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Abstract Objective To determine whether intra-mucosal injection of injectable platelet-rich fibrin (i-PRF) can promote healing after Diode Laser Gingival Depigmentation (DLGD). Methodology A total of 20 arch sites of hyperpigmented gingiva of 10 patients underwent DLGD. For each patient, two arch sites were randomly assigned for either intra-mucosal injection of i-PRF (G1-i-PRF) (n=10 sites) or no treatment (G2-Control): (n=10 sites). Wound Healing Score (WHS), patient satisfaction, and Pigmentation Index (DOPI) were measured at 1 week and 1 and 3 months postoperatively. Histological assessment of tissue specimens was performed at baseline and 1 week. Results The percentage change in WHS at 1 week was significantly higher in G1 (58.34±15.43) compared to G2 (37.50±11.79). At day 1, 50% of patients in G1 were pain free compared with 75% in G2, who had mild pain. Mean DOPI decreased significantly at 3 months in both groups (P-value <0.001), without significant differences between groups. G1 specimens showed significantly higher epithelial thickness (P-value <0.001), as well as a higher number of blood vessels and less percentage of inflammatory cells. Conclusions i-PRF demonstrated better clinical and histological healing potential and less patient discomfort compared to sites without treatment after DLGD. Registered at https://clinicaltrials.gov/ as (NCT05283668).

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The use of aesthetic procedures that improve body image is constantly growing, as well as infections associated with them, such as atypical mycobacteriosis. Mesotherapy is a minimally invasive aesthetic procedure that consists of the application of substances that seek to stimulate the dermis and subcutaneous cellular tissue, for the treatment of cellulite and skin rejuvenation. We report a case of mycobacterial infection after mesotherapy in the buttocks and thighs that appeared as subcutaneous abscesses, they responded satisfactorily to prolonged antibiotic treatment with clarithromycin and trimethoprim-sulfamethoxazole. Infections associated with mesotherapy have been reported in Spain, Latin America and the Caribbean, all possibly related to lack of health controls. We emphasize the importance of being aware of these infectious complications and the need to reinforce the necessary security measures to avoid them.

La utilización de procedimientos estéticos que mejoren la imagen corporal está en constante crecimiento, y también las infecciones asociadas a ellos, como las micobacteriosis atípicas. La mesoterapia es un procedimiento mínimamente invasivo que consiste en la aplicación de sustancias que buscan estimular la dermis y el tejido celular subcutáneo, para el tratamiento de la celulitis y el rejuvenecimiento de la piel. Reportamos un caso de infección micobacteriana posterior a una mesoterapia en glúteos y muslos que se presentó como abscesos subcutáneos, que respondieron satisfactoriamente al tratamiento antibiótico prolongado con claritromicina y trimetoprima-sulfametoxazol. Se han informado infecciones asociadas a mesoterapia en España, América Latina y el Caribe, que tendrían posiblemente un origen común: la falta de controles sanitarios. Destacamos la importancia de estar alertados sobre estas complicaciones infecciosas y la necesidad de reforzar las medidas de seguridad necesarias para evitarlas.

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Introducción: La creciente necesidad de una piel de aspecto juvenil impulsa innovaciones continuas con procedimientos mínimamente invasivos. El plasma rico en plaquetas autólogo representa una terapéutica regenerativa incluida en el novedoso arsenal de intervenciones que buscan este efecto. Objetivo: Evaluar los resultados de la terapéutica con plasma rico en plaquetas autólogo en pacientes con envejecimiento facial. Métodos: La muestra estuvo constituida por 68 pacientes valorados con la escala para valoración clínica de fotoenvejecimiento cutáneo al inicio del tratamiento. Se sometieron a cuatro sesiones de plasma rico en plaquetas cada 15 días y una sesión adicional a los 3 meses de concluir el tratamiento inicial. Los pacientes fueron seguidos durante 6 meses al cabo de los cuales se volvieron a evaluar con el mismo instrumento. Resultados: Las edades estuvieron comprendidas entre 21 y 73 años con una media de 46,80 años, predominó el sexo femenino (89,9 %). Los resultados significativos en el tratamiento de las arrugas, los surcos, la textura de la piel y las lesiones cutáneas estuvieron relacionados con la mesoterapia con plasma rico en plaquetas. El procedimiento produjo una mejoría valorada a través de la escala para valoración clínica de fotoenvejecimiento cutáneo. Conclusiones: La terapia con plasma rico en plaquetas tiene buenos resultados en el tratamiento de pacientes con envejecimiento facial.

Introduction: The growing need for youthful looking skin drives continued innovations with minimally invasive procedures. Autologous platelet-rich plasma represents a regenerative therapeutic included in the new arsenal of interventions that seek this effect. Objective: Assess the results of platelet-rich plasma therapy in patients with facial aging. Methods: The sample consisted of 68 patients assessed with the scale for the clinical assessment of cutaneous photoaging (SCACPH). They underwent four PRP sessions every 15 days and an additional session 3 months after completing the initial treatment. The patients were followed up for 6 months, after which they were reevaluated which the same instrument. Results: The ages of the patients were between 21 and 73 years with a mean of 46.80 years, the female sex predominated (89.9%). Significant results in the treatment of wrinkles, furrows, and skin texture and skin lesions were related to PRP mesotherapy. The procedure produced an improvement assessed with the SCACPH. Conclusions: Autologous PRP therapy has good results in the treatment of patients with facial aging.

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Resumen La utilización de procedimientos estéticos que mejoren la imagen corporal está en constante crecimiento, y también las infecciones asociadas a ellos, como las micobacteriosis atípicas. La meso terapia es un procedimiento mínimamente invasivo que consiste en la aplicación de sustancias que buscan estimular la dermis y el tejido celular subcutáneo, para el tratamiento de la celulitis y el rejuvenecimiento de la piel. Reportamos un caso de infección micobacteriana posterior a una mesoterapia en glúteos y muslos que se presentó como abscesos subcutáneos, que respondieron satisfactoriamente al tratamiento antibiótico prolonga do con claritromicina y trimetoprima-sulfametoxazol. Se han informado infecciones asociadas a mesoterapia en España, América Latina y el Caribe, que tendrían posiblemente un origen común: la falta de controles sanitarios. Destacamos la importancia de estar alertados sobre estas complicaciones infecciosas y la necesidad de reforzar las medidas de seguridad necesarias para evitarlas.

Abstract The use of aesthetic procedures that improve body image is constantly growing, as well as infections associated with them, such as atypical mycobacteriosis. Mesotherapy is a minimally invasive aesthetic procedure that consists of the application of substances that seek to stimulate the dermis and subcutaneous cellular tissue, for the treatment of cellulite and skin rejuvenation. We report a case of mycobacterial infection after mesotherapy in the buttocks and thighs that appeared as subcutaneous abscesses, they responded satisfactorily to prolonged antibiotic treatment with clarithromycin and trimethoprim-sulfamethoxazole. Infections associated with mesotherapy have been reported in Spain, Latin America and the Caribbean, all possibly related to lack of health controls. We emphasize the importance of being aware of these infectious complications and the need to reinforce the necessary security measures to avoid them.

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BACKGROUND: Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet-rich plasma (PRP) have been reported as adjuvant treatments. AIMS: This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL. METHODS: Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered. CONCLUSION: Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.

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BACKGROUND: Topical exogenous lipase has been approved for cosmetic use and has been used to mobilize fat from adipocytes. The objective of this study was to determine the effects of exogenous lipase in the subcutaneous adipose tissue. METHODS: Three different concentrations of exogenous lipase 1× (2 Units per ml), 5× (10 units per ml), and 10× (20 units per ml) were applied in a porcine model. Normal saline (NS) solution (as negative control) and phosphatidylcholine (as positive control) were also injected. Skin and subcutaneous tissue biopsies, up to the fascia, were obtained from each injection site on the 3rd day after injection. The number of cells per 20× field was counted as an indirect measurement of the size of the adipocytes. RESULTS: For 1× lipase, the number of cells per field was 47.80 (±7.63) versus 27.26 (±4.93), and 34.66 (±6.84) for NS, and phosphatidylcholine, respectively. For 5× lipase, the count was 36.06 (±4.74) versus 24.13 (±5.18), and 33.2 (±9.34). For 10× lipase, it was 40.06 (±4.35) versus 29.26 (±2.34) and 32.66 (±6.30) (p < .05 for all groups). CONCLUSIONS: A higher number of cells per field were observed in the lipase samples, inferring a decreased volume of adipocytes. No inflammation and/or loss of cell architecture were evidenced in the exogenous lipase groups.

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Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy-or intradermotherapy-is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4 days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.

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Las arrugas son surcos o pliegues en la piel, que aparecen principalmente por efecto del envejecimiento. Este artículo describe el caso de un paciente masculino de 47 años de edad, piel blanca, que acudió a consulta de cirugía plástica ocular por inconformidad con el aspecto envejecido de su rostro a causa de las arrugas perioculares. Se le aplicó plasma rico en plaquetas intradérmico en el trayecto de las arrugas a razón de 3 dosis con intervalo promedio de 30 días entre cada una. Se logró la corrección total de las arrugas, con buenos resultados estéticos. No se encontró reacción adversa. Se reafirma el criterio planteado por estudios de que el plasma rico en plaquetas es una opción terapéutica de primera línea para rejuvenecer la región periocular(AU)

Wrinkles are a creases or folds which appear in the skin mainly as a result of aging. A case is described of a male 47-year-old patient of white skin color who attended ocular plastic surgery consultation for dissatisfaction with the periocular wrinkles on his face, which gave it an aged appearance. Intradermal platelet-rich plasma was applied along the course of the wrinkles at three doses with an average separation of 30 days between them. Total wrinkle correction was achieved, with good esthetic results. There was not any adverse reaction. The case confirms the criterion contained in previous studies that platelet-rich plasma is a first-line therapeutic option to rejuvenate the periocular region(AU)

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Pain evaluation during local injections is a complex process. Injections cause patient's distress, especially when the target is a sensitive area such as scalp. Nonpharmacological methods as vibration before and during the procedure have been used to reduce pain. Mesotherapy has become a popular nonsurgical procedure for nonscarring alopecia, such as androgenetic alopecia (AGA) and alopecia areata (AA). Vibration has been successfully used in dermatological procedures, pediatrics, and dentistry. No study was found on vibration anesthesia during scalp mesotherapy. To analyze the effect of a vibration anesthetic device (VAD) during scalp mesotherapy on the patients' comfort.This is a randomized split-scalp study; thirty patients received mesotherapy with or without VAD on half of their scalp. Numerical rating scale (NRS) was used to measure self-reported pain. To test difference in means and medians in comparing device use and by treatment (AGA or AA), Student's t tests and Wilcoxon signed rank tests were used. Overall mean pain score on the no vibration-assisted side was 8.0 ± 1.0 while pain score for the vibration side was 2.3 ± 1.5, for AGA (P < .001) and 7.4 ± 1.2 and 2.1 ± 1.3, respectively, for AA (P < .001). Findings were similar for medians. No complications were found following procedure. To the best of our knowledge, this is the first study analyzing the effect of VAD in patients undergoing scalp mesotherapy. The VAD technique was found to be safe, effective, simple, and suitable for scalp procedures.

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Female androgenetic alopecia is one cause of alopecia in women, although the ideal treatment for this condition remains far from defined. The objective of this study was to evaluate the efficacy and safety of intradermal injections with 0.5% minoxidil for the management of female androgenetic alopecia in a randomized, placebo-controlled trial. A total of 54 women diagnosed with female androgenetic alopecia were divided into two groups: one group received intradermal injections of 0.5% minoxidil, and the other received 0.9% saline. Biopsy, trichogram, Trichoscan (Tricholog GmbH, Freiburg, Germany), and self-assessment findings were used to evaluate the outcomes of treatment with minoxidil. In the treated group, there was a significant increase in the terminal-to-vellus hair ratio (P < .001) and in the percentage of anagen hairs (P = .048) and an improvement in hair loss and volume (P = .021 and P = .028, respectively). These results show that intradermal injections with minoxidil were more effective than placebo (P < .001) in the treatment of female androgenetic alopecia with a good safety profile.

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