Rahman Syed, Ameer Afzal Khan, Suleman Shah, Anfal Khan, Mohammad Idrees, Mohsin Ali, Mohammed Al Sinani, Mohammed Al Maqbali
Background
Platysma prominence (PP) is a common aesthetic concern associated with aging, leading to visible neck bands and loss of jawline definition. OnabotulinumtoxinA has emerged as a minimally invasive treatment; however, data from randomized controlled trials (RCTs) remain fragmented.
Aims
To systematically evaluate the efficacy and safety of onabotulinumtoxinA for treating moderate to severe PP through meta-analysis of RCTs.
Methods
PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to March 2025 for RCTs comparing onabotulinumtoxinA with placebo in adults with PP. Two reviewers independently extracted data and assessed bias using the Cochrane RoB 2.0 tool. The primary outcomes were ≥ 1-grade and ≥ 2-grade improvement on the Clinician (C-APPS) and Participant (P-APPS) Allergan Platysma Prominence Scales. Secondary outcomes included patient satisfaction and treatment-emergent adverse events (TEAEs). Random-effects meta-analysis was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs).
Results
Three RCTs (n = 912) were included. OnabotulinumtoxinA significantly increased ≥ 1-grade (RR = 4.11; 95% CI, 3.60–4.69) and ≥ 2-grade (RR = 1.83; 95% CI, 1.54–2.17) improvements compared to placebo. Patient satisfaction was higher in the treatment group (RR = 5.55; 95% CI, 4.15–7.43). The incidence of TEAEs was similar between groups (RR = 0.95; 95% CI, 0.76–1.20), with most being mild and transient.
Conclusions
OnabotulinumtoxinA is an effective and well-tolerated minimally invasive option for improving platysma prominence, offering significant aesthetic and patient-reported benefits without increasing adverse effects.
{"title":"Efficacy and Safety of OnabotulinumtoxinA for the Treatment of Platysma Prominence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Rahman Syed, Ameer Afzal Khan, Suleman Shah, Anfal Khan, Mohammad Idrees, Mohsin Ali, Mohammed Al Sinani, Mohammed Al Maqbali","doi":"10.1111/jocd.70701","DOIUrl":"10.1111/jocd.70701","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Platysma prominence (PP) is a common aesthetic concern associated with aging, leading to visible neck bands and loss of jawline definition. OnabotulinumtoxinA has emerged as a minimally invasive treatment; however, data from randomized controlled trials (RCTs) remain fragmented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To systematically evaluate the efficacy and safety of onabotulinumtoxinA for treating moderate to severe PP through meta-analysis of RCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to March 2025 for RCTs comparing onabotulinumtoxinA with placebo in adults with PP. Two reviewers independently extracted data and assessed bias using the Cochrane RoB 2.0 tool. The primary outcomes were ≥ 1-grade and ≥ 2-grade improvement on the Clinician (C-APPS) and Participant (P-APPS) Allergan Platysma Prominence Scales. Secondary outcomes included patient satisfaction and treatment-emergent adverse events (TEAEs). Random-effects meta-analysis was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs (<i>n</i> = 912) were included. OnabotulinumtoxinA significantly increased ≥ 1-grade (RR = 4.11; 95% CI, 3.60–4.69) and ≥ 2-grade (RR = 1.83; 95% CI, 1.54–2.17) improvements compared to placebo. Patient satisfaction was higher in the treatment group (RR = 5.55; 95% CI, 4.15–7.43). The incidence of TEAEs was similar between groups (RR = 0.95; 95% CI, 0.76–1.20), with most being mild and transient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>OnabotulinumtoxinA is an effective and well-tolerated minimally invasive option for improving platysma prominence, offering significant aesthetic and patient-reported benefits without increasing adverse effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In countries with intense solar irradiation such as Brazil, the skin operates simultaneously as a biological organ, a phenotypic marker of aging, and a visible marker of social belonging [<span>1</span>]. Marks produced by chronic photoexposure acquire meanings that extend beyond cutaneous physiology. They become embedded in social, economic, and symbolic dynamics that influence behavior, aesthetic expectations, and subjective experiences of aging. Amid ongoing ethical debates on whether aging should be viewed as pathological or socially constructed, it is relevant to examine how photoaged skin in Brazil may function as a visible stigma linked to social class and structural inequality [<span>2, 3</span>]. This phenomenon is deeply rooted in the structural hierarchy of labor and racialized class stratification, where cutaneous health outcomes are inextricably linked to systemic inequalities that determine environmental exposure and access to protective resources [<span>4</span>].</p><p>A significant clinical paradox emerges: while these patients pursue idealized digital textures, they frequently present with Fear of Overfilling (FOF) [<span>9</span>], a clinically meaningful anticipatory anxiety frequently observed in aesthetic practice centered on iatrogenic identity loss that acts as a psychological barrier to treatment. The coexistence of these phenotypes reveals an ethical dilemma for cosmetic dermatology: while one population seeks to reduce stigmata linked to structural inequality, the other navigates a tension between unrealistic digital ideals and the fear of clinical distortion [<span>9</span>].</p><p>Sun exposure in Brazil is marked by ambivalence. While culturally associated with leisure, it often reflects occupation and unequal access to care [<span>1, 2</span>]. Conversely, smooth skin signals aesthetic capital. Treating photoaging may partially reduce perceived inequalities, while lack of access tends to reinforce them [<span>2, 8, 10</span>]. At the same time, the hypervisibility of distorted results in digital environments has reshaped public perception. The widespread use of filters modifies subjective perceptions of normality [<span>3</span>], while “Zoom dysmorphia” has intensified self-scrutiny [<span>4, 5</span>]. Among clinicians, repeated exposure to filtered demands may induce “perception drift,” where normal variations are reinterpreted as defects [<span>8</span>].</p><p>Furthermore, the normalization of Overfilled Face Syndrome (OFS) in social media reinforces FOF, challenging the therapeutic alliance as patients overestimate the risk of unnatural outcomes [<span>9, 11</span>]. Beyond the aesthetic and psychological dimensions, it is imperative to acknowledge that photoaging, regardless of social class, is the primary clinical precursor to skin cancer. Both phenotypes are subject to the cumulative and deleterious effects of ultraviolet radiation, which remains a critical public health concern in Brazil due to the high
{"title":"Photoaging as a Social Marker and the D.I.F.A. Assessment: Addressing Social Stratification, the Filtered Ideal, and Identity Preservation in Brazil","authors":"Rafael Rodrigo Crisanto de Oliveira","doi":"10.1111/jocd.70700","DOIUrl":"10.1111/jocd.70700","url":null,"abstract":"<p>In countries with intense solar irradiation such as Brazil, the skin operates simultaneously as a biological organ, a phenotypic marker of aging, and a visible marker of social belonging [<span>1</span>]. Marks produced by chronic photoexposure acquire meanings that extend beyond cutaneous physiology. They become embedded in social, economic, and symbolic dynamics that influence behavior, aesthetic expectations, and subjective experiences of aging. Amid ongoing ethical debates on whether aging should be viewed as pathological or socially constructed, it is relevant to examine how photoaged skin in Brazil may function as a visible stigma linked to social class and structural inequality [<span>2, 3</span>]. This phenomenon is deeply rooted in the structural hierarchy of labor and racialized class stratification, where cutaneous health outcomes are inextricably linked to systemic inequalities that determine environmental exposure and access to protective resources [<span>4</span>].</p><p>A significant clinical paradox emerges: while these patients pursue idealized digital textures, they frequently present with Fear of Overfilling (FOF) [<span>9</span>], a clinically meaningful anticipatory anxiety frequently observed in aesthetic practice centered on iatrogenic identity loss that acts as a psychological barrier to treatment. The coexistence of these phenotypes reveals an ethical dilemma for cosmetic dermatology: while one population seeks to reduce stigmata linked to structural inequality, the other navigates a tension between unrealistic digital ideals and the fear of clinical distortion [<span>9</span>].</p><p>Sun exposure in Brazil is marked by ambivalence. While culturally associated with leisure, it often reflects occupation and unequal access to care [<span>1, 2</span>]. Conversely, smooth skin signals aesthetic capital. Treating photoaging may partially reduce perceived inequalities, while lack of access tends to reinforce them [<span>2, 8, 10</span>]. At the same time, the hypervisibility of distorted results in digital environments has reshaped public perception. The widespread use of filters modifies subjective perceptions of normality [<span>3</span>], while “Zoom dysmorphia” has intensified self-scrutiny [<span>4, 5</span>]. Among clinicians, repeated exposure to filtered demands may induce “perception drift,” where normal variations are reinterpreted as defects [<span>8</span>].</p><p>Furthermore, the normalization of Overfilled Face Syndrome (OFS) in social media reinforces FOF, challenging the therapeutic alliance as patients overestimate the risk of unnatural outcomes [<span>9, 11</span>]. Beyond the aesthetic and psychological dimensions, it is imperative to acknowledge that photoaging, regardless of social class, is the primary clinical precursor to skin cancer. Both phenotypes are subject to the cumulative and deleterious effects of ultraviolet radiation, which remains a critical public health concern in Brazil due to the high ","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrei Metelitsa, R. Sonia Batra, Anne Chapas, Jeffrey Fromowitz, Emmy Graber
<p>The contact-cooled 1726 nm laser (Aviclear, Cutera Inc., Brisbane, CA) treats acne vulgaris by selective thermolysis of sebaceous glands [<span>1</span>]. The device has demonstrated efficacy and safety across a broad range of patients with mild to severe inflammatory acne in clinical trials [<span>2, 3</span>]. In the pivotal trial leading to FDA clearance, 104 subjects (103/104 were graded as moderate or severe at baseline) received three treatments at 2–5 week intervals [<span>3</span>]. A per-protocol analysis of the trial (Table 1) showed significant improvements in both inflammatory lesion count (ILC) and investigator global assessment (IGA) [<span>3, 4</span>]. While study findings are promising, guidance on effective translation of findings to real-world clinical practice and how to best approach patients who may already be on medications is needed.</p><p>Here, an expert consensus group of five dermatologists presents best-practice recommendations for patient selection, treatment optimization, adjunctive therapies, and management strategies. Panelists were selected based on having performed the highest number of contact-cooled 1726 nm treatments, to date, as well as recognized expertise in managing acne. A nominal group technique was used: individual participant best practices were first collected individually via 1-h phone interview and clarified via follow-up e-mail communications. Next, a series of two 1-h virtual discussions were held, where panelist approaches were shared and discussed and a consensus was developed on the guidance for clinical practice presented here. The recommendations presented herein have been approved by all panelists/authors. Agreement was discussion based and there was no formal voting or Delphi process. Recommendations are based on clinical experience in treating over 1600 patients, collectively.</p><p>Contact-cooled 1726 nm laser therapy represents an innovative and effective addition to the acne treatment armamentarium. Its targeted selectivity for sebaceous glands and sustained clinical results set it apart from earlier laser-based modalities. Achieving optimal outcomes requires careful patient selection, clear expectation-setting, thorough counseling regarding the potential for transient acne flares, and the judicious use of adjunctive medications and supportive therapies. As clinical experience and evidence continue to accumulate, treatment protocols will likely become increasingly individualized, further refining and enhancing the role of contact-cooled 1726 nm laser therapy in comprehensive acne management.</p><p>All of the Authors Listed Participated in the Development of Recommendations and Each Aided in the Development and Review of This Commentary.</p><p>The authors have nothing to report.</p><p>The patient featured provided written consent for use of their image.</p><p>All authors serve as consultants for Cutera Inc.</p><p>Data sharing not applicable to this article as no datasets were generate
{"title":"Consensus Panel Recommendations for Optimizing Use of a Contact-Cooled 1726 nm Laser for the Treatment of Acne","authors":"Andrei Metelitsa, R. Sonia Batra, Anne Chapas, Jeffrey Fromowitz, Emmy Graber","doi":"10.1111/jocd.70699","DOIUrl":"10.1111/jocd.70699","url":null,"abstract":"<p>The contact-cooled 1726 nm laser (Aviclear, Cutera Inc., Brisbane, CA) treats acne vulgaris by selective thermolysis of sebaceous glands [<span>1</span>]. The device has demonstrated efficacy and safety across a broad range of patients with mild to severe inflammatory acne in clinical trials [<span>2, 3</span>]. In the pivotal trial leading to FDA clearance, 104 subjects (103/104 were graded as moderate or severe at baseline) received three treatments at 2–5 week intervals [<span>3</span>]. A per-protocol analysis of the trial (Table 1) showed significant improvements in both inflammatory lesion count (ILC) and investigator global assessment (IGA) [<span>3, 4</span>]. While study findings are promising, guidance on effective translation of findings to real-world clinical practice and how to best approach patients who may already be on medications is needed.</p><p>Here, an expert consensus group of five dermatologists presents best-practice recommendations for patient selection, treatment optimization, adjunctive therapies, and management strategies. Panelists were selected based on having performed the highest number of contact-cooled 1726 nm treatments, to date, as well as recognized expertise in managing acne. A nominal group technique was used: individual participant best practices were first collected individually via 1-h phone interview and clarified via follow-up e-mail communications. Next, a series of two 1-h virtual discussions were held, where panelist approaches were shared and discussed and a consensus was developed on the guidance for clinical practice presented here. The recommendations presented herein have been approved by all panelists/authors. Agreement was discussion based and there was no formal voting or Delphi process. Recommendations are based on clinical experience in treating over 1600 patients, collectively.</p><p>Contact-cooled 1726 nm laser therapy represents an innovative and effective addition to the acne treatment armamentarium. Its targeted selectivity for sebaceous glands and sustained clinical results set it apart from earlier laser-based modalities. Achieving optimal outcomes requires careful patient selection, clear expectation-setting, thorough counseling regarding the potential for transient acne flares, and the judicious use of adjunctive medications and supportive therapies. As clinical experience and evidence continue to accumulate, treatment protocols will likely become increasingly individualized, further refining and enhancing the role of contact-cooled 1726 nm laser therapy in comprehensive acne management.</p><p>All of the Authors Listed Participated in the Development of Recommendations and Each Aided in the Development and Review of This Commentary.</p><p>The authors have nothing to report.</p><p>The patient featured provided written consent for use of their image.</p><p>All authors serve as consultants for Cutera Inc.</p><p>Data sharing not applicable to this article as no datasets were generate","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taikong Blue Lavender Essential Oil (TLEO) is derived from a proprietary space-bred cultivar of Lavandula angustifolia and cultivated under pristine conditions in Xinjiang, China. TLEO has long been used by regional people to treat various skin disorders such as hyperpigmentation, trans-epidermal water loss, collagen degradation, and poor wound healing. Despite the ethnopharmacological applications of TLEO, the molecular basis of its dermatological efficacy remains poorly defined.
Method
This study integrated network pharmacology, molecular docking, and in vitro assays to systematically investigate how TLEO works against inflammatory skin conditions, focusing on its key compounds and biological targets.
Results
A total of 66 skin disorder-related genes were identified through network pharmacology, with gene enrichment analyses highlighting the TNF signaling pathway as a critical mediator. Protein–protein interaction analysis revealed MMP9, EGFR, and PTGS2 as core targets. Molecular docking confirmed that linalool and linalyl acetate, the primary constituents of TLEO, exhibited moderate binding affinities with these targets. In vitro experiments using TNF-α-stimulated HaCaT cells demonstrated that treatment with 0.01% TLEO significantly (p < 0.05) reduced oxidative stress markers (NO, ROS, MDA), restored antioxidant enzymes (SOD, CAT), and downregulated inflammatory cytokines (IL-6, IL-1β, IL-8). TLEO also inhibited the phosphorylation of p38 MAPK and NF-κB p65, suppressed PTGS2 and MMP9 expression, and restored EGFR levels, indicating anti-inflammatory and barrier-restorative functions.
Conclusions
The study establishes a scientific foundation for the use of TLEO as a multifunctional ingredient in dermatological applications and highlights its value as a sustainable crop for regional economic development in Xinjiang.
背景：泰康蓝薰衣草精油（Taikong Blue Lavender精油，TLEO）是在中国新疆的原始条件下，由一种太空栽培的薰衣草（Lavandula angustifolia）衍生而成。TLEO长期以来被地区人民用于治疗各种皮肤疾病，如色素沉着、经表皮失水、胶原蛋白降解、伤口愈合不良等。尽管TLEO的民族药理学应用，其皮肤功效的分子基础仍然不明确。方法：本研究结合网络药理学、分子对接、体外实验等方法，系统研究TLEO抗炎性皮肤的作用机制，重点研究其关键化合物和生物学靶点。结果：通过网络药理学共鉴定了66个皮肤疾病相关基因，基因富集分析突出了TNF信号通路是一个关键的中介。蛋白-蛋白相互作用分析显示MMP9、EGFR和PTGS2是核心靶点。分子对接证实，TLEO的主要成分芳樟醇和乙酸芳樟醇与这些靶标具有中等的结合亲和力。结论：本研究为TLEO作为一种多功能成分在皮肤科的应用奠定了科学基础，突出了其作为新疆区域经济发展的可持续作物的价值。
{"title":"Unveiling the Therapeutic Potential of “Taikong Blue” Lavender Essential Oil and Its Key Compounds in Skin Problems via Network Pharmacology and In Vitro Validation","authors":"Fei Liu, Yingyu Zhang, Minhazul Abedin, Jingyi Song, Suzhen Yang, Hongxiang Lou, Xixi Dou, Junsong Xiao, Hua Wu","doi":"10.1111/jocd.70640","DOIUrl":"10.1111/jocd.70640","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Taikong Blue Lavender Essential Oil (TLEO) is derived from a proprietary space-bred cultivar of <i>Lavandula angustifolia</i> and cultivated under pristine conditions in Xinjiang, China. TLEO has long been used by regional people to treat various skin disorders such as hyperpigmentation, trans-epidermal water loss, collagen degradation, and poor wound healing. Despite the ethnopharmacological applications of TLEO, the molecular basis of its dermatological efficacy remains poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study integrated network pharmacology, molecular docking, and in vitro assays to systematically investigate how TLEO works against inflammatory skin conditions, focusing on its key compounds and biological targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 66 skin disorder-related genes were identified through network pharmacology, with gene enrichment analyses highlighting the TNF signaling pathway as a critical mediator. Protein–protein interaction analysis revealed MMP9, EGFR, and PTGS2 as core targets. Molecular docking confirmed that linalool and linalyl acetate, the primary constituents of TLEO, exhibited moderate binding affinities with these targets. In vitro experiments using TNF-<i>α</i>-stimulated HaCaT cells demonstrated that treatment with 0.01% TLEO significantly (<i>p <</i> 0.05) reduced oxidative stress markers (NO, ROS, MDA), restored antioxidant enzymes (SOD, CAT), and downregulated inflammatory cytokines (IL-6, IL-1<i>β</i>, IL-8). TLEO also inhibited the phosphorylation of p38 MAPK and NF-<i>κ</i>B p65, suppressed PTGS2 and MMP9 expression, and restored EGFR levels, indicating anti-inflammatory and barrier-restorative functions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study establishes a scientific foundation for the use of TLEO as a multifunctional ingredient in dermatological applications and highlights its value as a sustainable crop for regional economic development in Xinjiang.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed AlJabr, Aseel Muhana I. AlAnazi, Rakan Abdulkarim A. AlEtebi
Background
Hyperpigmentation disorders, including melasma and post-inflammatory hyperpigmentation (PIH), are common dermatologic conditions associated with significant cosmetic and psychological burden. Tranexamic acid (TXA), an antifibrinolytic agent, has gained increasing attention due to its anti-inflammatory and antimelanogenic properties.
Objective
To review the current evidence on the efficacy and safety of tranexamic acid in the management of hyperpigmentation disorders, particularly melasma and PIH.
Methods
A narrative literature review was conducted using PubMed, Scopus, and Google Scholar to identify clinical and observational studies evaluating the efficacy, safety, and comparative outcomes of oral, topical, and intradermal tranexamic acid in hyperpigmentation disorders. Data were descriptively analyzed with comparison to standard treatments such as hydroquinone and laser therapies.
Results
Evidence from randomized and comparative studies demonstrates that oral, topical, and intradermal TXA significantly reduce pigmentation indices and improve quality-of-life scores in patients with melasma and PIH. Oral TXA at doses of 250–500 mg twice daily showed sustained clinical improvement with minimal adverse effects, most commonly mild gastrointestinal symptoms and menstrual irregularities. Topical and intradermal formulations demonstrated comparable or superior efficacy to hydroquinone with fewer irritant reactions. Combination therapies (e.g., TXA with hydroquinone or laser) yielded enhanced and longer-lasting outcomes.
Conclusion
Tranexamic acid represents a promising and well-tolerated therapeutic option for hyperpigmentation disorders. Its efficacy across multiple administration routes, favorable safety profile, and synergistic potential with existing therapies support its expanding role as both a primary and adjunctive treatment in dermatologic pigment management.
{"title":"Tranexamic Acid for Hyperpigmentation Disorders: A Literature Review on Efficacy and Safety in Melasma and PIH","authors":"Ahmed AlJabr, Aseel Muhana I. AlAnazi, Rakan Abdulkarim A. AlEtebi","doi":"10.1111/jocd.70692","DOIUrl":"10.1111/jocd.70692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hyperpigmentation disorders, including melasma and post-inflammatory hyperpigmentation (PIH), are common dermatologic conditions associated with significant cosmetic and psychological burden. Tranexamic acid (TXA), an antifibrinolytic agent, has gained increasing attention due to its anti-inflammatory and antimelanogenic properties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review the current evidence on the efficacy and safety of tranexamic acid in the management of hyperpigmentation disorders, particularly melasma and PIH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative literature review was conducted using PubMed, Scopus, and Google Scholar to identify clinical and observational studies evaluating the efficacy, safety, and comparative outcomes of oral, topical, and intradermal tranexamic acid in hyperpigmentation disorders. Data were descriptively analyzed with comparison to standard treatments such as hydroquinone and laser therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Evidence from randomized and comparative studies demonstrates that oral, topical, and intradermal TXA significantly reduce pigmentation indices and improve quality-of-life scores in patients with melasma and PIH. Oral TXA at doses of 250–500 mg twice daily showed sustained clinical improvement with minimal adverse effects, most commonly mild gastrointestinal symptoms and menstrual irregularities. Topical and intradermal formulations demonstrated comparable or superior efficacy to hydroquinone with fewer irritant reactions. Combination therapies (e.g., TXA with hydroquinone or laser) yielded enhanced and longer-lasting outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tranexamic acid represents a promising and well-tolerated therapeutic option for hyperpigmentation disorders. Its efficacy across multiple administration routes, favorable safety profile, and synergistic potential with existing therapies support its expanding role as both a primary and adjunctive treatment in dermatologic pigment management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gustavo Carneiro Nogueira, Raquel Iracema de Freitas Macedo Oliveira, Mariana Rocha Andrade, Bárbara Arze Rocha, Naides Carneiro Nogueira, Márcio Roberto Silva, Ana Carolina Tardin Rodrigues de Medeiros, Marina Vieira Rodrigues de Queiroz, Felipe Xavier Clo, Ticiano Teixeira Cesar Clo, Carlos Gustavo Wambier, Gisele Viana de Oliveira
Background
Phenol-croton peels are the gold standard for treating sun-damaged skin and static wrinkles; their long-term outcomes and patient satisfaction rates have yet to be thoroughly investigated.
Aims
To evaluate patient satisfaction and both short- and long-term cutaneous side effects in individuals undergoing phenol-croton peels.
Materials and Methods
This retrospective cohort study analyzed 102 female patients who underwent phenol-croton peels and were followed up until 3 months after the procedure to assess short-term side effects and to identify any long-term side effects that persisted beyond this period. Univariate and multivariate analyses were performed to assess patient satisfaction and long-term cutaneous side effects.
Results
Ninety-two percent of patients rated their satisfaction as 4 or 5. Persistent cutaneous side effects were observed in 12% of cases (hypopigmentation: 6, hyperpigmentation: 5, dryness: 1). Despite mild hypopigmentation, five patients expressed willingness to undergo the procedure again. In the univariate analyses, full-face treatment, increasing age, and the absence of cutaneous side effects were significantly associated with higher satisfaction scores (p < 0.05). In the multivariate model, age and the absence of cutaneous side effects remained independently and significantly associated with the outcome. Full-face treatment, although not statistically significant in the final model, showed a trend toward association and contributed to the overall adjustment. Notably, cutaneous side effects decreased at follow-up performed at least 15 months after the procedure compared to follow-up conducted within 3 months post-procedure (p = 0.039).
Conclusions
Phenol-croton peels demonstrated high satisfaction rates despite occasional prolonged cutaneous side effects. However, these side effects significantly decreased at ≥ 15 months post-procedure compared to ≤ 3 months post-procedure. Careful patient selection and expertise in performing this procedure remain crucial for optimizing outcomes.
{"title":"Predictive Factors of Better Patient Satisfaction After Phenol-Croton Peel: A Retrospective Study of 102 Patients","authors":"Gustavo Carneiro Nogueira, Raquel Iracema de Freitas Macedo Oliveira, Mariana Rocha Andrade, Bárbara Arze Rocha, Naides Carneiro Nogueira, Márcio Roberto Silva, Ana Carolina Tardin Rodrigues de Medeiros, Marina Vieira Rodrigues de Queiroz, Felipe Xavier Clo, Ticiano Teixeira Cesar Clo, Carlos Gustavo Wambier, Gisele Viana de Oliveira","doi":"10.1111/jocd.70609","DOIUrl":"10.1111/jocd.70609","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Phenol-croton peels are the gold standard for treating sun-damaged skin and static wrinkles; their long-term outcomes and patient satisfaction rates have yet to be thoroughly investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate patient satisfaction and both short- and long-term cutaneous side effects in individuals undergoing phenol-croton peels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed 102 female patients who underwent phenol-croton peels and were followed up until 3 months after the procedure to assess short-term side effects and to identify any long-term side effects that persisted beyond this period. Univariate and multivariate analyses were performed to assess patient satisfaction and long-term cutaneous side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-two percent of patients rated their satisfaction as 4 or 5. Persistent cutaneous side effects were observed in 12% of cases (hypopigmentation: 6, hyperpigmentation: 5, dryness: 1). Despite mild hypopigmentation, five patients expressed willingness to undergo the procedure again. In the univariate analyses, full-face treatment, increasing age, and the absence of cutaneous side effects were significantly associated with higher satisfaction scores (<i>p</i> < 0.05). In the multivariate model, age and the absence of cutaneous side effects remained independently and significantly associated with the outcome. Full-face treatment, although not statistically significant in the final model, showed a trend toward association and contributed to the overall adjustment. Notably, cutaneous side effects decreased at follow-up performed at least 15 months after the procedure compared to follow-up conducted within 3 months post-procedure (<i>p</i> = 0.039).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Phenol-croton peels demonstrated high satisfaction rates despite occasional prolonged cutaneous side effects. However, these side effects significantly decreased at ≥ 15 months post-procedure compared to ≤ 3 months post-procedure. Careful patient selection and expertise in performing this procedure remain crucial for optimizing outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intense pulsed light (IPL) therapy is widely used for facial rejuvenation, targeting vascular, pigmentary, and textural changes. However, comprehensive, real-world evidence evaluating long-term, regular IPL treatment across multiple dimensions of skin improvement remains limited.
Objectives
This study aimed to assess the efficacy and safety of long-term, regular IPL therapy in improving facial erythema, pigmentation, and wrinkles, and to identify predictors of favorable response.
Methods
This retrospective real-world study included 236 patients who underwent six or more IPL sessions between 2020 and 2025. Patients were categorized as acne, rosacea, or cosmetic subjects. VISIA imaging quantified erythema, pigmentation, and wrinkle indices, while the Global Aesthetic Improvement Scale (GAIS) was used to assess aesthetic outcomes. Logistic regression identified predictors of good response.
Results
Significant improvements were observed in erythema, pigmentation, and wrinkle indices after treatment (all p < 0.05). Regular treatment intervals and total number of sessions were independently associated with better outcomes (OR = 13.62 and 3.80, respectively, both p < 0.05). Patients with Fitzpatrick Type IV skin showed lower response rates (OR = 0.12, p = 0.001). VISIA analyses demonstrated quantifiable reductions in erythema and pigmentation areas, while wrinkles showed notable textural improvement. No severe adverse events occurred.
Conclusions
Long-term, regular IPL therapy effectively improves facial erythema, pigmentation, and wrinkles, confirming its value as a comprehensive rejuvenation strategy. Regular treatment intervals optimize cumulative effects, while objective imaging enhances precision in outcome evaluation. These findings support IPL as a safe, evidence-based, and multidimensional approach to long-term facial rejuvenation.
{"title":"Comprehensive Facial Skin Rejuvenation With Long-Term Regular Intense Pulsed Light Therapy: A Real-World Study","authors":"Birao Fan, Ruixing Yu","doi":"10.1111/jocd.70691","DOIUrl":"10.1111/jocd.70691","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intense pulsed light (IPL) therapy is widely used for facial rejuvenation, targeting vascular, pigmentary, and textural changes. However, comprehensive, real-world evidence evaluating long-term, regular IPL treatment across multiple dimensions of skin improvement remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess the efficacy and safety of long-term, regular IPL therapy in improving facial erythema, pigmentation, and wrinkles, and to identify predictors of favorable response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective real-world study included 236 patients who underwent six or more IPL sessions between 2020 and 2025. Patients were categorized as acne, rosacea, or cosmetic subjects. VISIA imaging quantified erythema, pigmentation, and wrinkle indices, while the Global Aesthetic Improvement Scale (GAIS) was used to assess aesthetic outcomes. Logistic regression identified predictors of good response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant improvements were observed in erythema, pigmentation, and wrinkle indices after treatment (all <i>p</i> < 0.05). Regular treatment intervals and total number of sessions were independently associated with better outcomes (OR = 13.62 and 3.80, respectively, both <i>p</i> < 0.05). Patients with Fitzpatrick Type IV skin showed lower response rates (OR = 0.12, <i>p</i> = 0.001). VISIA analyses demonstrated quantifiable reductions in erythema and pigmentation areas, while wrinkles showed notable textural improvement. No severe adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term, regular IPL therapy effectively improves facial erythema, pigmentation, and wrinkles, confirming its value as a comprehensive rejuvenation strategy. Regular treatment intervals optimize cumulative effects, while objective imaging enhances precision in outcome evaluation. These findings support IPL as a safe, evidence-based, and multidimensional approach to long-term facial rejuvenation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Regeneration has emerged as a key concept in aesthetic medicine as the field evolves from predominantly volumetric correction toward biologically oriented strategies aimed at improving tissue quality, function, and long-term structural integrity. However, the widespread use of the term “regenerative” has often been used without biological precision, leading to conceptual overlap with repair, remodeling, and biostimulation. A critical evaluation of the biological basis and clinical evidence supporting regenerative claims is needed.</p> </section> <section> <h3> Objective</h3> <p>To critically synthesize current biological, translational, and clinical evidence related to skin regeneration in aesthetic medicine, with emphasis on extracellular matrix remodeling, immune modulation, mechanotransduction, and dermal–hypodermal integration, and to contextualize the regenerative potential and limitations of commonly used biomaterials.</p> </section> <section> <h3> Methods</h3> <p>A narrative review was conducted based on experimental studies, translational research, narrative and systematic reviews, and clinical investigations cited in the reference set. Evidence was qualitatively analyzed focusing on mechanisms of action, tissue-level interactions, immune responses, extracellular matrix dynamics, involvement of subcutaneous adipose compartments, and durability of clinical outcomes.</p> </section> <section> <h3> Results</h3> <p>Cutaneous regeneration is a multilevel functional process driven by coordinated extracellular matrix reorganization, controlled inflammation, mechanotransduction, angiogenesis, and dermal–hypodermal crosstalk. Particulate collagen biostimulators (poly-<span>l</span>-lactic acid, poly-<span>d</span>,<span>l</span>-lactic acid, calcium hydroxyapatite, and polycaprolactone) demonstrate the most consistent evidence for sustained functional remodeling, with poly-<span>l</span>-lactic acid showing the strongest longitudinal and histological support. Hyaluronic acid–based fillers and skinboosters primarily act as microenvironmental modulators with limited regenerative depth. Polydioxanone threads induce localized mechanobiological remodeling that is highly technique dependent. Biological bioregenerators, including polynucleotides, polydeoxyribonucleotides, and extracellular vesicles, show strong mechanistic plausibility but limited and heterogeneous clinical evidence.</p> </section> <section> <h3> Conclusion</h3>
{"title":"Regeneration in Aesthetic Medicine: Mechanisms, Evidence, and Clinical Boundaries","authors":"Antony de Paula Barbosa","doi":"10.1111/jocd.70669","DOIUrl":"10.1111/jocd.70669","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Regeneration has emerged as a key concept in aesthetic medicine as the field evolves from predominantly volumetric correction toward biologically oriented strategies aimed at improving tissue quality, function, and long-term structural integrity. However, the widespread use of the term “regenerative” has often been used without biological precision, leading to conceptual overlap with repair, remodeling, and biostimulation. A critical evaluation of the biological basis and clinical evidence supporting regenerative claims is needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To critically synthesize current biological, translational, and clinical evidence related to skin regeneration in aesthetic medicine, with emphasis on extracellular matrix remodeling, immune modulation, mechanotransduction, and dermal–hypodermal integration, and to contextualize the regenerative potential and limitations of commonly used biomaterials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review was conducted based on experimental studies, translational research, narrative and systematic reviews, and clinical investigations cited in the reference set. Evidence was qualitatively analyzed focusing on mechanisms of action, tissue-level interactions, immune responses, extracellular matrix dynamics, involvement of subcutaneous adipose compartments, and durability of clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cutaneous regeneration is a multilevel functional process driven by coordinated extracellular matrix reorganization, controlled inflammation, mechanotransduction, angiogenesis, and dermal–hypodermal crosstalk. Particulate collagen biostimulators (poly-<span>l</span>-lactic acid, poly-<span>d</span>,<span>l</span>-lactic acid, calcium hydroxyapatite, and polycaprolactone) demonstrate the most consistent evidence for sustained functional remodeling, with poly-<span>l</span>-lactic acid showing the strongest longitudinal and histological support. Hyaluronic acid–based fillers and skinboosters primarily act as microenvironmental modulators with limited regenerative depth. Polydioxanone threads induce localized mechanobiological remodeling that is highly technique dependent. Biological bioregenerators, including polynucleotides, polydeoxyribonucleotides, and extracellular vesicles, show strong mechanistic plausibility but limited and heterogeneous clinical evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 ","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In aesthetic clinical practice, the treatment of “bunny lines”—the fine diagonal or vertical wrinkles that appear on the nasal sidewall during facial expressions such as smiling or laughing—has conventionally involved direct botulinum toxin (BoNT) injection into the crease itself (Figure 1). This approach assumes the presence of a hyperactive muscle immediately beneath the visible wrinkle. However, emerging evidence from detailed cadaveric dissections and ultrasonographic (US) analyses challenges this long-standing assumption and may explain the inconsistent and sometimes suboptimal outcomes associated with the “in-the-line” injection approach [<span>1</span>].</p><p>Recent anatomical and imaging data demonstrate that the region between the medial canthus and nasal dorsum—where bunny lines manifest—is not underlain by a discrete muscle but rather represents a non-muscular interval termed the bunny triangle. In their multimodal study involving 39 cadaveric dissections and dynamic US examinations of 13 volunteers, Ahn et al. [<span>1</span>] delineated this muscle-free triangle bordered by the procerus (superior-medial margin), transverse nasalis (superior-lateral margin), levator labii superioris alaeque nasi (LLSAN, inferomedial margin), and medial fibers of the orbicularis oculi (OOc, lateral margin). During active nose scrunching, US confirmed that the visible wrinkles correspond to skin folding over this non-muscular region, while adjacent muscles contract peripherally. The nasalis thickened dynamically in most participants, confirming its primary mechanical role in bunny line formation. Thus, the wrinkle is not generated by a localized underlying muscle but by convergent traction from neighboring muscles. Injecting BoNT directly into the crease therefore targets connective tissue and relies on passive diffusion, resulting in unpredictable efficacy and a higher likelihood of over- or under-treatment depending on the diffusion pattern [<span>2, 3</span>].</p><p>The clinical implication of these findings is that the traditional “in-the-line” injection paradigm may be anatomically unsound. Instead, practitioners should adopt a border-targeted chemodenervation strategy focusing on the muscles actually responsible for wrinkle formation. This concept aligns with modern principles of functional anatomy, emphasizing selective modulation of active muscle borders rather than superficial crease injection.</p><p>Before injection, dynamic facial assessment should be performed. The patient is asked to smile, scrunch the nose, or express disgust to identify which borders contract most prominently—procerus, nasalis, LLSAN, or medial OOc. This individualized mapping acknowledges inter-patient variability in perinasal muscle dominance (Figure 2).</p><p>(Figure 3) Transverse nasalis (primary driver): Small intramuscular injections (1–2 U of BoNT-A) along its superior border on the upper nasal sidewall effectively attenuate line formation [<span>4</span>].</p>
在美学临床实践中，治疗“兔纹”——在微笑或大笑等面部表情时出现在鼻侧壁上的细小对角线或垂直皱纹——通常涉及直接向皱纹本身注射肉毒杆菌毒素（BoNT）（图1）。这种方法假定在可见的皱纹下面有一块过度活跃的肌肉。然而，来自详细尸体解剖和超声（US）分析的新证据挑战了这一长期存在的假设，并可能解释与“在线”注射方法相关的不一致和有时不理想的结果[1]。最近的解剖学和影像学数据表明，在内眦和鼻背之间的区域——兔纹显示的地方——并不是由一个离散的肌肉所覆盖，而是代表了一个被称为兔三角的非肌肉间隔。在他们的多模式研究中，Ahn等人对13名志愿者进行了39例尸体解剖和动态超声检查，描绘了这个无肌肉的三角形，其边界是前肌（上内侧缘）、鼻横肌（上外侧缘）、鼻上唇提肌（内内侧缘）和眼轮匝肌内侧纤维（外侧缘）。在主动揉鼻子的过程中，美国证实，可见的皱纹对应于这个非肌肉区域的皮肤折叠，而邻近的肌肉在周围收缩。鼻肌在大多数参与者中动态增厚，证实了其在兔线形成中的主要机械作用。因此，皱纹不是由局部的下层肌肉产生的，而是由邻近肌肉的收敛牵引力产生的。因此，将BoNT直接注射到皱褶中针对结缔组织，并依赖于被动扩散，导致不可预测的疗效，并且根据扩散模式，治疗过度或治疗不足的可能性更高[2,3]。这些发现的临床意义是，传统的“在线”注射模式可能在解剖学上是不合理的。相反，从业者应该采用一种针对边缘的化学神经支配策略，专注于实际负责皱纹形成的肌肉。这个概念与现代功能解剖学原理一致，强调活动肌肉边界的选择性调节，而不是表面折痕注射。注射前应进行动态面部评估。病人被要求微笑，皱鼻子，或表示厌恶，以确定哪个边界收缩最突出- - -前肌，鼻肌，LLSAN，或内侧OOc。这种个体化的定位确认了鼻周肌优势在患者间的可变性（图2）。（图3）鼻横肌（主要驱动因素）：沿着鼻上侧壁的上边界进行少量肌肉注射（1-2 U BoNT-A），有效地减弱了线形成[4]。LLSAN（次要贡献者）：在其上内侧边界的微等分（0.5-1 U）可以抑制鼻翼的过度升高，但必须谨慎放置，以避免鼻翼下垂或上唇提升无力。内眼轮匝肌：当强烈的外侧牵引使皱褶加重时，应在内侧眦缘处保守注射。前肌：如果眉间窝收缩延伸到鼻根，在其内外侧缘注射低剂量（1u）可以补充治疗。高精度、小容量注射可最大限度地减少毒素扩散。扩散研究表明，大体积和低浓度会增加邻近肌肉的非预期失神经支配[5,6]。因此，限制在活跃边界内的微配额提高了安全性和可预测性。b模式美国成像允许实时可视化兔子三角形和收缩边界。超声引导下注射提高了准确性，确保了正确的深度（通常在皮下平面1.5-2.0 mm），并避免了附近的血管，如角状动脉。该技术还降低了不对称和扩散相关并发症的风险。在功能上，兔子三角形充当被动变形区，当周围肌肉的张力汇聚时折叠。前肌提供上内侧牵拉，鼻横肌向外侧压迫，LLSAN和内侧OOc分别施加垂直和斜向牵拉。这种协同复合物的重复招募会引起动态皱纹，后来由于真皮变薄和重复牵引[8]而成为静态皱纹。因此，针对皱褶本身并不能有效地抑制产生皱褶的肌肉力量。相反，外围的注射会中断直接导致褶皱的收缩力。这一精细化的理解也解释了为什么过量注射BoNT会不可预测地扩散到附近的电梯，导致功能和美学并发症，如嘴唇不对称、鼻翼下降或下眼睑无力。
{"title":"Where Should We Inject Botulinum Toxin for the Bunny Lines?","authors":"Kyu-Ho Yi, Soo-Bin Kim","doi":"10.1111/jocd.70673","DOIUrl":"10.1111/jocd.70673","url":null,"abstract":"<p>In aesthetic clinical practice, the treatment of “bunny lines”—the fine diagonal or vertical wrinkles that appear on the nasal sidewall during facial expressions such as smiling or laughing—has conventionally involved direct botulinum toxin (BoNT) injection into the crease itself (Figure 1). This approach assumes the presence of a hyperactive muscle immediately beneath the visible wrinkle. However, emerging evidence from detailed cadaveric dissections and ultrasonographic (US) analyses challenges this long-standing assumption and may explain the inconsistent and sometimes suboptimal outcomes associated with the “in-the-line” injection approach [<span>1</span>].</p><p>Recent anatomical and imaging data demonstrate that the region between the medial canthus and nasal dorsum—where bunny lines manifest—is not underlain by a discrete muscle but rather represents a non-muscular interval termed the bunny triangle. In their multimodal study involving 39 cadaveric dissections and dynamic US examinations of 13 volunteers, Ahn et al. [<span>1</span>] delineated this muscle-free triangle bordered by the procerus (superior-medial margin), transverse nasalis (superior-lateral margin), levator labii superioris alaeque nasi (LLSAN, inferomedial margin), and medial fibers of the orbicularis oculi (OOc, lateral margin). During active nose scrunching, US confirmed that the visible wrinkles correspond to skin folding over this non-muscular region, while adjacent muscles contract peripherally. The nasalis thickened dynamically in most participants, confirming its primary mechanical role in bunny line formation. Thus, the wrinkle is not generated by a localized underlying muscle but by convergent traction from neighboring muscles. Injecting BoNT directly into the crease therefore targets connective tissue and relies on passive diffusion, resulting in unpredictable efficacy and a higher likelihood of over- or under-treatment depending on the diffusion pattern [<span>2, 3</span>].</p><p>The clinical implication of these findings is that the traditional “in-the-line” injection paradigm may be anatomically unsound. Instead, practitioners should adopt a border-targeted chemodenervation strategy focusing on the muscles actually responsible for wrinkle formation. This concept aligns with modern principles of functional anatomy, emphasizing selective modulation of active muscle borders rather than superficial crease injection.</p><p>Before injection, dynamic facial assessment should be performed. The patient is asked to smile, scrunch the nose, or express disgust to identify which borders contract most prominently—procerus, nasalis, LLSAN, or medial OOc. This individualized mapping acknowledges inter-patient variability in perinasal muscle dominance (Figure 2).</p><p>(Figure 3) Transverse nasalis (primary driver): Small intramuscular injections (1–2 U of BoNT-A) along its superior border on the upper nasal sidewall effectively attenuate line formation [<span>4</span>].</p>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maurizio Cavallini, Andre Braz, Daniela Greiner-Krüger, Sylwia Lipko-Godlewska, Tapan Patel, Marva Safa, Sophie Shotter, Fernando Urdiales Gálvez, Graeme Kerson
Background
The hybrid injectable HA-CaHA contains a formulated matrix of crosslinked hyaluronic acid (HA) gel with embedded calcium hydroxyapatite (CaHA) microspheres to increase skin elasticity and hydration as well as promote neocollagenesis, respectively. Clinical practice recommendations for use of HA-CaHA are limited.
Aims
The objective of this article was to provide global recommendations on safe and effective practices for injecting HA-CaHA.
Patient/Methods
An expert panel consisting of eight international consultants was invited to discuss and provide best-practice recommendations on HA-CaHA patient selection, skin laxity assessment, injection techniques, touch-up/retreatment practices, combination treatment protocols, and safety considerations.
Results
The expert panel recommended using HA-CaHA for structural support and soft tissue repositioning in patients with skin laxity, sagginess, and mild to moderate loss of volume and contour. They also recommended defining injection entry points by referring to the line of ligaments and the zygomatic arch and keeping injections in the lateral and thus less mobile areas of the face. Experts advised using a cannula instead of a needle, retreating only if mild to moderate skin laxity recurs, and injecting in small volumes. Measures to minimize potential side effects, including injection site responses, were discussed.
Conclusions
Expert clinical recommendations affirm the safe and effective use of HA-CaHA to improve soft tissue quality over time.
{"title":"Global Recommendations for Facial Rejuvenation Using a Hyaluronic Acid and Calcium Hydroxyapatite Hybrid Injectable","authors":"Maurizio Cavallini, Andre Braz, Daniela Greiner-Krüger, Sylwia Lipko-Godlewska, Tapan Patel, Marva Safa, Sophie Shotter, Fernando Urdiales Gálvez, Graeme Kerson","doi":"10.1111/jocd.70608","DOIUrl":"10.1111/jocd.70608","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The hybrid injectable HA-CaHA contains a formulated matrix of crosslinked hyaluronic acid (HA) gel with embedded calcium hydroxyapatite (CaHA) microspheres to increase skin elasticity and hydration as well as promote neocollagenesis, respectively. Clinical practice recommendations for use of HA-CaHA are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The objective of this article was to provide global recommendations on safe and effective practices for injecting HA-CaHA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient/Methods</h3>\u0000 \u0000 <p>An expert panel consisting of eight international consultants was invited to discuss and provide best-practice recommendations on HA-CaHA patient selection, skin laxity assessment, injection techniques, touch-up/retreatment practices, combination treatment protocols, and safety considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The expert panel recommended using HA-CaHA for structural support and soft tissue repositioning in patients with skin laxity, sagginess, and mild to moderate loss of volume and contour. They also recommended defining injection entry points by referring to the line of ligaments and the zygomatic arch and keeping injections in the lateral and thus less mobile areas of the face. Experts advised using a cannula instead of a needle, retreating only if mild to moderate skin laxity recurs, and injecting in small volumes. Measures to minimize potential side effects, including injection site responses, were discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Expert clinical recommendations affirm the safe and effective use of HA-CaHA to improve soft tissue quality over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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