PEER-REVIEW | FACIAL AESTHETICS |
Table 3 Wrinkle Severity Rating Scale (WSRS) patient scoring chart
DEGREE
5 Extreme 4 Severe
3 Moderate 2 Mild 1 Absent DESCRIPTION Extremely deep and long folds, detrimental to facial appearance
Very long and deep folds; prominent facial features; less than 2 mm visible
Moderately deep folds; clear facial feature visible at normal appearance, but not when stretched
Shallow but visible fold with a slight indentation; minor facial feature
No visible nasolabial fold; continuous skin, injectable implant alone
DEGREE
Table 4 Global Aesthetic Improvement Scale (GAIS) DESCRIPTION
1 Exceptional improvement Excellent corrective result at week 12. No further treatment required
2 Very improved patient 3 Improved patient 4 Unaltered patient 5 Worsened patient
Marked improvement of appearance, but not completely optimal
Improvement of the appearance, better compared with the initial condition. Touch-up is advised
The appearance substantially remains the same compared with the original condition
The appearance has worsened compared with the original condition
three areas 1 week prior to the other treatments as an
adjunct to the laser resurfacing. The DUBLiN Lift was introduced as three phases over a
period of 3 weeks. Phase 1 included Dysport– at dilution 3.5 : 1 to three areas ® glabellar, frontalis (off-label) and periorbital (off-label). Phase 2 introduced intense fibroblast stimulation and modification through microneedling, PRP growth factor induction, and near-red phototherapy. Phase 3 administered the lowÐ level (CO2
)
UltraPulse laser at 100 mJ 14 w CPG 3/5/2, and adjunct near-red 633 nm phototherapy. The study evaluated post- procedural aesthetic results at 2 weeks, 4 weeks and 12 weeks. The length of downtime, patient discomfort and adverse side-effects were noted for each phase. Clinical assessment of patients in each group was
made at 2 weeks, 1 month and 3 months post-operatively in the presence of two aesthetic staff. The degree of improvement in photoageing was based on the degree of re-epithelialisation rate, reduction of rhytides, reduction of tactile roughness, and loss of hyperpigmentation and telangiectasias. The prolongation and severity of erythema as well as the presence of negative side-effects (e.g. herpes) were also recorded. The efficacy of treatment was evaluated using a
variation of the five-point scale (Table 1) originally suggested by Dover et al36
. Investigators and patients
evaluated efficacy using palpability assessments and change from baseline score at 0, 6 and 12 weeks. A total global score was recorded in each patient based on the addition of points obtained from six photodamage variables. The degree of perceived improvement in
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Figure 4 Patients before (A, C) and after (B, D) the DUBLiN Lift
overall aesthetic effect reflecting chronological age was assessed separately by patients and physicians using the Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS). The WSRS is recognised as a valid and reliable instrument for quantitative assessment of facial skin folds, with good inter- and intra-observer consistency5
. Wrinkle severity is
measured using a wrinkle severity rating scale with 1 being absent and 5 being extreme. By allowing objective grading of data, these proved useful clinical tools for assessing the effectiveness of facial volumisation with PRP and microneedlingÐ 633.
Interventions The following treatment protocols were used for this study: Lumenis ActiveFX CO2
laser, Traylife PRP, Omnilux
633 nm red light, Dermaroller–, and Dysport–. All participants received selective regional anaesthesia blocks with 2% lignocaine plus adrenaline, a topical combination anaesthetic of 23% lignocaine, and prophylactic Valtrex 500 mg twice daily for 8 days. Valium 5–10 mg stat was given as a pre-medication to some patients. A post-procedural advice sheet and ibuprofen or codeine with paracetamol ® as required ® was also given to patients. The ActiveFX is a protocol of settings applied in
conjunction with an improved computer pattern generator to the ultrapulsed CO2
laser (UltraPulse Clinical assessment of patients in
each group was made at 2 weeks, 1 month and 3 months post-operatively in the presence of two aesthetic staff.
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