A retrospective study on treatment of moderate cervicomental laxity with subdermal monopolar radiofrequency with real-time monitoring

Kar Wai Phoebe Lam,MBChB,MRCS,PgDipSEM,DPD,MScDPD 대한미용의학회 2018 대한미용의학회지 Vol.2 No.2

Subdermal monopolar radiofrequency (RF) redefines jawline by delivering controlled thermal energy that induced soft tissue contraction. However, the type of candidates best suited for this treatment has not been determined. A retrospective analysis of the treatment results and satisfaction, at 6 weeks and 3 months, in 15 female patients, aged 34 to 77 years, with mild to moderate skin laxity (Submental Skin Laxity Grading [SMSLG], 1-3) and submental fat (SMF) (Clinician rating-SMF-Rating Scale [CR-SMF-RS], 1-3), and a Subject Self Rating Scale (SSRS) ≤2. They received ThermiRF to either jowl and neck or neck only, in a single clinic, between the period of October 2017 to July 2018. The probe treatment temperature was set and maintained between 52°C to 65°C whereas the epidermal temperature was targeted around 42°C to 43°C. All patients with SMSLG 2 to 3, reported at least 1 grade SMSLG response with a mean change of 1.23 of CR-SMF-RS and mean change of 3.08 of SSRS. None of the patients experienced a burn or erythema following treatment. Transient swelling, nodule and mild numbness following ThermiRF procedure has been reported but all resolved completely with time. All reported GAIS ≥3 and 46.7% reported a Global Aesthetic Improvement Scale (GAIS) score of 5, i.e. optimal results by 3 months. Therefore, according to treatment results those with good to at least moderate skin laxity (SMSLG, 2-3), mild to moderate SMF (CR-SMF, 1-3) and absent of platysmal pathology reported at least a one-grade improvement on SMSLG and CR-SMF-RS within 3 months of ThermiRF treatment. Level of Evidence: IV

Periorbital changes in patients with Poly(Lactic Acid/Caprolactone) threads for brow augmentation

Phoebe Kar Wai Lam,Wang Lung Luk 대한미용의학회 2020 대한미용의학회지 Vol.4 No.1

Background: Overlooked compensatory brow ptosis can lead to patients dissatisfaction and poor surgical results. Objective: To evaluate the quantitative changes in periorbital dimensions in 11 patients with mild to moderate brow ptosis after browlift with Poly(Lactic Acid/Caprolactone) (P[LA/CL]) sutures. Method: Retrospective analysis and data collected from reviewing clinical records, 11 patients, with mild to moderate brow ptosis, whom only has P(LA/CL) browlift, fulfilled the criteria and included in the analysis. All patients had 2-dimensional clinical photos and 3-dimensional clinical pictures in 5 standard views at baseline and follow-up. All periorbital measurements determined by the computer and collected for analysis. Results: There was a significant difference in all periorbital measurements at 4 to 6 months’ follow-up when compared with baseline (p<0.05). Moderate lifting refers to changes in brow height of at least 2 mm at follow-up. A higher proportion of patients with moderate brow lift were able to achieve moderate lifting compared with mild brow ptosis. Moderate lifting is observed in 30% to 60% medial brow and 45% to 60% lateral brow for patients with moderate brow ptosis compared with 25% in those with mild brow ptosis. Infection, significant bruising, or scarring did not occur. Transient side effects, such as bruising and dimpling, eventually resolved. Conclusion: Preoperative examination is vital to identify pre-existing compensatory brow ptosis. P(LA/CL) thread-lifting for brow augmentation is a simple and effective procedure which can be used as an adjunct to upper eyelid surgery to prevent secondary brow ptosis following eyelid surgery and in turn, improve patients’ satisfaction.

Twenty-four months long-term follow-up report on the effect of poly lactic-co-glycolic acid suspension suture in Asian with mild-moderate face laxity

Lam Phoebe Kar Wai,Fung Chi Pun,Lam James Yui,Luk Wang Lung,Lee Alvin Ka Wai,Lee Cheuk Hung,Tam Paul Man Kei,Lau Edwin Kwan Chark 대한미용의학회 2022 대한미용의학회지 Vol.6 No.1

Background: There was evidence of improvement in mid-face laxity using three pairs of suspension sutures in mid-face lifting in our early and mid-term follow-up. Objective: This 24-month prospective follow-up study aimed to determine the efficacy of mid-face lifting and lower jawline contouring using poly lactic-co-glycolic acid (PLGA) sutures in Asian patients. Methods: Ten healthy volunteers received three pairs of 8-cones bidirectional cones sutures at the mid-face. One of the ten volunteers lost to follow-up, and all remaining patients followed up for 24 months. Our primary outcome measure is the change in the facial laxity rating scale (FLRS), an “improvement” defined as at least “one-grade change” in FLRS. Other assessment parameters include the severity of the nasolabial fold (NLF), assessed on the wrinkle severity rating scale (WSRS). The secondary outcome measures were the self-satisfaction rating scale (SSRS) and global aesthetic improvement scale (GAIS), rated by participants at each follow-up interval. Results: A linear improvement in the mid-face was observed almost immediately after treatment, with progressive improvement up to at least 12 months following the intervention and no deterioration by 24 months. This improvement was significant (p<0.05), and the differences between before and after treatment at each follow-up interval were large (Cohen’s d>0.8). Contour improvement for the lower face followed a similar trend, except for a delay in the observable differences at three months (Cohen’s d=0.29, 0.8 at six weeks and three months, respectively). The differences in the level of patient satisfaction were significant (p<0.05) from 6 weeks to 24 months, peaking between 12 and 18 months, based on both the GAIS and SSRS ratings. No observed complications. Conclusion: Mid-facing lifting in Asian patients with mild-to-moderate laxity is safe and effective with PLGA bidirectional cone sutures, with concurrent improvement in the lower face contour and elevated patient satisfaction over the 24-month follow-up period.

The troublesome triad: festoons, malar mounds, and palpebral bags

Lam Kar Wai Phoebe 대한미용의학회 2017 대한미용의학회지 Vol.1 No.1

The ill-defined lid-cheek junction continues to be one of the most challenging regions for rejuvenation. Malar mounds, festoons or palpebral bags, may occur alone, or in combination, in the infraorbital area. These pathological variants are distinctly different and may contribute to patients’ perception of their eyebags. Traditional lower blepharoplasty (fat repositioning/ removal) with skin adjustment alone may be insufficient in addressing all of these pathologies, and recurrence may occur. This literature review aims to look at current definitions and treatment of festoons, malar mounds, and palpebral bags in Asian blepharoplasty. A Medline literature search for articles with anatomic descriptions of malar mounds, palpebral bags and festoons, particularly in Asian eyelids, was performed. This was supplemented by a manual search of the references of articles obtained. The details of all of the different surgical options for eyelid rejuvenation are beyond the scope of this review article. Thus, only the basic concepts that illustrate the anatomical relationship and the natural progression of malar mounds, festoons, and palpebral bags will be discussed in this article. Some of the treatment options, both invasive and non-invasive, will also be reviewed. There is no singular treatment for malar mounds, festoons, and palpebral bags. Standard lower blepharoplasty with skin excision is ineffective to lift and re-drape malar mounds or festoons. Repositioning of the malar septum, on the other hand, allows for resolution of the edema (malar festoons) above its cutaneous insertion. A number of liposculpturing techniques to volumize deficient areas, such as fat repositioning (cheek, suborbicularis and descended malar fat pad) with lifting of the midface, can be beneficial to restore a smooth lid-cheek junction.Non-invasive techniques like laser resurfacing and Ultherapy ?? (Ulthera, Inc., Meza, AZ, USA) may be useful in periorbital rejuvenation in selected cases.

Early results of bidirectional cone sutures for mid-face lifting in Asian patients

Phoebe Kar Wai Lam,James Yui Lam,Edwin Kwan Chark Lau,Wang Lung Luk 대한미용의학회 2020 대한미용의학회지 Vol.4 No.1

Background: There are intrinsic difference facial aesthetics between Asian and Caucasian, as well as racial differences in beauty standards. Bi-directional cones threads are effective in mid-face lifting but there was yet no study in Asians. Objective: This study aimed to determine the effects on mid-face laxity the effect size of using bidirectional cone suture for facelifting in Asian patients. Methods: In this prospective study, three pairs of bidirectional cone threads were used for mid-face lifting in 10 healthy volunteers with mild-to-moderate facial laxity. Results: The validated assessment parameters used in the study were the facial laxity rating scale (FLRS) to evaluate the severity of mid-face laxity and the wrinkle severity rating scale (WSRS) to assess the severity of the nasolabial fold (NLF). Overall, there was a substantial improvement in mid-face laxity and the NLF after thread lifting, supported by treatment effect size (Kendall W’s value: 0.96 and 0.85, respectively). Significant improvements for both mid-face laxity and NLF were observed in all patients by 3 months (p<0.05), with significant differences in FLRS (p=0.000) and WSRS (p=0.001). At each follow-up, all patients would complete a selfadministered questionnaire that included the subjective satisfaction rating scale. The results showed that patient satisfaction was substantially improved; the differences between baseline and the 6-week and 3-month follow-up were significant (p<0.05), and the treatment effect size was W=0.950 (p<0.05). All subjects tolerated the procedure well with transient and minimal side effects. Conclusion: In Asians with mild-to-moderate laxity, absorbable cones sutures produced considerable improvement in mid-face laxity and NLF within three months. The findings were consistent among the three reviewers and were statistically significant (p<0.05). Patient satisfaction was higher at the 6-week and 3-month follow-up compared to the baseline (p<0.05).

Outcome of mid- and lower face lifting using bidirectional cone sutures at 6 months and 1 year

Phoebe Kar Wai Lam,James Yui Lam,Alvin Kar Wai Lee,Clyde Wang Lung Luk,Paul Man Kei Tam,Cheuk Hung Lee 대한미용의학회 2021 대한미용의학회지 Vol.5 No.1

Soft tissue ptosis occurs with age, leading to loss of facial volume. The facial retaining ligamentous system is an intricate network of fibrous tissues connecting the whole face, restraining soft tissues from gravitational forces, and opposing facial movements. With proper positioning and anchorage within the ligamentous grid and superficial fat repositioning, lifting the mid-face and adjacent areas (e.g., jowl) is likely to occur. We aimed to determine whether inserting 3 pairs of bidirectional cone sutures can effectively improve the nasolabial fold (mid-face) and jowl (lower face) in Asian patients with mild to moderate mid-face laxity at 6 months and 12 months. Ten healthy volunteers with mild to moderate facial laxity received 3 pairs of bidirectional cone threads, inserted in a straight parallel technique. Based on validated evaluation parameters: facial laxity rating scale (FLRS) and the wrinkle severity rating scale, a total of 7 independent reviewers, among which 3 assessed the change in mid-face laxity (nasolabial fold), and the other 4 reviewers evaluated the change in jowl or lower face contour based on FLRS at 6 months and 12 months. All reviewers were experienced esthetic doctors. According to the reviewers’ evaluation based on the validated parameters, there was a linear improvement in the mid-face laxity/nasolabial fold and lower face laxity/jawline contour self-reporting patients’ satisfaction at 6 months and 12 months compared to baseline in all 10 patients. There was continuous improvement in mid-face laxity and lower face laxity from baseline, 6 months, and 12 months after treatment. The evaluation results among the reviewers were similar, apart from reviewer 7. All patients gave their best rating at 12 months, and their satisfaction almost doubled compared to that before treatment.

Treatment of acne fulminans with intense pulsed light: a case report

Cheuk Hung Lee(Cheuk Hung Lee),Kar Wai Alvin Lee(Kar Wai Alvin Lee),Kwin Wah Chan(Kwin Wah Chan),Kar Wai Phoebe Lam(Kar Wai Phoebe Lam ) 대한미용의학회 2022 대한미용의학회지 Vol.6 No.2

Acne fulminans is a severe form of acne that has a considerable psychosocial impact. Acne scarring is a potential complication of this condition. The treatment of acne fulminans includes conventional topical antibiotics, systemic antibiotics, hormonal therapy, isotretinoin, and light therapy. Intense pulsed light can have marked effects on acne fulminans. We aimed to describe the treatment of acne fulminans with intense pulsed light. This article is a case report together with a literature review to demonstrate how intense pulsed light can be used to treat acne fulminans. Pre-treatment and post-treatment clinical photographs are provided to show the effects of intense pulsed light therapy on acne fulminans. No comparisons were made with the other treatment modalities; nevertheless, this study provides an alternative treatment option for acne fulminans. Our case report revealed that intense pulse light using multiple filters at certain energy levels can effectively treat acne fulminans. Current evidence suggests that ablative CO2 and Er:YAG lasers provide the best curative effect on acne scars on all skin types. Potential complications with intense pulsed light include pain, burns, and post-inflammatory hyperpigmentation. Intense pulsed light is an effective treatment modality for acne fulminans. However, more cases of acne fulminans treated with intense pulsed light need to be documented in order to affirm intense pulsed light as one of the best options for treating this severe form of acne.

Review of topical vitamins in photoaging skin

Cheuk Hung Lee(Cheuk Hung Lee),Kar Wai Alvin Lee(Kar Wai Alvin Lee),Kwin Wah Chan(Kwin Wah Chan),Kar Fai Victor Lee(Kar Fai Victor Lee),Kar Wai Phoebe Lam(Kar Wai Phoebe Lam ) 대한미용의학회 2022 대한미용의학회지 Vol.6 No.2

Photoaging is a process of normal skin architecture damage caused by ultraviolet radiation. Topical vitamins have been used to treat these conditions. The authors aimed to understand the mechanism and level of evidence of topical vitamins used to treat photodamaged skin. A range of topical vitamins has been used in cosmetic medicine for many years to treat photodamaged skin. This review article compares their efficacy and level of evidence. This study was a systematic review to evaluate the efficacy of different topical vitamins. Keywords including “Photoaging,” “Botanicals,” “Peptides,” “Retinoids,” “Vitamins” were searched on Ovid, PubMed, MEDLINE for relevant studies published on photoaging treatment. There is a wealth of Level I evidence supporting the use of topical retinoic acid, vitamins B and C. There is evidence supporting the use of topical vitamin E although it is mainly drawn from Level IV studies of the evidence hierarchy. Topical vitamins can effectively treat photodamaged skin. Level of Evidence: I

Laser resurfacing in acne scarring: a review

Lee Cheuk Hung,Lee Kar Wai Alvin,Chan Kwin Wah,Lam Kar Wai Phoebe,Wong Tin Hau 대한미용의학회 2022 대한미용의학회지 Vol.6 No.1

Scarring can complicate acne vulgaris and lead to considerable psychosocial implications. Resurfacing and collagen regeneration treatments for acne scars include cryotherapy, chemical peeling, lasers and lights, and radiofrequency. Lasers have become popular among these options. A range of lasers with varying designs, wavelengths, and fractional technologies have become available as treatment choices for acne scars. This review compares the efficacy and adverse effects of these treatments. This is a literature review to determine whether the use of a combination of laser treatments yields superior outcomes compared to a single-device method in the management of acne scars. Our literature review revealed that patient factors, including Fitzpatrick skin phenotype and acne scar subtype, are essential determinants of outcome success in acne treatment with laser. Evidence suggests that ablative CO2 and Er:YAG lasers provide the best curative effects on acne scars in all skin types. Both non-fractional and fractional techniques can effectively treat atrophic acne scars. However, when using a pulse-dye laser to treat hypertrophic scars, the outcomes are variable. Potential complications of ablative lasers include acne flares, infections, and scarring.

How to correct and prevent mid-face widening after using floating (or non-fixation) type polydioxanone thread-lift

Kyoungjin Kang,Sun Woo Lee,Phoebe Kar Wai Lam 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

Thread-lifting is a minimally invasive face-lifting procedure that lifts and reposition ptotic soft tissue associated with ageing. This procedure has become increasingly more popular in the last decade. mid-face widening (MFW) is a frequent complaint after thread-lifting, as the descended ptotic soft tissues gathered to the middle of the thread during repositioning. The bunching up of the lax soft tissue increases both the facial volume and the MFW. We attempt to overcome the MFW as an unexpected common complication. Three patients underwent our thread-lifting procedure and followed up for six months. The assessment parameter, bizygomatic diameter (BZD), taken at baseline, three and six-month follow-up with standardised digital computerised 3-dimensional (3D) images using MIRAGE 3D, Taiwan. The floating 90 mm and 115 mm threads, were inserted in the following sequence: first, two single-layers (temporal and high temporal, along the superior temporal line) and then, one dual-layer (zygomatic/cheek region). This thread arrangement aims to overcome and correct the position-dependent downward sagging and volume loss associated with facial ageing, but without increasing the MFW of the patients. None of the patients developed MFW following thread-lifting at three- and six months following treatment. An observed reduction between 4.7-17.9 mm (average, 11.3 mm) in BZD recorded at six-month follow-up. There was no significant discomfort or complications have been reported. Based on the results of our cases, this floating technique, combining two single and one dual-layer, in the three regions (temporal, high temporal and zygomatic/cheek) appears favourable in achieving satisfactory face-lifting and rebalancing facial volume without an increase in MFW.