Journal of Cosmetic Dermatology最新文献

{"title":"Hylacross Hyaluronic Acid Injectables in the Lips: Global Expert Perspectives for Achieving Optimal Esthetic Outcomes","authors":"Sarah G. Boxley,&nbsp;Kathleen M. Morno,&nbsp;Lina María Cadena Ortiz,&nbsp;William McGillivray,&nbsp;Hani Aljohani,&nbsp;Dario Bertossi,&nbsp;Carola de la Guardia","doi":"10.1111/jocd.71013","DOIUrl":"https://doi.org/10.1111/jocd.71013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lips are a common area of concern for patients seeking facial esthetic treatment. Hyaluronic acid (HA) injectables are the gold standard for nonsurgical lip improvement, and the Hylacross products may be particularly well suited to this area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To provide expert considerations on how Hylacross products can be used to achieve effective, individualized, natural, and durable lip outcomes in contemporary practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international group of clinicians with various specialties and extensive experience of these products completed a written questionnaire. Their collective clinical expertise forms the basis of the current considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hylacross products can be used to address a wide range of patient needs in the lips, such as counteracting age-related changes, volume augmentation, improving symmetry and balance, border definition, and contouring. Most patients prioritize natural results. Achieving this requires adherence to key technical principles, including: whole-face consideration; respect for individual lip anatomy and proportions; appropriate selection of product, injection device, and injection depth; and the use of small volumes within a conservative initial approach in treatment-naïve patients. A key safety principle relates to assessment of the position and depth of the labial arteries and the use of techniques that minimize the risk of vascular compromise. Patients with significant anxiety around unnatural results may be reassured through a comprehensive approach that combines relationship building, patient education, and cautious treatment planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By following these principles, Hylacross HA injectables can deliver well-tolerated, effective, and durable outcomes in the lips.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386242","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}

{"title":"Association of Social Media-Driven Cosmetic Consumption With Skin Barrier Damage, Delayed Medical Consultation, and Disease Severity in Acne Vulgaris: A Physician-Assessed Cross-Sectional Study","authors":"Orhan Şen,&nbsp;Atıl Avcı","doi":"10.1111/jocd.71020","DOIUrl":"https://doi.org/10.1111/jocd.71020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Social media content influences cosmetic consumption among acne patients; however, its clinical consequences remain incompletely understood. This study aimed to evaluate the association of social media-driven cosmetic consumption, information sources, and cosmetic awareness levels with clinical outcomes (barrier damage, acne severity, delayed medical consultation) in acne vulgaris patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional, descriptive study was conducted in 408 acne patients presenting to a dermatology outpatient clinic. Social media usage habits, dermocosmetic term awareness, and product consumption behaviors were assessed using a structured data collection form, while acne severity, barrier damage, and cosmetic polypharmacy history were evaluated by an attending dermatologist. Data were analyzed using chi-square test, Mann–Whitney <i>U</i> test, Spearman correlation, and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of participants was 20.9 ± 5.1 years, and 77.5% were female. Barrier damage was significantly higher in patients who purchased products through social media (64.3% vs. 10.2%; <i>p</i> &lt; 0.001). In multivariate analysis, social media-driven product purchase (OR = 3.25; <i>p</i> = 0.002) and delayed medical consultation (OR = 6.65; <i>p</i> &lt; 0.001) were identified as independent risk factors for barrier damage. TikTok users exhibited greater delays in seeking medical care (66.7% vs. 49.0%; <i>p</i> = 0.028) and higher rates of severe acne compared with Instagram users. Paradoxically, a higher number of known dermocosmetic terms was associated with increased barrier damage risk and delayed consultation, a pattern that may reflect superficial rather than clinically applicable knowledge. Conversely, following dermatologist accounts emerged as an independent protective factor against barrier damage (OR = 0.28; <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Social media-driven cosmetic consumption is strongly associated with barrier damage and worsening clinical disease severity in acne patients. Increasing evidence-based content production by dermatologists on social media platforms may positively contribute to the patient care process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386385","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}

{"title":"Avoiding Parotid Gland Injury During Lateral Cheek Cogged Thread Lifting (Sihler Thread): Cadaveric Study","authors":"Gi-Woong Hong,&nbsp;Kyu-Ho Yi","doi":"10.1111/jocd.71009","DOIUrl":"https://doi.org/10.1111/jocd.71009","url":null,"abstract":"&lt;p&gt;Thread-based lifting with barbed or cogged sutures was developed as a minimally invasive alternative to rhytidectomy and has evolved into multiple absorbable and nonabsorbable systems, insertion techniques, and vector designs [&lt;span&gt;1-3&lt;/span&gt;]. The procedure is generally performed in a subcutaneous, SMAS-adjacent, or selectively sub-SMAS plane to reposition ptotic soft tissue along planned lifting vectors. Compared with open facial rejuvenation surgery, thread lifting offers shorter recovery and lower procedural invasiveness, but it also has a distinct complication profile [&lt;span&gt;4-7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Common adverse events include swelling, bruising, dimpling, contour irregularity, thread palpability, and thread extrusion [&lt;span&gt;4-7&lt;/span&gt;]. Less frequent but clinically consequential complications include facial nerve injury and salivary system injury. Parotid gland or duct injury may present as focal swelling, sialocele, salivary fistula, meal-related pain, or ductal obstruction, and may require aspiration, compression, botulinum toxin injection, sialendoscopic treatment, or surgical management [&lt;span&gt;5, 8, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The lateral cheek is an anatomically complex region for thread lifting because commonly used vectors traverse the preauricular and lateral cheek area, where the parotid gland, masseter muscle, retaining ligaments, SMAS, parotid-masseteric fascia, and facial nerve branches are closely related. Classic and modern anatomical studies have shown that retaining ligaments and facial spaces define predictable tissue boundaries and zones of adherence [&lt;span&gt;10-14&lt;/span&gt;]. These structures provide important landmarks for safe dissection in facelift surgery and may also explain why resistance is encountered during blind cannula passage in minimally invasive thread procedures.&lt;/p&gt;&lt;p&gt;Despite increasing recognition of thread-lifting complications, the specific anatomical mechanism of parotid gland injury remains insufficiently characterized. Existing reports identify salivary complications as rare but clinically important events, yet few studies directly correlate lateral cheek thread trajectories with cadaveric anatomy of the parotid-masseteric fascia, parotid capsule, and sub-SMAS spaces. As a result, the distinction between safe superficial or SMAS-adjacent passage and potentially hazardous deep fascial violation is not always clearly defined in the thread-lifting literature.&lt;/p&gt;&lt;p&gt;This anatomical technical note synthesizes relevant lateral cheek anatomy, correlates the literature with cadaveric demonstrations, and proposes a practical mechanism by which parotid gland injury may occur during lateral cheek cogged thread lifting. In response to the need for clinically translatable guidance, the article also introduces a plane-control framework, discusses the tradeoffs between superficial and deeper thread placement strategies, integrates ultrasound-based safety concepts, and proposes a stepwise approach for suspected parotid violation. T","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386227","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}

{"title":"No. 11 Blade-Based Surgical Techniques for Steatocystoma Multiplex: A Systematic Review","authors":"Jia Qi Adam Bai,&nbsp;Sherilyn Wen,&nbsp;Aleksandra Frątczak,&nbsp;Chaocheng Liu","doi":"10.1111/jocd.71021","DOIUrl":"https://doi.org/10.1111/jocd.71021","url":null,"abstract":"&lt;p&gt;Steatocystoma multiplex (SM) is a rare benign disorder of the pilosebaceous unit characterized by the development of multiple sebum-filled dermal cysts that commonly occur on the trunk, neck, and proximal extremities and often represent a cosmetic concern [&lt;span&gt;1&lt;/span&gt;]. Recently, simple minimally invasive surgical approaches using a No. 11 blade to create a small incision followed by expression and removal of the cyst wall have increasingly been reported as a promising therapy with favorable cosmetic outcomes. This systematic review aimed to evaluate the efficacy and safety of No. 11 blade-based surgical techniques for the treatment of SM.&lt;/p&gt;&lt;p&gt;This systematic review followed PRISMA guidelines and was prospectively registered on PROSPERO (CRD420261293468). MEDLINE and Embase were searched with predefined keywords (Table S1). Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Articles were independently screened by two reviewers, resulting in six articles reporting on 53 patients (Figure 1; Table 1) [&lt;span&gt;2-7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Of the 53 patients, the mean age was 26.5 years with 56.3% (27/48) males (Table 1). Mean number of lesions per patient was 14.7 (range: 5–45) and lesion size ranged from 1 to 15 mm. Lesions most commonly involved the genitalia (47.4%, 45/95), upper extremities (26.3%, 25/95), and neck (21.1%, 20/95).&lt;/p&gt;&lt;p&gt;All six included studies employed a minimally invasive incision technique using a No. 11 blade followed by expression of cyst contents and removal of cyst wall using adjunctive instruments such as forceps (100%, 6/6), curettes (33.3%, 2/6), or vein hooks (16.7%, 1/6). Procedures were completed in a single treatment session (100%, 6/6) and were typically performed under local anesthesia (66.7%, 4/6). Postoperative care was variably reported and included simple wound cleaning with alcohol-soaked gauze (33.3%, 2/6), tissue adhesive closure (16.7%, 1/6), sterile strips (16.7%, 1/6), or wound dressings (16.7%, 1/6).&lt;/p&gt;&lt;p&gt;Complete resolution of treated lesions was reported in all patients (100%, 53/53). Mean follow-up duration was 12.4 months (range: 4.0–30.0). Cosmetic outcomes were favorable, with minimal scarring described as practically unnoticeable in 81.1% (43/53) of patients, while no scarring was reported in 18.9% (10/53). Transient hyperpigmentation was reported in one study and resolved within 2–4 weeks. When reported, patient satisfaction was described as high (100%, 2/2). No adverse events or recurrences were reported during follow-up.&lt;/p&gt;&lt;p&gt;SM lesions are composed of cystic structures arising from the pilosebaceous unit, often requiring complete removal of the cyst wall to prevent recurrence [&lt;span&gt;1&lt;/span&gt;]. Traditional excisional approaches can be time-consuming and impractical in patients with numerous lesions. Alternative treatments such as surgical excision, cryotherapy, or laser-based modalities may also result in suboptimal cosmetic outc","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386275","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}

{"title":"The Interaction of Artificial Intelligence and Social Media in Dermatology","authors":"Mohamad Goldust","doi":"10.1111/jocd.71035","DOIUrl":"https://doi.org/10.1111/jocd.71035","url":null,"abstract":"&lt;p&gt;The integration of artificial intelligence (AI) with social media is reshaping dermatology by creating new opportunities for education, outreach, and early disease detection. As a visually driven specialty, dermatology is particularly well-suited for image-based AI applications and digital dissemination. However, alongside these advantages, there are significant concerns related to diagnostic accuracy, misinformation, bias, and regulatory oversight that require urgent attention [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;AI-enabled tools are increasingly integrated into platforms such as Instagram, TikTok, and Snapchat, where they facilitate automated skin analysis, lesion triage, and cosmetic simulations. Advances in deep learning, including convolutional neural networks and vision transformers, have shown dermatologist-level performance in controlled settings for tasks such as classifying pigmented lesions and grading acne. However, real-world performance remains inconsistent. Many commercially available tools lack external validation, standardized datasets, and regulatory clearance as Software as a Medical Device (SaMD). As a result, users may misinterpret outputs from non-medical algorithms as clinical advice, increasing the risk of delayed diagnoses or inappropriate self-treatment [&lt;span&gt;2&lt;/span&gt;]. Importantly, a distinction should be made between consumer-facing AI applications designed primarily for wellness, cosmetic visualization, or general educational purposes and clinically validated AI tools that undergo regulatory review and are intended to support medical decision-making. Failure to differentiate these categories may contribute to public misunderstanding and inappropriate reliance on non-medical platforms for diagnostic guidance.&lt;/p&gt;&lt;p&gt;A major limitation of these tools is the quality and context of user-generated images. Unlike curated clinical datasets, social media images are often affected by poor lighting, filters, occlusion, and a lack of clinical metadata, such as lesion history or symptoms. Algorithm performance may decline significantly under these conditions. Furthermore, the “black box” nature of many AI systems limits interpretability, which reduces clinician trust and complicates medico-legal accountability.&lt;/p&gt;&lt;p&gt;Ethical and equity concerns further complicate this landscape. Algorithmic bias is a critical issue, with reduced diagnostic accuracy reported for individuals with darker skin types due to underrepresentation in training datasets. This risks exacerbating disparities in skin cancer detection and inflammatory conditions. Additionally, AI tools often require users to upload sensitive images, raising concerns about informed consent, data ownership, and compliance with privacy regulations like HIPAA and GDPR [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Beyond diagnostics, AI is transforming how dermatological information is created and disseminated. Generative AI and large language models can rapidly produce educational content, increasing efficiency f","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386075","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}

{"title":"Long-Term Safety of Intradermal Polynucleotides in the Periocular Region: A Retrospective Study","authors":"Elena Caride Miana","doi":"10.1111/jocd.71029","DOIUrl":"https://doi.org/10.1111/jocd.71029","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The use of polynucleotides (PN) has increased significantly in aesthetic medicine due to their regenerative properties and favorable short-term safety profile. However, evidence regarding their long-term safety, particularly in real-world clinical practice, remains limited.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate the short- and long-term safety of intradermal polynucleotide treatment (PN-HPT) in the periocular region based on routine clinical practice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective observational study was conducted through medical record review. Patients consecutively treated with PN-HPT for periocular rejuvenation between January and March 2024 were included. This inclusion period was defined to ensure a minimum available timeframe of 24 months from the first treatment session at the time of data analysis. All patients completed an initial protocol of three sessions, administered at 4-week intervals. Polynucleotides (PN-HPT 7.5 mg/mL) were administered intradermally using a 33G needle, with 1 mL injected per periocular side. Data on treatment sessions and adverse events were collected from clinical records. As part of routine clinical care, all patients were systematically contacted 24 h after each treatment session to assess early adverse events, and underwent at least one in-person evaluation approximately 1 month after the final session. Subsequently, clinical records of all included patients were reviewed up to March 2026 to identify any additional or delayed adverse events. Safety assessment was based on documented events during routine clinical practice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 23 patients were included, accounting for 91 treatment sessions between January 2024 and March 2026. Fifteen patients (65.2%) underwent additional sessions beyond the initial protocol, reflecting repeated exposure under real-world conditions. Only two mild and self-limited adverse events were documented: one case of transient periocular edema and one case of prolonged intradermal papules. No moderate or severe adverse events were recorded. Importantly, no delayed adverse events were identified in the medical records during the study timeframe. All patients continued receiving care during this period, and no additional treatment-related adverse events were documented.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this retrospective real-wo","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386362","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}

{"title":"Post-Filler Complications: Beware of Early Warning Signs of Systemic Diseases","authors":"Hang Wang,&nbsp;Xingcheng Pan,&nbsp;Ziyao Wang,&nbsp;Chihchieh Lo,&nbsp;He Qiu","doi":"10.1111/jocd.71036","DOIUrl":"https://doi.org/10.1111/jocd.71036","url":null,"abstract":"&lt;p&gt;The use of injectable materials for facial aesthetic procedures has increased substantially over the past decades, accompanied by a growing spectrum of procedure-related complications. Early adverse events, such as vascular occlusion, acute hypersensitivity reactions, and immediate post-injection erythema or edema, are relatively well recognized and can often be promptly identified and managed due to their acute onset and characteristic clinical presentation. In contrast, delayed complications have gained increasing attention in recent years, including foreign body granulomas, delayed hypersensitivity reactions, filler migration, and chronic inflammatory responses of unclear etiology [&lt;span&gt;1&lt;/span&gt;]. These reactions may occur months to years after injection, and in rare cases, even decades later, significantly complicating clinical diagnosis and management. Their heterogeneous and often non-specific manifestations frequently overlap with infectious or allergic conditions, thereby increasing the risk of misdiagnosis and delayed intervention.&lt;/p&gt;&lt;p&gt;All fillers represent exogenous implanted materials that may elicit varying degrees of host immune response. Particularly, collagen-stimulating agents and animal-derived fillers may carry inherent immunogenic potential, which could predispose susceptible individuals to abnormal immune activation. Previous studies have suggested that patients with atopic predisposition or heightened immune reactivity may exhibit exaggerated immune responses following filler injection [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;An often-overlooked aspect is that systemic immune-related disorders may initially manifest or become accentuated at filler-injected sites. In such cases, local findings, such as erythema, swelling, or nodularity, may closely mimic delayed allergic or infectious complications, thereby confounding early clinical assessment. Fail to recognize this possibility may lead to inappropriate treatment and, in some cases, progression to severe systemic involvement.&lt;/p&gt;&lt;p&gt;Therefore, when encountering unexplained, persistent, or atypical inflammatory reactions in previously injected areas, clinicians should extend the differential diagnosis beyond conventional filler-related complications and maintain a high index of suspicion for systemic conditions, particularly autoimmune diseases. Herein, we report a case of anti-melanoma differentiation-associated gene 5 (MDA5) positive dermatomyositis (MDA5-DM) presenting initially as localized inflammatory changes in facial filler-injected regions. This case highlights that injection sites may function not only as loci of local complications but also as potential windows for the early detection of systemic immune disorders, providing important implications for clinical decision-making and patient safety.&lt;/p&gt;&lt;p&gt;Written informed consent was obtained from the patient, and this study was conducted according to the Declaration of Helsinki guidelines. A 40-year-old woman presented with progre","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386076","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}

{"title":"Layer-by-Layer Multidermal Rejuvenation","authors":"Kyu-Ho Yi,&nbsp;Suyeon Lee,&nbsp;Ting Song Lim,&nbsp;Diala Haykal","doi":"10.1111/jocd.71004","DOIUrl":"https://doi.org/10.1111/jocd.71004","url":null,"abstract":"&lt;p&gt;The clinical label “skin rejuvenation” encompasses multiple patient priorities, including smoother texture, brighter tone, more uniform pigmentation, reduction of fine lines, improved firmness, and enhanced facial contour. These clinical domains arise from distinct anatomical and biological substrates rather than from a single structural layer. Chronological aging and photoaging alter epidermal turnover and pigmentation, remodel collagen and elastin throughout the dermis, and modify the mechanical support provided by superficial fat compartments and the fibroseptal network [&lt;span&gt;1&lt;/span&gt;]. Therefore, facial skin-quality optimization should be understood as a multidimensional and depth-dependent process rather than as a single-surface problem.&lt;/p&gt;&lt;p&gt;Because these processes occur across multiple anatomical depths, treatment strategies that focus on a single modality may inadequately address the dominant driver of visible skin aging. In clinical practice, when depth-dependent contributors are not explicitly considered, clinicians may compensate by increasing treatment energy, repeating procedures, or empirically combining products and devices. Such approaches may increase inflammation, downtime, cost, and complication risk without proportionally improving outcomes. This limitation is particularly relevant because many contemporary rejuvenation strategies remain organized around treatment categories—such as injectables, energy-based devices, resurfacing, or topical regimens—rather than around the anatomical substrates responsible for the patient's primary concern. An anatomically informed strategy may therefore provide a more coherent basis for treatment planning. Recognizing that different skin-quality concerns originate predominantly from different tissue layers allows clinicians to align interventions with the anatomical depth most responsible for the observed changes (Figure 1). We therefore propose a practical anatomy-guided framework for layer-by-layer multidermal rejuvenation. The framework involves three steps: (1) identifying the skin-quality domains most relevant to the patient, (2) mapping each domain to its dominant anatomical contributors—epidermis, papillary dermis, reticular dermis, or subdermis—and (3) selecting and sequencing interventions that primarily act at those depths (Figure 1).&lt;/p&gt;&lt;p&gt;The importance of this narrative lies in reframing facial rejuvenation from a product-centered or procedure-centered approach into a layer-specific anatomical logic. Its novelty is not the introduction of a single new device, injectable, or topical agent, but the integration of established and emerging modalities into a unified depth-based framework. This framework is not intended to replace clinical judgment or device-specific treatment protocols. Rather, it provides a consistent anatomical rationale for modality selection, expectation setting, procedural sequencing, risk reduction, and the construction of staged multimodal treatment plans t","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386212","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}

{"title":"The Role of High-Frequency Ultrasonography in Managing Adverse Reactions to Exosome-Based Rejuvenation","authors":"Yezdan İpek Davarcıoğlu,&nbsp;Ayşenur Botsalı","doi":"10.1111/jocd.71023","DOIUrl":"https://doi.org/10.1111/jocd.71023","url":null,"abstract":"&lt;p&gt;The increasing popularity of exosome-based therapies in aesthetic medicine is accompanied by a rise in reports of potential side effects, particularly when used off-label via intradermal injection. Although serious complications such as skin necrosis and persistent granulomatous inflammation after exosome administration have been highlighted in the current literature [&lt;span&gt;1, 2&lt;/span&gt;], the challenges in diagnosing these newly emerging safety issues still remain important. We report a case of delayed inflammatory nodules following periorbital exosome injection and discuss the role of high-frequency ultrasonography (HFUS) as a non-invasive diagnostic tool in the evaluation and management of these reactions.&lt;/p&gt;&lt;p&gt;A 52-year-old woman presented to our clinic with firm, erythematous-to-skin-colored papules along the lateral orbital rims, appearing 2 weeks after a periorbital “rejuvenation” procedure. The patient had received an intradermal injection of a human dermal fibroblast-derived exosome product, which was originally intended for topical application. The patient reported that post-procedural papules at the injection sites resolved spontaneously within a few hours. Approximately 2 weeks later, persistent papules developed in the treated areas. Clinical examination revealed multiple non-fluctuant, non-tender papules that showed no signs of infection or vascular occlusion (Figure 1A).&lt;/p&gt;&lt;p&gt;Given the sensitive periorbital location, the patient declined a skin biopsy. To characterize the lesions, 20-MHz HFUS was performed, which revealed multiple well-defined hypoechoic nodules measuring 2–5 mm in diameter at the dermal–subcutaneous interface (Figure 2). No internal vascularity was detected on Doppler examination. These sonographic findings were suggestive of foreign-body granulomas, consistent with the clinical history of exogenous material injection. Because histopathologic confirmation was not available, the diagnosis remained presumptive and was based on the combined clinical and ultrasonographic findings. Prior to presentation at our clinic, the patient had tried massage, topical corticosteroids, and warm compresses without clinical improvement. Given the persistence of the localized lesions despite these conservative measures, intralesional triamcinolone acetonide injection was selected as a targeted anti-inflammatory treatment and administered without ultrasound guidance. Triamcinolone acetonide (40 mg/mL) was diluted with 2% prilocaine hydrochloride at a ratio of 0.3–0.7 mL (0.3 mL triamcinolone acetonide and 0.7 mL prilocaine hydrochloride), and approximately 0.1 mL of diluted solution was injected into each nodule. Complete resolution was achieved within 1 month, leaving only mild post-inflammatory hyperpigmentation (Figure 1B).&lt;/p&gt;&lt;p&gt;This case supports growing concerns that exosome formulations, especially those not approved for injection, may cause significant inflammatory responses. In our patient, the absence of infectious symptom","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386213","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}

{"title":"Efficacy and Safety of L-Carnosine-Containing Hyaluronate Injection for Facial Skin Hydration and Brightness: A Randomized, Controlled, Evaluator-Blinded Trial","authors":"Zhanhong Li,&nbsp;Jingfang Sun,&nbsp;Zhehu Jin,&nbsp;Wei Guo,&nbsp;Aili Cui,&nbsp;Huaigu Wang,&nbsp;Jiahua Wang,&nbsp;Xiaoyi Qiu,&nbsp;Heyang Xi,&nbsp;Yao Zhang,&nbsp;Lu Zhang,&nbsp;Ligen Xuan,&nbsp;Lingzhi Shi,&nbsp;Yangliang Yi,&nbsp;Huiyin Qiu,&nbsp;Fangke Guan,&nbsp;Yaling Xie,&nbsp;Zhouwei Liu,&nbsp;Lili Liang,&nbsp;Haijun Yang,&nbsp;Chunfang Chen,&nbsp;Huiying Wang,&nbsp;Xiaoling Sun,&nbsp;Fengsheng Che,&nbsp;Qiong Meng","doi":"10.1111/jocd.71030","DOIUrl":"https://doi.org/10.1111/jocd.71030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>L-carnosine, a dipeptide with superior antioxidant and antiglycation properties, serves as the core active component in this study. We aimed to evaluate the efficacy and safety of a novel injectable composite solution, which features L-carnosine in combination with non-crosslinked sodium hyaluronate, glycine, alanine, proline, and vitamin B₂, for improving facial skin dryness and dullness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, multicenter, randomized, evaluator-blinded, superiority clinical trial, 466 subjects were randomized 1:1 to receive either the composite solution injections every 4 weeks for three sessions (treatment group) or no intervention (control group). The control group served as a baseline reference for natural temporal changes. Efficacy was assessed using the Global Aesthetic Improvement Scale (GAIS), the Skin Dryness and Dullness Improvement Scale (SDDIS), the Allergan Fine Lines Scale (AFLS), and the Allergan Skin Roughness Scale (ASRS). A predefined superiority margin of 15% was set for between-group differences. Blinded evaluators used standardized photographs to score the scales. Safety was evaluated based on adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From baseline to Week 12, the treatment group exhibited significantly superior improvements in GAIS, SDDIS, AFLS, and ASRS scores relative to the control group. Efficacy assessed at Week 12 further highlighted this advantage (GAIS: 86.49% vs. 5.26%, SDDIS: 82.88% vs. 5.70%, AFLS: 36.07% vs. 4.57%, ASRS: 47.49% vs. 5.02%; all <i>p</i> &lt; 0.05). These findings were consistent across both full analyses and per-protocol analyses. Participant satisfaction was significantly higher in the treatment group (<i>p</i> &lt; 0.05). Treatment-related adverse events occurred in 94/228 (41.23%) of treated participants, predominantly mild injection-site reactions (e.g., erythema, swelling) that resolved within 2 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This randomized trial demonstrated that the LIVIGI Sodium Hyaluronate Composite Solution for Injection provided favorable clinical efficacy and acceptable safety in improving facial skin dryness and dullness, suggesting its potential as a promising option for skin quality enhancement in aesthetic practice. Furthermore, these findings underscore the growing role of multi-component synergistic formulations in the evolving field of mesotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 7","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocd.71030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386349","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}