd, Global rules are constantly changing. It can be challenging for many appeal to a subset of viewers in a different way. For
Aesthetics Consultancy, a aesthetic practices and medspas to learn how to create example, you wouldn’t use the same exact content in
marketing communications good content or what that even entails. It can be tricky to terms of verbiage, style, and images, on Facebook and
group in New York. An
award-winning writer, her determine why they are not attracting enough new patients LinkedIn, although I see this very frequently. A Facebook
textbook. Aesthetic Clinic or selling more treatments from all their efforts. business page is primarily used by aesthetic practices to
Marketing in the Digital Age.
(CRC Press) will have a second
Content marketing is a marketing strategy used to reach consumers, whereas LinkedIn is a B2B platform
edition in 2022. She is a attract, engage, and retain an audience by creating and where you can connect with colleagues, vendors, and
frequent presenter at virtual sharing relevant articles, videos, podcasts, images, like-minded businesses. Clearly, consumers and
and live conferences worldwide.
infographics, and other forms of media. This approach is prospective patients are also active on LinkedIn, but it’s
contact [email protected] key to establishing your expertise, promoting brand important to reach them in a different way with key

34 January/February 2022 | prime-journal.com

 | CONTENT STRATEGY | PRACTICE MANAGEMENT

messages that vary from other social channels. at a time. This tone demonstrates to prospective patients
If you collect a deluge of content in the form of photos, that you offer solutions that meet their needs and
audio, video, articles, images, etc., you need a system to respect their ability to evaluate what is best for them.
sort through it all. Get organized by creating a simple way Strive to hit all stages of the customer journey from the
to manage your content in all forms to be filed, distributed, initial contact to signing up for a procedure.
shared, or deleted as needed. A collection of content that
is not carefully evaluated and properly managed can Get ready to make a change
waste valuable time that may be better devoted to finding Start by focusing on what you want your practice or
new opportunities to market your practice and stand out medspa to accomplish in the next 12 months, as an
from the competition. example. Work up a growth strategy and key targets.
In some cases, great content can be repurposed for This can be in the form of a percentage of growth year
several platforms in different ways. For example, a great over year or a specific revenue number. Profit targets
video of a provider doing a treatment can be posted on may be considered as a percentage or as a set monetary
Instagram first and then re-used on another channel at a amount over last year’s performance.
future time. You may also re-post it on Instagram as a Think about how you expect to achieve this growth,
‘#throwbackthursday’ post with a fresh caption and/or for example, new patients and customers, bringing on a
intro copy. An article about a new product or research new treatment or device or upgrading your current
work may be cut down to 500-750 words for a blog post treatment portfolio, incentivizing staff with perks and
with an image added. benefits based on sales and revenue, product add-on
There is no ‘one size fits all’ template for sales to current clients, attracted a steady stream of new
building a content marketing strategy. clients, staffing up with more providers, and more.
Each one should be unique to its owner. It Consider any other factors that may arise to contribute
needs to be customized based on your Quantity to your success within the specified time period; a new
goals, bandwidth, and ultimately your does matter, but strain of COVID-19, increased competition nearby,
budget. Your strategy should outline your economic challenges in your local market, construction
key business and client needs and how
quality trumps in or around your facility, lack of adequate parking, etc.
your content efforts will address them. quantity. You need Even brilliantly crafted, eye-catching content may not
Quantity does matter, but quality more of your be sufficient to meet your needs for growth and revenue.
trumps quantity. You need more of your This is just one component of a comprehensive
better content and
better content and less of the content that marketing strategy. All or most of these seemingly
does nothing useful for your brand. less of the content minuscule details can be critical success factors, so
that does nothing carefully consider this before you build your content
Content marketing useful for your marketing plan. Include key stakeholders in the process
strategy brand.
to work as a cohesive team, set reasonable and attainable
At its core, a content marketing strategy is goals, and meet or exceed them.
your understanding of the ‘why, who, and Simply creating more content will not get you where
how.’ Why you are creating content, who you can help, you want to go. Rather it needs to be about creating the
and how you will help them in a way that stands out from minimum amount of content that will encourage the
the pack of providers in the market. Strategic content maximum amount of behaviour change in your clients.
marketing will work to build an audience and to achieve To do so, the content you are creating must add value, be
results that may include increased revenue, improved useful, compelling, and above all, differentiated.
value proposition, lower costs, or additional loyal
customers who spend more in your business.
If you don’t have the bandwidth to prepare a lengthy
and detailed strategy, start with a one-page outline. Break 4 KEY ELEMENTS OF A CONTENT MARKETING PLAN
down the more detailed strategy you had in mind into Objectives: What qualitative results during the time frame specified? This
just a single page to make it easier to share and execute. do you hope to accomplish over the may include potential benefits of
This can serve as a good first step to defining a content next year? For example, growth in fans strong content marketing to increase
marketing strategy for your practice. or followers by a certain percentage awareness, create an elevated
Content marketing is the process of creating valuable, on key social channels, increased customer experience, enhanced word
relevant content to attract, acquire, and engage your social proof. of mouth through 5-star reviews, etc.
audience. Providing helpful and entertaining content can Goals: How will content marketing Metrics: How will you measure the
form a strong bond between your brand and customers help your business achieve its goals, outcomes of content marketing
that continues to grow and strengthen over time. and how will you measure progress? strategies? This can be determined in
Personalized messaging is a strong strategy for This may be tricky to monitor. It is hard several ways, including the percentage
aesthetic marketing practices to succeed. This can be to measure revenue based on the of increased awareness, delivering a
defined as producing content that is relevant for every number of likes, comments, or shares specific quantity of qualified leads that
stage of the customer journey. People tend to trust on an Instagram post, for example. convert to treatments or purchases,
solutions that aim to walk them through various paths Strategy: What should enriched producing a certain amount of
toward decisions rather than just giving them one choice content marketing support deliver revenue, etc..

prime-journal.com | January/February 2022 35

PRACTICE MANAGEMENT | CONTENT STRATEGY |

send post

text
A content inventory should ideally influencers, and social
include key pieces of content across all experts on staff that will
relevant channels, i.e., website, blog, need to work from the
share

buy
Instagram, Facebook, TikTok, same content marketing

do schedule go
YouTube, etc. Organizing strategy for consistency
these content buckets in see of messaging.
bring

download
one place will make It’s important to circle
it easier to back to your strategy
decide what to periodically to change up

make
keep, update, or your plan as new forms
remove. This of content and additional

call
content audit channels emerge.
will help your
read DM (direct message)
team determine
which content is
join fill click see Content plan
A content plan should be

reply
working for your very tactical. It documents the
business so you will specifics of how you will execute
know to create more of your strategy, and who on your team
that form and tone. The audit will will be handling each task. It’s important to
also unroof redundancies in your themes write understand that you need a content
and messaging that should be tweaked or removed. marketing strategy before you build your content
For example, if you are posting a steady stream of offers plan. Think of it as a marketing plan that specifically
and discounts, it will be clear that you need to tone this relates to content; thus, it should include details such as
practice down. If you are publishing a plethora of articles CALL TO the key topic areas you will cover, what content you will
on facial injectables and recycling the same points and ACTION WORDS create, when and how to share your content, and specific
patient photos, your audience will likely get bored and calls to action you will include.
move on. Think about what you Your strategy should be well documented so everyone
want your audience to involved is in the know and will be empowered to be
Executing your plan do as a result of reading successful. Adapt the template to suit your needs and
or experiencing your
Next step is to drill down to the actionable details, and include the most relevant elements. The next step will be
content and include the
assign tasks for who will do what, when, and how. Get words to get them there: to align all content creators involved in your marketing
your whole team involved to have ownership of their Bring plan, both internal and external to your practice.
responsibilities and contributions. Buy
The budget to be allocated should be determined Call What should be included in your
before executing your plan. There is no set strategy for Click content marketing strategy?
predicting the total costs of content marketing needed to DM (direct message) Think of a content marketing strategy as an outline of
produce the results you want to achieve. This number Do your key business and customer needs, plus a detailed
will fluctuate by market, timing, size of your business, and Download plan for how you will use content to address them. There
overriding goals. Start with a budget that is manageable Fill is no ‘one size fits all’ template for building a content
Go
and track results to determine what is working to calculate marketing strategy. It will need to be unique to your
Join
the ROI achieved from each tactic. Begin with a budget Make business model, however, there are certain general
that is affordable for your practice and go from there over Post guidelines to follow.
time. For example, the more revenue generated through Read
your marketing efforts, the more budget you may have to Reply Updating your content strategy
spend to take your marketing to the next level. Schedule Content marketing helps to build brand awareness
Document your content marketing strategy to share See organically. When your content ranks high on key search
with all stakeholders so everyone is on the same page. Send engines or is shared across social channels, your visibility
Start by keeping it to a single page that can be easily Share soars without having to buy into pricey promotions or ad
shared to maximize its impact and expediency with Text campaigns. This content also is also more sticky because
Write
internal staff as well as any external content creators you your target audience is more likely to engage with it over
may be working with. It is important to keep all content paid promotions. A program that includes both can help
producers strategically aligned. This may include external cover all your bases. People tend to buy from brands and
agencies, freelancers, copywriters, digital marketers, businesses that they have relationships with.
Some components of your strategy, such as your
mission and goals, can remain consistent even as your
There is no ‘one size fits all’ content marketing program evolves. However, other
aspects of your content marketing should be reviewed
template for building a content
and updated periodically. To ensure that your strategy
marketing strategy. Each one should be stays on target, revisit this periodically, quarterly or semi-
unique to its owner. annually — to evaluate where you are with active

36 January/February 2022 | prime-journal.com

 | CONTENT STRATEGY | PRACTICE MANAGEMENT

channels, core themes and topics, best performing posts

and images, etc. The more you review your plan, the
quicker you can respond to something that is not
delivering results or may be negatively affecting your
digital presence in some way.

Build authentic engagements

through snackable content
Content is the heart and soul of the customer experience.
It takes center stage when it comes to creating
connections with patients and clients. As our attention
spans keep shrinking, content needs to be fast and
snackable to get seen by your audience. Headlines
should be short and catchy. Videos are getting shorter;
most people won’t watch videos that are longer than 30
seconds. Images should be crisp and clear to get more
eyes on them.
In a world where we are inundated with choices, it is
increasingly hard to stand out. Start by building
connections through sensibly paced marketing and
content where you are building a strong, healthy
relationship over time. Positioning your brand and
business as a source of information can help get you
there.
Focus on developing a deeper connection with
SHARE YOUR CONTENT
customers by providing real value. It is not just about MARKETING STRATEGY WITH
speed, length, or time. It’s about finding the right data and KEY STAKEHOLDERS
using meaningful creative ideas. Strive to increase Best practice is to include all or most individuals in
consumption of your content by consistently giving your your practice to have a say in the content marketing
audience text and visuals that resonate and are strategy. This can help maintain a cohesive brand
memorable. Content that is emotion-driven or personal while minimizing duplication of efforts and keeping
tends to make people more loyal and build trust with a everyone on the same page.
brand. They will also be more open to forgiving errors Sharing your documented strategy is also good
and mishaps that may arise along the way. practice for businesses that are just starting out with
There is no such thing as a perfect content marketing, for content teams that rely on
internal or external subject matter experts, or for
content strategy. Every strategy needs to
companies that outsource any part of the content
evolve and change over time to stay Be sure to make it creation and distribution process. How you
current and interesting to your target communicate your strategy depends on the
audience. By nature, we are always clear from the outset what structure and culture of your organization. It is wise
hungry for a good story and an appealing is NOT acceptable; for to get everyone on board with the strategy to make
graphic or image. Give your audience example, a staff member them feel part of something bigger than just
what they crave and cannot get themselves as an employee. This attitude will tend to
everywhere else, and they will be more
posting a photo of a generate a higher interest, camaraderie and interest
likely to keep coming back for more. patient on his or her in participating in the process as a team.
Be sure to make it clear from the outset what is
personal Instagram NOT acceptable; for example, a staff member posting
Future of Content without express a photo of a patient on his or her personal Instagram
By all accounts, advancements in AI will without express permission.
push the envelope in terms of emerging permission.
trends in content creation and how
content gets deployed. Pay close attention to these
developments to stay on top of future innovations that another plan cooked up in Mark Zuckerberg’s big brain to
will undoubtedly affect your content strategy. torture us all. But it’s here and it’s happening, so we can no
In the simplest terms, the ‘Metaverse’ (which combines longer afford to ignore this encompassing trend.
the words ‘meta’ and universe’) can be defined as, “a As David Baszucki writes in WIRED1, ‘The Metaverse is
digital place where people seamlessly get together and
References arguably as big a shift in online communication as the
interact in millions of 3D virtual experiences.” It is 1. David Baszucki. The Metaverse is telephone or the internet. Within the next few decades its
considered a future evolution of the internet also referred coming. Wired. Jan 2, 2021. Available applications will exceed our wildest imaginations.’
at: https://www.wired.co.uk/article/
to as Web 3.0 that promises a rise in 3-D or virtually metaverse. [last accessed 15
augmented reality experiences. Right now, to me at least, February 2022.]

it seems like a remake of Blade Runner, The Matrix, or just

prime-journal.com | January/February 2022 37

 PROMOTION

ADVANCED SUPERFICIAL RESURFACING

WITH A NOVELFRACTIONAL HANDPIECE:
FRAX 1940
Firas Al-Niaimi evaluates the latest non-ablative fractional laser
technology in two clinical cases of photodamaged skin

F
ACIAL REJUVENATION wavelength and fluence used) with The new Frax
treatments have become ultimately a wound healing process 1940 nm handpiece
increasingly popular with that translates into visible clinical Candela’s newest handpiece device,
the advent of various improvements in aspects of the Frax 1940, is a major
interventions with photoaging and photodamage advancement in the field of non-
shorter downtime and such as texture, fine lines, and ablative fractional laser technology
faster recovery, including the wrinkles. with very little matched technology
non-ablative fractional laser There are currently several available to date. The technology
technology. This technology is devices in the market with relies on a solid state diode emitting
based on the fractional delivery of wavelengths in this range with a 1940 nm wavelength in a scanning
PROF. FIRAS AL-NIAIMI, MD,
beams of light in columns in a various specifications including the mode with in-built cooling (Softcool).
Dermatologist; London, UK wavelength that is absorbed by Candela handpiece of Frax 1550 nm This wavelength is unique since it
tissue water but below the with unique features such as the lies very close to the peak of the
vaporising threshold and typically in-built cooling system and an water absorption wavelength in the
in the near infrared range of 1200 adjustable scanner width2. The non-ablative range just below the
and 1600 nm1. The resultant tissue 1550 nm treatment has largely ablative threshold (1935 nm). This
interaction leads to thermal become one of the most sought results in a unique avid light-tissue
coagulation of the epidermis and after non-ablative fractional laser interaction with water with a
dermis (depth related to treatments. superficially located biological
interaction manifesting as
coagulation and epidermal and
superficial papillary dermal injury3.
Microscopic Epidermal Necrotic
Debris (also known as MENDs) lead
to epidermal renewal and pigment
clearance, and together with the
superficial nature of the injury this
leads to clinically visible
improvements in tone, texture, and
superficial pigment clearance.
There are currently very few
available technologies aside from
ablative lasers that have such a
marked impact on the epidermis
giving clinical results described by
patients as: ‘glowing skin’, ‘smoother
skin’, and a ‘porcelain feel’ of the
treated skin.

Features of the Frax

1940 nm handpiece
Figure 1 Case 1: The handpiece is relatively light and
(A) Before, (B) after treatment ergonomically friendly with an

38 January/February 2022 | prime-journal.com

 “There are currently very few available
technologies aside from ablative lasers that
have such a marked impact on the
epidermis giving clinical results described
by patients as: ‘glowing skin’, ‘smoother skin’,
and a ‘porcelain feel’ of the treated skin.”

aiming beam and a disposable single treatment session using the make-up simply sits much nicer on
roller with in-built Softcool following parameters: Fluence of the skin and her facial skin is
technology for comfort. The device 8 mj, 40% density, scanner width radiant with a glow.
allows for energy adjustment from 12 mm, 4 passes and with softcool
6 to 20 mj, giving an estimated technology. Immediately post F
 ind out more at: candelamedical.com
depth of 200 micron. The density is treatment topical vitamin C serum
adjustable between 20 and 50%, and non-cross-linked hyaluronic
and the scanner width has the acid serum was applied to the skin.
References
choices of 4, 6, 8, 10, and 12 mm. Downtime was 5 days of erythema
1. Geronemus RG. Fractional
The latter is particularly a huge with darkening of the superficial photothermolysis: current and future
applications. Lasers Surg Med. 2006;38:169- 176.
advantage as it allows for a pigmented lesions. One month post 2. Tidwell WJ, Green C, Jensen D, Ross EV.
customised treatment in smaller treatment the patient reported Clinical evaluation and in-vivo analysis of the
performance of a fractional infrared 1550 nm
areas, as well as targeting with significant improvement in the ‘feel laser system for skin rejuvenation. J Cosmet
Laser Ther. 2018;20:360-363.
precision and maximum impact of the skin’, texture and marked 3. Miller L, Mishra V, Alsaad S, et al. Clinical
evaluation of a non-ablative 1940 nm fractional
smaller lesions, such as lentigos Figure 2 Case 2: reduction in signs of photodamage. laser. J Drugs Dermatol.2014;13:1324-1329.
and flat seborrheic keratoses. (A) Before, (B) after treatment She particularly explained that her

Case 1
A 56 year-old woman with evidence
of photodamage and dull, rough
facial skin was treated with the Frax
1940 handpiece, using the following
parameters: Energy of 10 mj,
density of 35%, scanner width of
10 mm, 4 passes over the entire
face with 2 additional passes on the
large individual lentigos using a
4 mm scanner width, 50% density
and 7 mj fluence. The clinical
endpoint is erythema and post care
consisted of a light-based
moisturizer regularly with strict sun
protection. The downtime is around
4 to 5 days with erythema and
darkening of the lentigos, and a
total of 2 treatments were
performed with significant
improvement in pigment reduction,
smoothening of the skin and the
‘glow’ described by the patient that
continued for weeks post treatment.

Case 2
A 46 year-old woman with
Fitzpatrick Skin Type 2 and
evidence of photodamage, as well
as what she described as a ‘dull
and lifeless facial skin’ underwent a

prime-journal.com | January/February 2022 39

 PROMOTION

RENÉE [BIONIC-HA]® GELS

FOR FACIAL AESTHETICS
WHY BIONIC DESIGN MATTERS?
Qventis shares the results of a recent study evaluating the safety and efficacy of
RENÉE hyaluronic acid gels for tissue augmentation and facial wrinkles

A
T QVENTIS, WE TAKE Regarding the basic Figure 1
inspiration from biological rheological properties (G’, G” RENÉE family
of products
systems and make use of and tan δ) for RENÉE fillers; G’
science to design products and G” increase with the
that exhibit features found in concentration of HA, as
biological tissues. This is expected, so that a hydrogel
Bionic (from bion-, unit of life and -ic, like) with a higher concentration of
design or biologically inspired hyaluronic acid also has the
engineering — the transfer of information most pronounced volumizing
from biological systems into the design of effect.
medical solutions. It is easy to understand Tan δ is an important
that bionic designed products exhibit parameter, which gives
superior physical, chemical and biological information about the
compatibility and therefore are less prone to hydrogel behaviour: when tan
trigger side-effects; in other words, they δ < 1, it means that we are
have a high safety profile. dealing with a crosslinked
RENÉE, a set of bionic gels, is a versatile line hydrogel having an elastic
with concentrations ranging from 18 mg HA to modulus (G’) higher than the
28 mg of HA. The RENÉE product line is viscous modulus (G”), if tan
composed of a set of 4 dermal fillers — RENÉE δ > 1 the gel behaves as a viscous fluid. This is In conclusion, RENÉE formulations have an
SMILE (22 mg HA), RENÉE TOUCH (24 mg HA), the case of RENÉE PRIME, our skin booster. unparalleled rheological profile with a unique
RENÉE LIFT (26 mg HA) and RENÉE VOLUME For the RENÉE set of fillers with combination of elasticity, cohesivity, and
(28 mg HA) and the skin booster RENÉE concentrations ranging from 22 mg HA to stretchability.
PRIME (18 mg HA). All products, including 28 mg HA, rheological results show that tan δ
RENÉE PRIME, are formulated with crosslinked is approximately constant, with a value Evaluation of safety and
HA, with a crosslinking degree of 6% and are between 0.4 and 0.5. This shows that the efficacy of RENÉE BIONIC GELS
enriched with amino acids — glycine and formulations of RENÉE fillers are hydrogels, Study design
proline. All RENÉE formulations are having a good degree of viscosity. This is The aim of this open-label, retrospective,
homogeneous, cohesive and true why RENÉE fillers are soft, well-hydrated, monocentric study was to evaluate the safety
monophasic, thanks to an advanced easy to inject and have excellent tissue and efficacy of RENÉE hyaluronic acid gels for
manufacturing process, during which the HA integration. soft tissue augmentation and correction of
chains are exposed to minimal mechanical The value of G’ for RENÉE fillers is carefully facial wrinkles. The study was conducted
and thermal stress. controlled so that it is never higher between January 2021 and December 2021 at
than 200 mPa in order to have the best the Centro Medico Polispecialistico (CMP) in
Rheology profile combination of cohesivity, elongation and Pavia, Italy, by an unblinded treating
The rheology of a HA filler is crucial to resistance for the hydrogel formulations. investigator (TI) along with a blinded
understand its properties and to get the best Thanks to an advanced manufacturing evaluating investigator (EI) who performed all
aesthetic outcome for the patients. RENÉE process, the RENÉE formulation hydrogels safety and effectiveness assessments. Different
family of dermal fillers has been designed to have a truly monophasic structure that, areas of the face were treated. The investigator
combine easy injection with good tissue together with carefully tuned rheological selected the product to use on the basis of the
integration while offering optimal lifting and properties, leads to a unique combination of characteristics of the area to treat and
volumizing effect rounded by natural, cohesivity, elongation and resistance, which determined the technique and injection
long-lasting results. can be shown with a simple finger test. volume based on clinical experience. No

40 January/February 2022 | prime-journal.com

 “The RENÉE family of dermal fillers
has been designed to combine easy
injection with good tissue integration
while offering optimal lifting and
volumizing effect rounded by natural,
long-lasting results.”

touch-up treatment was performed. All patients by a blinded evaluating investigator (EI) considered ‘very much improved’ (46.15%), 21
were followed up for 6 months. The TI took comparing the pre-treatment pictures with the patients were rated as ‘much improved’
pictures of the patients at baseline, 1 week, 2 post-treatment pictures, using the Global (53.85%). No patient was rated as ‘improved,
weeks, 4 weeks, and 24 weeks after the Aesthetic Improvement Scale (GAIS). The GAIS ‘no change’, and ‘worse’.
treatment. The pictures were taken with a rating categories represents a five-point scale, GAIS assessment at 4 weeks post-treatment
classic 2D camera (Nikon D90) and with a 3D where 1 = very much improved; 2 = much showed that 17 patients were considered ‘very
camera (LifeViz Mini) to evaluate efficacy and improved; 3 = improved; 4 = no change; much improved’ (43.6%), 19 patients were rated
facial volume changes. All patients were asked 5 = worse. All patients completed a 30-day as ‘much improved’ (48.7%), 3 patients were
to record post-treatment adverse and rate safety diary after treatment reporting any rated as ‘improved’ (7.7%). No patient was rated
satisfaction with treatment. injection site responses. In addition, subjects as ‘no change’ or ‘worse’. Investigator GAIS
rated satisfaction with treatment 24 weeks assessment at 24 weeks post-treatment
Subjects post-injection using a 5-point Likert scale highlighted that 7 patients (17.95 %) were still
All patients were adults (aged ≥18 years) and (1 = very satisfied, 2 = satisfied, 3 = indifferent, considered as ‘much improved’, 21 patients
provided informed consent. Subjects were 4 = dissatisfied, 5 = very dissatisfied). (53.85%) were considered ‘improved’, 11
excluded if they had undergone facial tissue patients (28.2%) were judged as ‘no change’
augmentation in the lower two-thirds of the Results and no patient was considered ‘worse’ at this
face with dermal fillers within the previous Demographic and baseline time point.
12 months or with fat or botulinum toxin characteristics The degree of satisfaction with the cosmetic
injections within the previous 6 months, or had A total of 39 patients were included in the result was rated for the majority of patients as
received semipermanent fillers or permanent study, comprising 38 female (97.4%) and 1 male ‘very satisfied’ (18 subjects) or ‘satisfied’ (20
facial implants in the lower face. Subjects with (2.6%), mean age of 57 years (range: 20–78 subjects). Only one patient rated the
uncontrolled disease, active inflammation, years.) satisfaction with treatment as ‘indifferent’. No
infection, lesions in the treated area, or who patient was ‘dissatisfied’ or ‘very dissatisfied’.
had a tendency for developing hypertrophic Effectiveness
scarring were also excluded. Females who Results from the investigator assessment of Safety data
were pregnant or nursing were ineligible to GAIS at 1-week post-treatment showed that Treatment was well-tolerated, with only
participate. Drugs known to increase the majority of patients were ‘very much temporary adverse events recorded in 17
coagulation time were withdrawn for 10 days improved’ (19 patients [48.7%]) or ‘much patients (43.6%). There were no reports of
prior to and 3 days after study treatment. improved’ (20 patients [51.3%]). No patient serious adverse events, such as visual
was rated as ‘improved’, ‘no change’ and disturbance, tissue ischemia, necrosis, or
Assessments ‘worse’. allergy. The reported adverse events were
Clinical efficacy was assessed at 1 week, The assessment of GAIS 2 weeks post- bruising (4 cases), itching (4 cases), redness
2 weeks, 4 weeks, and 24 weeks post-injection treatment highlighted that 18 patients were (6 cases), pain after injection (7 cases),
tenderness to touch (12 cases), swelling
(4 cases).

Summary
From the analysis of the clinical data, we
concluded that the RENÉE range of bionic
hyaluronic acid gels have a good effectiveness
and safety profile. RENÉE hyaluronic acid gels
are easy to inject, and they are highly
appreciated by patients and doctors. In
conclusion, patients benefit from the aesthetic
outcome, facial rejuvenation effect and high
safety profile when treated with RENÉE range
of products.

Figure 1 Patient treated with RENÉE SMILE (lips) and RENÉE PRIME (cheeks). (A) before treatment, (B) after treatment F
 ind out more at: https://renee.com.de

prime-journal.com | January/February 2022 41

EVENTS CALENDAR |

events Industry events in 2022

for the aesthetic and
anti-ageing market

EUROPE NORTH AMERICA REST OF WORLD

31 MARCH – 2 APRIL 2022 9–11 JUNE 2022 4–7 MAY 2022 7–8 MAY 2022
AMWC 2022 Beauty Through Science 2022 Miami Cosmetic Surgery AMWC Asia 2022
Miami, FL Taipei, Taiwan
Monte Carlo, Monaco Stockholm, Sweden www.miamicosmeticsurgery.info www.euromedicom.com
www.euromedicom.com www.btsstockholm.com/2022
8–11 JUNE 2022 5–6 NOVEMBER 2022
27–29 APRIL 2022 17–18 JUNE 2022 Vegas Cosmetic Surgery & AMWC Japan
FACE London Aesthetic Dermatology
European Rhinoplasty Course Tokyo, Japan
Las Vegas, NV
London, UK www.vegascosmeticsurgery.info
www.euromedicom.com
Brussels, Belgium
www.euromedicom.com
www.europeanrhinoplastycourse.eu 24–26 NOVEMBER 2022
7–10 JULY 2022
5–7 JULY 2022 The Aesthetic Show 2022 ICAD Bangkok 2022
7–8 MAY 2022
Annual Meeting of British Las Vegas, NV Bangkok, Thailand
Beyond Beauty Live www.aestheticshow.com www.euromedicom.com
Association of Dermatologists
London, UK
Glasgow, Scotland
www.beyondbeauty.co.uk
badannualmeeting.co.uk

12–14 MAY 2022 7–11 SEPTEMBER 2022

17th EADV Symposium 31st EADV Congress
Ljubljana, Slovenia Milan, Italy
www.eadv.org www.eadv.org

42 January/February 2022 | prime-journal.com

 2022

AESTHETIC & ANTI-AGING MEDICINE WORLD CONGRESS

CELEBRATING THE

EDITION OF
AMWC MONACO
March 31 • April 1-2
Under the High
Patronage of H.S.H.
Prince Albert II
of Monaco

MONTE-CARLO,
MONACO
GRIMALDI FORUM

REGISTRATION CONTACT US

Following the success of our last edition, AMWC 2022 is back at the
Grimaldi Forum, Monaco and will be broadcasted live, worldwide.
Join us on March 31 to April 2, 2022 to celebrate the 20th edition of this
world leading aesthetic & anti-aging medicine congress.

+82-2-6952-8770
[email protected]
www.gorgeousgouri.com
WWW.EUROMEDICOM.COM
 ❚ ❚ ❚
AMWC 2022 Practice Management Advanced Superficial Resurfacing RENÉE [Bionic-HA]® Gels

Jan/Feb 2022 ❙ Volume 12 ❙ Issue 1

Jan/Feb 2022
❙
Volume 12 Issue 1

INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE

INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE

CORRECTING
THE GLUTEAL
REGION
WITH THREADS
AND FILLERS

CHIN FILLER
TREATMENTS
DIFFERENCES BETWEEN
MEN AND WOMEN

Treating post-inflammatory
hyperpigmentation
WITH A TYROSINASE-
INHIBITOR
prime-journal.com