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Published for the period of January -2025
Cover Credit-Model : Bianca Contractor
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From Rejuvenation to Restoration: Key Advances in Dermatology
In recent years, the field of aesthetic dermatology has witnessed remarkable progress, ushering in a new era of advanced skin rejuvenation techniques. These modern approaches are underpinned by cutting-edge technologies and a more nuanced understanding of skin biology, allowing practitioners to achieve exceptional results while minimizing discomfort and recovery time. Energy-based devices, such as lasers, radiofrequency, and ultrasound systems, have revolutionized how we address various skin concerns, offering precise and customizable treatments. Alongside these technologies, the development of innovative topical agents, biologically active injectable and regenerative therapies like platelet-rich plasma (PRP) and stem-cell-based treatments have further expanded our capabilities in restoring skin health and vitality.
Dermatologists continuously explore transformative innovations, focusing on their efficacy, safety, and long-term outcomes. Personalized treatment plans, tailored to factors like skin type, age, and aesthetic goals, ensure effective and natural results. Staying updated on advancements is a responsibility, enabling us to provide patients with the latest science-backed solutions.
In this issue, we spotlight key advancements in aesthetic dermatology, including modern techniques for undereye rejuvenation, combining energy-based devices, fillers, and regenerative therapies to address dark circles and fine lines with natural results. We also explore the role of nail surgery and lasers in managing disorders like onychomycosis and nail tumors, enhancing both function and aesthetics. These articles offer valuable insights to elevate your clinical and aesthetic practice, inspiring you to navigate the dynamic field of dermatology with confidence and innovation.
HOPE YOU HAVE A GREAT READ
Thanks & Cheers
- Dom Daniel
Executive Editor & Publisher
Editorial Board Advisory Board
Dr. Pallavi Rathi
MD, DDV, FCPS
Dermatologist, Cosmetologist & Trichologist
My Skin My Health, Mumbai
DR. ABDUL SAMAD
DR. MANJUNATH HULMANI
DR. SATISH K. M.
DR. ABHIRAM RAYAPATI
DR. NITHIN S.U.
DR. SYED SALAHUDINN
DR. POORNIMA M.
Dr. Geeta Fazalbhoy
MBBS, DPD (UK), AAAM (USA)
Managing Director & Founder Skin & You Clinic, Mumbai Consultant Dermatologist, St. Elizabeth Hospital, Mumbai
Undereye Rejuvenation: Modern Approaches in Aesthetic Dermatology
Dr. Pallavi Rathi MD, DDV, FCPS
Dermatologist, Cosmetologist & Trichologist
My Skin My Health, Mumbai
Introduction
As dermatologists, we understand that undereye rejuvenation has
become one of the most soughtafter treatments in aesthetics, addressing concerns like dark circles, puffiness, fine lines, and hollowness. The primary goal is to restore a youthful and refreshed appearance while preserving the delicate balance of the periorbital region. Dark circles often arise from pigmentation, vascular pooling, or shadows caused by volume loss, while hollowness results from aging and fat loss in the tear trough area. Fine lines and wrinkles are typically linked to skin laxity, sun exposure, and collagen degradation, whereas puffiness may stem from fluid retention or fat protrusion. Fortunately, advances in dermatology offer a range of non-invasive and minimally invasive solutions to restore a youthful appearance to the delicate under-eye area with treatments that are effective, safe, and natural-looking.
Among the many treatment options, hyaluronic acid fillers are widely used to restore volume, diminish hollowness, and reduce shadowing, offering immediate results with minimal downtime. Platelet-rich plasma
(PRP) therapy enhances skin elasticity, texture, and reduces dark circles naturally by stimulating collagen production. Laser resurfacing with Fractional CO2 or Erbium lasers is highly effective for reducing wrinkles, tightening skin, and improving pigmentation. Chemical peels, using agents like glycolic acid or TCA, exfoliate and promote collagen synthesis, addressing pigmentation and fine lines. NCTF mesotherapy, which delivers hyaluronic acid and nutrients through microinjections, hydrates and revitalizes the under-eye area, enhancing skin quality and elasticity. Topical creams enriched with ingredients such as retinoids, vitamin C, peptides, caffeine, and niacinamide complement these procedures by brightening the under-eye area, reducing puffiness, and stimulating collagen.
1. Hyaluronic Acid Fillers
Injectable hyaluronic acid fillers, are among the most popular treatments for undereye rejuvenation. These fillers help restore volume in the tear trough area, which can diminish the appearance of hollowness and dark circles. The results are immediate, and the procedure
is quick with minimal downtime. Moreover, the hydrophilic nature of hyaluronic acid attracts and retains moisture, further enhancing skin hydration and texture over time. Advanced filler formulations are tailored to the delicate under-eye area, providing natural-looking outcomes while minimizing risks like swelling or the Tyndall effect.
When administered by a skilled dermatologist, hyaluronic acid fillers not only rejuvenate but also harmonize with the overall facial features, offering a subtle yet impactful enhancement. Periodic touch-ups, typically every 6-18 months, help maintain the results, making HA fillers a reliable and popular choice for under-eye rejuvenation.
2. Platelet-Rich Plasma (PRP)
PRP therapy, often referred to as the vampire facial, involves injecting a patient's own plasma, rich in growth factors, into the under-eye region. PRP promotes collagen production and improves skin texture and elasticity, effectively reducing dark circles and fine lines over time. The treatment is natural, with no risk of allergic reactions. One of the standout benefits of PRP is its versatility; it works well for patients seeking subtle, progressive improvements without introducing foreign substances. Multiple sessions, typically spaced 4-6 weeks apart, may be needed to achieve optimal results, with improvements becoming more pronounced over several months as collagen remodeling occurs. PRP therapy is particularly effective for patients with pigmentation-induced dark circles or early signs of aging, offering a safe and minimally invasive solution. With no significant downtime, it fits seamlessly into most lifestyles, making it an increasingly popular choice for those looking to rejuvenate the under-eye area naturally and effectively.
3. Laser Resurfacing
Fractional CO2 and Erbium lasers are excellent options for improving skin texture and addressing wrinkles around the eyes. These lasers work by stimulating collagen production, tightening the skin, and reducing pigmentation irregularities. The treatment requires minimal downtime, and multiple sessions may be needed for optimal results. These lasers work on the principle of fractional photothermolysis, where microscopic beams of light target the skin in a grid-like pattern, leaving surrounding areas intact. This stimulates the skin's natural healing response, promoting collagen and elastin production while simultaneously resurfacing the treated area.
Fractional
CO2 Laser is a more aggressive option, ideal for deeper wrinkles and pronounced skin laxity. It penetrates deeper into the dermis, making it effective for significant skin tightening and texture improvement. While it requires slightly more downtime compared to Erbium lasers, the results are more dramatic and longer-lasting. Erbium Laser, on the other hand, is less invasive and better suited for patients with mild to moderate skin concerns or those seeking a gentler treatment with quicker recovery. It is particularly effective for targeting fine lines and pigmentation around the delicate under-eye area.
Both lasers can address concerns like sun damage, uneven pigmentation, and crepiness by precisely targeting damaged skin layers. The treatments are customizable, allowing dermatologists to adjust
Undereye
settings based on the patient's skin type, concerns, and tolerance for downtime. Patients typically experience mild redness and swelling after the procedure, which subsides within a few days. Multiple sessions, spaced 4-6 weeks apart, are often recommended to achieve optimal results. Aftercare, including the use of sunscreen and gentle moisturizers, is crucial to protect the newly treated skin and enhance outcomes. Fractional lasers offer a transformative, non-surgical option for under-eye rejuvenation, making them an excellent choice for patients seeking smoother, firmer, and more evenly toned skin. When performed by experienced dermatologists, these treatments provide a safe, effective, and long-lasting solution to aging and tired-looking eyes.
4. Chemical Peels
Superficial chemical peels using agents like glycolic acid or trichloroacetic acid (TCA) can improve the appearance of dark circles and fine lines by exfoliating the top layer of skin and stimulating collagen production. These treatments are cost-effective and customizable, though they require skilled application to avoid irritation or uneven pigmentation in the delicate under-eye area.
Glycolic Acid Peels are derived from sugarcane and are wellsuited for treating pigmentation and early signs of aging. Their small molecular size allows them to penetrate the skin effectively, making them particularly beneficial for addressing superficial dark circles caused by uneven pigmentation. Trichloroacetic Acid (TCA) Peels are more potent and ideal for moderate concerns, including fine lines and discoloration. TCA peels can be customized in strength to address specific issues in the delicate under-eye area without compromising safety. The procedure is quick and minimally invasive, typically performed in a dermatologist’s office. After cleansing the skin, the chosen chemical agent is applied to the under-eye area for a controlled duration before being neutralized or removed. Patients may experience mild redness, peeling, or sensitivity for a few days post-treatment, which resolves as the skin heals and regenerates. Chemical peels are cost-effective and highly customizable, making them accessible to a wide range of patients. However, the delicate nature of the under-eye skin requires skilled application by an
experienced dermatologist to avoid potential risks such as irritation, hyperpigmentation, or uneven results. Post-treatment care is essential, including diligent use of sunscreen and hydrating creams, as the newly treated skin is more sensitive to UV exposure. For optimal results, a series of peels spaced 2-4 weeks apart is often recommended. Superficial chemical peels offer a safe, efficient, and transformative option for under-eye rejuvenation, providing brighter, smoother, and more youthful-looking skin with minimal downtime.
5. NCTF Treatment
NCTF (New Cellular Treatment Factor), a mesotherapy solution containing hyaluronic acid, vitamins, amino acids, and antioxidants, is gaining popularity for under-eye rejuvenation.
Delivered through microinjections, it hydrates the skin, improves elasticity, and revitalizes the under-eye region. This treatment is ideal for patients seeking a comprehensive approach to combat signs of aging and fatigue.
The hyaluronic acid in NCTF acts as a hydrating powerhouse, attracting and retaining moisture to plump and smooth the undereye region. Vitamins and amino acids stimulate collagen and elastin production, improving skin elasticity and reducing the appearance of fine lines and wrinkles. Antioxidants neutralize free radicals, protecting the skin from environmental damage and oxidative stress that contribute to premature aging. Together, these components enhance skin texture, brightness, and overall vitality, creating a refreshed and youthful appearance. The procedure is minimally invasive and typically well-tolerated. A series of tiny injections is performed using fine needles or mesotherapy devices to distribute the solution evenly across the targeted area. The treatment is often described as feeling like small pinpricks, with mild redness or swelling that subsides within a day or two. For optimal results, a series of sessions is recommended, typically spaced 2-4 weeks apart, followed by maintenance treatments every 6-12 months.
NCTF is an ideal choice for patients looking for a natural, comprehensive approach to under-eye rejuvenation. It not only addresses visible signs of aging like fine lines, hollowness, and dullness but also enhances the skin’s intrinsic quality, leaving it healthier and more resilient. When performed by skilled dermatologists, NCTF mesotherapy provides subtle yet impactful improvements, revitalizing the under-eye area without altering natural facial expressions.
6. Topical Creams
Topical formulations containing ingredients like retinoids, vitamin C, peptides, and caffeine provide a convenient, low-risk, and costeffective solution for addressing under-eye concerns such as dark circles, puffiness, fine lines, and collagen loss. Retinoids stimulate collagen production and promote skin cell turnover, helping to fade dark circles and reduce wrinkles. Vitamin C brightens the undereye area, fights free radicals, and supports collagen synthesis, while
peptides enhance skin elasticity and firmness. Caffeine’s vasoconstrictive properties reduce puffiness and improve circulation. When integrated into daily skincare routines, these creams complement inoffice treatments like fillers, laser resurfacing, or PRP therapy, enhancing and prolonging results by providing continuous support between sessions. The low risk and cost-effectiveness of these topical treatments make them an accessible option for long-term maintenance in undereye rejuvenation.
Summary
The advancements in under-eye rejuvenation provide a spectrum of solutions, ranging from noninvasive topical treatments to minimally invasive procedures like fillers, PRP, and lasers. Individualized treatment plans, tailored to the patient’s specific concerns and skin type, ensure optimal results while maintaining the natural integrity of the periorbital area. By combining techniques, dermatologists can achieve transformative outcomes that restore confidence and a youthful appearance.
Undereye Rejuvenation:
FAQ on Exosomes
1. What is exosome therapy?
Exosome therapy uses nano-sized, membranebound vesicles secreted by cells to transmit signals that stimulate regenerative processes, similar to stem cells but without the need for direct stem cell injections. These exosomes, formed through inward budding of multivesicular bodies, contain proteins, lipids, mRNA, and microRNA, enabling intercellular communication. By modulating immune responses, differentiation, and tissue repair, exosomes are emerging as promising tools in regenerative medicine, drug delivery, and disease biomarker discovery.
2. What is the primary function of exosomes in medical treatments?
Exosomes serve as key mediators in cellular communication by transferring regenerative signals from stem cells to recipient cells. This signalling process stimulates the recipient cells to initiate and regulate essential healing, repair, and regenerative functions, thereby facilitating tissue regeneration and modulating cellular responses in therapeutic contexts.
3. What types of cells produce exosomes relevant to skin and hair?
Keratinocytes, fibroblasts, and stem cells in the skin and hair follicles are key producers of exosomes, which are crucial for skin and hair health. Dermal papilla cells (DPCs) secrete essential growth factors and signalling molecules, facilitating intercellular communication. This modulates cellular proliferation, differentiation, and tissue regeneration, supporting the vitality of skin and hair.
4. What are the sources of exosomes?
Exosomes can be derived from a variety of sources, including human tissues such as adipose tissue, placenta, and umbilical cord, as well as plant-based sources like rose-derived exosomes. Microbial sources, particularly from bacteria, also contribute to exosome isolation, while synthetic exosomes can be engineered for specific therapeutic purposes. Although less commonly utilized, exosomes can also be derived from animal sources, expanding their potential applications across diverse fields of regenerative medicine, immunotherapy, and drug delivery.
5. What is the ideal size of exosomes for effective treatment?
Exosomes, ranging from 30 to 200 nm, are ideal for therapeutic applications due to their ability to efficiently interact with and penetrate target cells. This size allows optimal delivery of proteins, lipids, and nucleic acids,
promoting cellular communication and regeneration. Additionally, when combined with devices like microneedling, exosomes can effectively penetrate the skin to reach target cells for enhanced therapeutic effects.
6. What types of exosomes are available, and how do they differ?
Exosome preparations vary in purity and concentration. Conditioned medium contains a small amount of exosomes along with other extracellular components. Mid-level exosomes are a mixture of cultured medium and exosomes, offering moderate concentration. Isolated exosomes, which are purified, provide the highest concentration and purity, ensuring the most effective therapeutic results.
7. How do the growth factors transported by exosomes contribute to hair follicle cell proliferation?
Exosomes are essential for hair follicle health, containing proteins, lipids, and RNA for intercellular communication. They activate Wnt/a-catenin pathways, regulate gene expression via microRNAs, and enhance keratinocyte and fibroblast interactions, supporting hair shaft formation and promoting regeneration.
8. What role do exosomes play in cellular communication related to hair follicle health?
For hair follicle health, exosomes released by dermal papilla cells and other supportive cells communicate with hair follicle cells modulating their activity. This communication helps regulate processes such as cell proliferation, differentiation, and survival, ultimately influencing hair growth cycles and maintaining follicle integrity.
9. Do exosomes have anti-aging effects?
Yes, exosomes have anti-ageing promoting collagen synthesis, enhancing skin hydration, and reducing inflammation, improving the appearance of aging skin. They address aging-related processes like oxidative stress and cellular senescence by delivering bioactive molecules, thereby supporting overall skin health and vitality.
10.Can exosomes be used in patients with cancer recovery?
Yes, exosomes can be used in cancer recovery patients, provided plant-derived exosomes are used. These have been shown to help with regeneration and healing without the risks associated with other sources.
11.What is Exosome-based Stem Cell Regenerative Therapy, and what is its significance?
Exosome-based Stem Cell Regenerative Therapy is a specialized approach that isolates high-quality exosomes
derived from stem cells to enhance therapeutic efficacy. This technique ensures proper purification of exosomes, optimizing their regenerative potential by delivering concentrated, bioactive molecular signals to target cells. Compared to lower-grade exosome preparations, this method offers a more effective treatment modality for promoting tissue repair, cellular regeneration, and overall therapeutic outcomes.
Refining the Natural Look: CuttingEdge Lip Filler Solutions
Dr. Geeta Fazalbhoy
MBBS, DPD (UK), AAAM (USA)
Managing Director & Founder
Skin & You Clinic, Mumbai
Consultant Dermatologist
St. Elizabeth Hospital, Mumbai
Introduction
The lips are a key feature of the human face, the complex anatomical
structures of the lips play a critical role in facial aesthetics, communication, and the overall harmony of facial proportion. Each lips are divided into convex upper and lower lip, centrally the collumella connects the nose to the philtrum of the upper lip. Upper lip comprises distinct layers, including the skin, subcutaneous tissue, orbicularis oris muscle fibres, mucosa. The junction of the red part of the lips with the skin is the vermillion border. With aging the corners of the mouth (oral commissure) turn downwards, loss of dental vertical dimension as well as fat pad changes result in the lips ageing. Prominent sad angles (marionette lines) develop lateral to the oral commissures. The lips become thin from fat and muscle atrophy. Vertical upper and lower lip rhytides develop, especially in females. The loss of muscle tone and atrophy of the lip elevators, depressors and modiolus allow this “sling”like anatomy to weaken and produce generalized loss of lip support.
Below the lower lip, the labiomental groove passes between the lip and the chin. Superficial fat compartment is present under the semi mucosa and above the orbicularis oris muscle. Deep fat compartment, below the orbicularis oris muscle and above the lip mucosa. Dental profile can largely affect the lip profile and projection.
Aging particularly affects the lips, with reductions in thickness of lips and in vermilion dimensions, coupled with increments in the distance between the nose and the upper lip vermilion border, and in mouth width. Ideally lip measurements are larger in males than in females; aesthetic goals for the lip should include proper proportioning of vertical height and inter commissure width (lip length), as well as recreation of a distinct upper lip white roll. Ideal lip is in proportion of 1 for the upper lip and 1.618 for the lower lip (Asian and African American vertical lip dimensions may approach 1:1). The ideal feminine youthful lower lip should be fuller but the upper lip should project more in a profile by 1 to 2 mm positioned centrally in the
lower face, the lips, alongside the eyes and nose, form what is often referred to as the triangle of beauty. The vermilion border, a highly vascularized area, gives the lips their characteristic colour and shape, while the orbicularis oris muscle plays a crucial role in lip movement, expression and function. From an aesthetic perspective, the lips serve as a focal point in facial beauty, influencing perceptions of attractiveness, youthfulness, and health. Well-defined, full lips are often associated with vitality and femininity, making them a desirable trait across various cultures.1
The lips, with features like the Cupid’s bow, philtrum length, and symmetry, are essential for facial balance and harmony. Aesthetic ideals for lips have evolved, often reflecting societal trends that favour full, well-defined lips associated with youth, sensuality, and confidence. Beyond aesthetics, the lips are vital for speech, eating, and expression, and their interaction with other facial features highlights their importance in creating an attractive and harmonious appearance.2
Lip augmentation is increasingly sought after for both aesthetic enhancement and restorative purposes. The desire for fuller, well-defined lips is influenced by cultural standards of beauty that often associate voluminous lips with youthfulness and vitality. As individuals age, natural changes occur in lip morphology, including volume loss, thinning of the vermilion and a decrease in the definition of the lip borders. These changes can result in a less youthful appearance and
may negatively impact self-esteem. Additionally, lip augmentation serves a functional role in enhancing facial symmetry and balance, which are critical components of overall facial aesthetics. Patients may seek lip augmentation to address color, asymmetries or deformities resulting from congenital anomalies, traumatic injuries, or previous surgical interventions. Consequently, lip augmentation is both a cosmetic procedure and a therapeutic intervention aimed at restoring facial harmony and improving the psychological well-being of patients.3
Case report
A 40 -year-old female underwent lip augmentation with hyaluronic acid fillers for hydration to enhance volume, refine contours, and soften perioral rhytides. Following medical assessment, fillers were precisely injected into the upper and lower lips, including the vermilion border. Mild post-procedure swelling and erythema resolved within days. At follow-up, the patient was highly satisfied with the natural enhancement and improved facial balance hydration and color, demonstrating the effectiveness of tailored treatment and skilled techniques for achieving harmonious results.
Before treatment
After treatment
Figure 1 : Fillers injected into the upper and lower lips, including the vermilion border
Diagnosis
Diagnosing aesthetic lips involves assessing morphology, symmetry, and appeal to guide personalized treatments that enhance both function and aesthetics. High-resolution clinical photography and facial analysis software aid in evaluating proportions and symmetry. Lip ratios, often compared to the golden ratio and vermilion height are measured to ensure lip fullness, balance and definition, supporting tailored and informed aesthetic interventions. Three-dimensional imaging provides detailed volumetric analysis of lip volume, contour and symmetry for precise treatment planning. The Aesthetic Visual Analog Scale (VAS) captures patient satisfaction with lip aesthetics, guiding personalized interventions. Lip aesthetic scoring systems offer standardized evaluation of lip volume, symmetry and contour,
Refining the Natural Look: Cutting-Edge Lip Filler Solutions
while ultrasonography noninvasively assesses lip tissue structure, aiding in detailed pre-treatment planning.4,5,6,7 8,9
Treatment
Lip augmentation has evolved with hyaluronic acid and PolyL-lactic acid (PLLA) fillers. Hyaluronic acid fillers, derived from bovine or synthetic sources, enhance volume and reduce perioral lines. They require cleansing, topical anesthesia and injections, with effects lasting 3 to 6 months. PLLA fillers stimulate collagen production for gradual fullness and improved contour, suitable for correcting volume loss and smoothing fine lines. Both treatments involve a similar process with consultation, cleansing and topical anesthesia.10,11
As one of the newest advancements in dermal fillers, the hyaluronic acid gel injection provides a highly effective option for enhancing lip volume and achieving a youthful, natural appearance. The filler’s specialized formulation interacts seamlessly with the body’s tissues, improving flexibility and malleability for a more realistic and naturallooking result. Patients typically experience softer, fuller lips with enhanced volume, yielding natural results that feel more pliable and comfortable than other lip fillers. The minimally invasive injection procedure takes approximately 10 minutes or less, with minimal downtime and recovery. In addition to enhancing lip volume, the hyaluronic acid gel injection can help reduce the appearance of perioral rhytids, as well as improve the support and lift
of the lip corners, enhancing a youthful and refreshed appearance. The treatment is customizable to meet individual aesthetic goals and is FDAapproved for lip augmentation, ensuring safety and efficacy when used according to the manufacturer’s guidelines. To enhance patient comfort, the hyaluronic acid gel injection is pre-mixed with lidocaine, a local anaesthetic, which minimizes discomfort during the procedure.12, 13
The hyaluronic acid gel injection, formulated with Optimal Balance Technology (OBT), enhances lip volume and definition by using a crosslinked hyaluronic acid gel with 20 mg/mL concentration, 3 mg/ mL of lidocaine hydrochloride for pain relief, and cross linked with BDDE (1,4 –BUTANEDIOL DIGLYCIDYLETHER)
SUSPENDED IN phosphatebuffered saline at pH 7. The product is available in a 1 mL syringe with two ultra-thinwalled disposable needles (30G / 0.5”) or a blunt-tip, thin-walled cannula (25-27G). This dermal filler is designed to volumize lips, refine shape, and smooth perioral rhytids. Before the injection, patients should inform the healthcare provider of any medications or supplements to avoid complications. The procedure involves cleansing the treatment area, applying a topical anesthetic, and using an ultrafine needle for precise injection. Post-treatment, a cold compress may be used to minimize swelling. This process optimizes safety and effectiveness, ensuring a natural and aesthetically pleasing outcome.12,13
After the treatment, apply ice to the area and avoid touching the area any lumps or imbalance or asymmetry is swelling and swelling will settle down in 48 to 72 hours. After this period, the treated area can be gently cleansed with mild soap and lukewarm water. The effects of the hyaluronic acid gel injection typically last between 6 to 12 months, depending on individual factors such as metabolism, lifestyle, and the treated area. Follow-up treatments are recommended to maintain the preferred aesthetic result and volume of the lips, ensuring the longevity of the outcomes and allowing for regular adjustments tailored to the patient’s needs and goals.12,13
Discussion
Hyaluronic acid (HA) fillers are popular for lip augmentation due to their biocompatibility, minimal allergy risk, and ability to attract moisture, enhancing volume, hydration, and texture. The injectable gel mimics natural lip tissue for subtle, dynamic results and is reversible with hyaluronidase, ensuring safety and flexibility. Advances in formulations and techniques, like microcannulas, reduce bruising, swelling, and complications such as vascular occlusions while optimizing precision and outcomes.2
Precautions for hyaluronic acid injections include avoiding treatment in patients with active skin lesions, infections, or conditions like varicella. Patients with bleeding disorders, keloid scarring, or on immunosuppressive therapy must inform their provider.Post-
treatment, avoid sun exposure, extreme temperatures, strenuous activities, and blood-thinning medications to reduce bruising, swelling, and complications. 3,4,12
Conclusion
Hyaluronic acid gel injections for lip augmentation have significantly advanced aesthetic medicine, offering benefits such as biocompatibility, natural hydration, and the ability to
References
1. Votto SS, Read-Fuller A, Reddy L. Lip Augmentation. Oral Maxillofac Surg Clin North Am. 2021 May; 33(2): 185-195. doi: 10.1016/j. coms. 2021.01.004. Epub 2021 Mar 6. PMID: 33750653.
2. Hilton S, Frank K, Alfertshofer M, Cotofana S. Clinical outcomes after lip injection procedures-Comparison of two hyaluronic acid gel fillers with different product properties. J Cosmet Dermatol. 2023 Jan; 22(1): 119-127. doi: 10.1111/ jocd.15548. Epub 2022 Dec 2. PMID: 36459413.
3. Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg. 2023 Sep; 84:656-669. doi: 10.1016/ j.bjps. 2023.01.048. Epub 2023 Mar 7. PMID: 37002059.
4. George Pallivathukal R, Kumar S, Joy Idiculla J, Kyaw Soe HH, Ke YY, Donald PM, Ismail NM. Evaluating Digital Photography for Lip Print Recording: Compatibility with Traditional Classification Systems. Cureus. 2024 Apr 14; 16(4):e58238. doi: 10.7759/ cureus.58238. PMID: 38745819; PMCID: PMC11091944.
Refining
deliver subtle yet impactful enhancements. These fillers are commonly used to restore volume, refine lip contours, and reduce perioral rhytides, leading to rejuvenated and aesthetically pleasing results. The reversible nature of hyaluronic acid fillers provides practitioners with the flexibility to address patient concerns post-treatment,ensuring high levels of satisfaction and
Solutions
safety. Innovations in injection techniques have enhanced precision and efficacy, reducing risks and fostering optimal results. Overall, hyaluronic acid gel injections not only improve lip aesthetics but also broaden the range of cosmetic treatments available to physicians, enhance patient trust, and contribute to the growth of the aesthetic medicine field.
5. Fischer S, Diehm Y, Dorante MI, Kotsougiani D, Kueckelhaus M, Alhefzi M, Bueno EM, Pomahac B. Software-based video analysis of functional outcomes of face transplantation. Microsurgery. 2019 Jan; 39(1) :53-61. doi: 10.1002/ micr.30360. Epub 2018 Aug 29. PMID: 30159931.
6. Popenko NA, Tripathi PB, Devcic Z, Karimi K, Osann K, Wong BJF. A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness. JAMA Facial Plast Surg. 2017 Jul 1; 19(4):261-267. doi: 10.1001/jamafacial. 2016.2049. PMID: 28208179; PMCID: PMC5543334.
7. Perkins RA, Staley RN. Change in lip vermilion height during orthodontic treatment. Am J Orthod Dentofacial Orthop. 1993 Feb; 103(2):147-54. doi: 10.1016/ S0889-5406(05)81764-0. PMID: 8427219.
8. Au J, Mei L, Bennani F, Kang A, Farella M. Three-dimensional analysis of lip changes in response to simulated maxillary incisor advancement. Angle Orthod. 2020; 90(1):118124. doi: 10.2319/022219- 134.1.
9. Yang JW, Jia PY, Qiu LX, Lu C, Jiang T. [Feasibility analysis of visual analogue scale in esthetic evaluation of anterior implant-supported
single crown in maxilla]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Apr 9; 56(4):324-328. Chinese. doi: 10.3760/ cma.j.cn112144- 2020070900405. PMID: 33832032.
10. Rostan E. Collagen fillers. Facial Plast Surg Clin North Am. 2007 Feb; 15(1):55-61, VI. doi: 10.1016/ j.fsc.2006.11.001. PMID: 17317556.
12. Enright KM, Weiner SF, Durairaj KK, Gilardino MS, Nikolis A. Evaluation of the Hydrophilic, Cohesive, and Physical Properties of Eight Hyaluronic Acid Fillers: Clinical Implications of Gel Differentiation [published correction appears in Clin Cosmet Investig Dermatol. 2024 Jan 23;17:173-174. doi: 10.2147/ CCID.S460832]. Clin Cosmet Investig Dermatol. 2024; 17:89-101. Published 2024 Jan 12. doi:10.2147/ CCID.S446429.
13. Park KE, Mehta P, Kherani F, et al. Response of 21 Hyaluronic Acid Fillers to Recombinant Human Hyaluronidase. Plast Reconstr Surg Glob Open. 2023; 11(12):e5457. Published 2023 Dec 22. doi:10.1097/ GOX.0000000000005457.
Cacao Powder Shows Potential for Skin Rejuvenation in Aging Individuals
A recent clinical trial and in vitro study investigated the effects of cacao powder on skin rejuvenation, specifically its impact on moisturization and wrinkle reduction. Cacao beans, known for their high content of polyphenols and flavonoids, provide antioxidant and cardiovascular benefits. In this randomized, double-blind, placebocontrolled trial, participants with dry skin and periorbital wrinkles were administered either cacao powder or a placebo daily. The cacao group demonstrated significant
improvements in skin hydration and wrinkle reduction compared to the placebo group. Additionally, increased expression of collagen type I and enhanced antioxidant enzyme activity were observed. No adverse effects were reported during the study. These findings suggest that cacao powder may serve as a potential anti-photoaging agent, with further research needed to assess its long-term efficacy and the effects of other cacao-based formulations.
A New AI Model Can Exhibit High Diagnostic Accuracy in
A newly developed machine learning model shows promise in improving the assessment and diagnosis of onychomycosis and nail yellowing, areas traditionally lacking automated diagnostic approaches. Onychomycosis, a prevalent global condition, is typically diagnosed using methods such as direct microscopy, fungal culture, histopathology, and PCR testing. This AI model was trained on images from multiple European clinical trial sites evaluating a topical treatment for onychomycosis. Utilizing a deep learning architecture with contraction-expansion networks and residual connections, the model accurately detects infected nail areas. It demonstrated high accuracy in diagnosing toenail infections and distinguishing between healthy and infected regions, as well as tracking nail growth to estimate infection progression. Although the model's limitations include a focus on big toenails and participant diversity, it offers significant potential as a decision support tool for monitoring treatment response, particularly in areas with limited access to dermatologists. This advancement may enhance the management and treatment of onychomycosis, offering a novel approach for clinicians.
MUMBAI 2025
Treats Acne
Tea Tree Oil Aloe Vera D-
Clear Complexion Cleansing & Whitening Foamy Face Wash
To improve skin tone and fabulous glow
Modifies skin tone and restore complexion
Works on multiple level of melonogenesis
Kojic Acid
Glycolic Acid
Salicylic Acid
Nicotinamide
Liquorice
Lactic Acid
Vitamin C
Bianca Contractor is a Model, Beauty Content creator, and advocate for self-love and body positivity, sharing her skincare and haircare routine with guidance from her Dermatologist.
In this exclusive interview, Bianca Contractor shares her personalized skincare and haircare routines, focusing on dryness and the importance of tailored care. She highlights the link between mental health and well-being, emphasizing how self-care supports both. Despite her busy lifestyle, Bianca stays committed to maintaining healthy skin, hair, and mind with expert guidance from her Dermatologist.
1. How do you prioritize skin and hair care in your daily routine?
As a minimalist by nature, I have always preferred simplicity in my personal routine. But as a beauty creator, my job requires me to test and try dozens of products daily. While some of these products work wonders, others can really take a toll on my skin over time. To balance this, I keep my skincare routine as fuss-free and clean as possible. The one step I never skip is removing my makeup thoroughly at the end of the day, followed by deep moisturization to rehydrate my skin. For hair, I make it a point to give myself an oil massage whenever I can and ensure my scalp stays clean, especially since I use a lot of products in my hair regularly.
2. When you are experiencing changes in your skin or hair like breakouts, dullness, or dryness, how do you adjust
your approach to address those concerns?
I am fortunate to have clear skin, likely thanks to my genes, and I make sure to care for it. I avoid unnecessary stress and skip makeup when I am off-duty. I adjust my routine seasonally, using a heavier moisturizer in winter and a lighter gel-based one in summer. SPF is always a must for me!
3. When you experience skin or hair concerns like acne, dryness, or irritation, how do you adjust your routine under the guidance of your Dermatologist?
I trust my Dermatologist completely and value his simple, natural approach. Together, we have found that my skin responds best to natural ingredients, with minor adjustments as needed. I have also learned that my diet plays a huge role in my skin and hair health, and when my eating habits slip, it shows. My Dermatologist helped me realize
how much lifestyle impacts my skin’s well-being.
4. How do you simplify your skin and hair care routine when you are traveling or on busy workdays, and have you ever received Dermatologist advice on how to maintain it during these times?
My skincare and haircare routine is purposefully simple, making it easy to maintain even during busy days or while travelling. Regardless of how hectic my schedule may be, I always prioritize cleansing and moisturizing. Consistency is crucial for me, and I am fortunate to follow a straightforward regimen recommended by my Dermatologist that aligns with my needs. This simplicity allows me to stay committed to my routine, even during demanding periods.
5. What role do you believe lifestyle factors, such as
diet and hydration, play in maintaining healthy skin and hair?
Lifestyle is actually the biggest factor when it comes to skin and hair health. A balanced diet, good sleep, and staying hydrated will make a noticeable difference, I promise. For me personally, cutting back on sugar and dairy has had a significant impact on my skin. I have not eliminated them completely because I love my desserts, but on days when I indulge, I try to balance it out by being more mindful with my choices throughout the rest of the week.
6. Are there any holistic practices, like face massages or scalp treatments, that you incorporate into your skincare or haircare routine?
Yes, I incorporate several holistic practices into my skincare and haircare routine. Face massages have made a significant difference for me by providing an instant boost of blood flow to my face. While I occasionally use a gua sha or face roller, I mostly prefer using my hands, as I find it easier to target the contours of my face, drain my sinuses, and reduce puffiness. For my hair, I focus on keeping my scalp hydrated to prevent dryness and flakes, as hydration is key to maintaining balance and health.
7. What are some of the biggest mistakes people make when it comes to skin and hair care that you have learned to avoid?
In my opinion, one of the biggest mistakes people make in skincare and haircare is blindly following someone else's routine. Since everyone’s needs are unique,
a personalized approach is key. Another common mistake is overloading with products. Even great ingredients can cause negative interactions when layered too much. It's important to do your research, consult with a Dermatologist, and remember that sometimes, less is more.
8. How do you feel about the connection between mental health and the appearance of your skin and hair? Do you have practices that help with both?
I believe mental health directly impacts the appearance of skin and hair. From personal experience with anxiety and depression, I have learned that a healthy mind leads to a healthy body. A few things that would help with both would be exercise, a balanced diet (because gut health plays a major role in mental health, and I also feel meditating had a big impact for me.
9. Do you change your skin and hair care routine with the seasons, and has your Dermatologist provided any seasonal skincare recommendations to help you adjust?
I make a few small adjustments to my skincare routine with the changing seasons, such as switching to a richer moisturizer, a different serum, or a more hydrating lip conditioner. My Dermatologist has recommended these seasonal changes to help with hydration and protection. However, my overall routine remains consistent, and my hair care stays the same year-round, which continues to work well for me.
10. If someone is looking to develop a personalized skin and hair care routine, especially with the advice of a Dermatologist, what guidance would you give them to get started effectively?
If you are looking to develop a personalized skin and hair care routine with the guidance of a Dermatologist, I recommend starting by consulting a few Dermatologists to find one who truly understands your needs and goals. They can help tailor a routine based on your unique skin and hair concerns. Embrace the process of trial and error, and be patient as you adjust your routine. Consistency is key, and with time, you will discover what works best for you and see amazing results!
MUMBAI- 8th December'2024
Hands-on Workshop on Hair Restoration
Establishing the Standard for Advanced Hair Restoration!
AESTHETICCON Mumbai, December 8th’2024, the One-Day Hands-on Workshop on Hair Restoration” offered participants a DASIL certification. This workshop covered both basic and advanced topics, including GFC, Peptides, and Exosomes in hair Restoration. Attending Dermatologists gained practical experience through the Hands on sessions, informative presentations and LIVE DEMONSTRATIONS, which enhanced their clinical understanding. The event also featured an interactive Q&A session, providing a platform to discuss key developments in the field of hair restoration and offering valuable insights for further expertise.
The The event featured esteemed Dermatologists viz Dr. Pallavi Rathi sharing her expertise in GFC the treatment, Dr.Geetanjali Shetty in Peptides and Dr. Madhuri Agarwal in Exosomes which are the latest Hair Restoration innovations.
Each of faculties through Live demonstration showcased their expertise as their patiently guided the participants during the Hands On session.
The event concluded with the distribution of DASIL Certificate of Attendance to the participants.
Lecture on GFC by Dr. Pallavi Rathi, Faculty.
Lecture on Peptides by Dr. Geetanjali Shetty, Faculty.
Lecture on Exosomes by Dr. Madhuri Agarwal, Faculty.
Hands on session by Dr.Madhuri Agarwal
Hands on session by Dr. Pallavi Rathi
Hands on session by Dr. Geetanjali Shetty
Overview of Participant Responses and Impact from the AESTHETICCON Workshop
Overall Rating:
The event received exceptional feedback, with 57% of participants rating it as "Excellent" and 43% as "Very Good," reflecting high levels of satisfaction. The hands-on Hair Restoration workshop effectively combined theoretical instruction with practical application, exceeding attendee expectations and enhancing clinical proficiency.
Satisfaction with Workshop Expectations:
The workshop met participants' expectations with high satisfaction in content, structure, and delivery. Hands-on experience and expert discussions boosted confidence and aligned with current Aesthetic Dermatology standards.
Impact of Practical Learning on Hair Restoration Procedures:
Participants gained the skills and confidence to incorporate advanced Hair Restoration techniques like GFC, Peptides, and Exosomes into their clinical practice, with live demonstrations and expert guidance, enhancing patient outcomes in hair restoration.
Recommendation to Colleagues: The Positive Ripple Effect:
Participants expressed a strong intention to recommend the AESTHETICCON workshop to their colleagues, appreciating the valuable knowledge, excellent arrangements, and facilities. The positive feedback is expected to enhance its reputation as a leading educational resource in Aesthetic Dermatology.
Feedback
Dr. Radhika Gupta (Vapi): The Hair Restoration workshop was excellent, with relevant content and hands-on sessions that deepened my understanding of the latest techniques. Overall, it was an insightful and valuable learning experience.
Dr. Kajal Murade (Mumbai): The Hair Restoration workshop was "Very Good." The content on regenerative therapy, was highly relevant to my practice. The sessions were excellently delivered and provided valuable insights for my approach to hair restoration.
Dr. Monica Chouhan (Bhopal): The Hair Restoration workshop was insightful and wellorganized, with excellent content and a friendly, engaging environment. The valuable insights gained will benefit my practice. It was a truly enriching experience.
Dr.Vivek Singh (Noida): I found the workshop to be "Very Good." The interactive sessions were particularly valuable, providing an engaging learning experience. Overall, it was highly informative and beneficial.
Dr. Farida Kapadia (Mumbai): The workshop was excellent, providing a deep dive into advanced hair restoration techniques. The content was highly applicable, and the way it was delivered ensured that I gained practical insights that will benefit my work in this field.
Dr.P Pon Saranya (Chennai): The workshop was excellent. The content was highly relevant, and I appreciated the excellent choice of faculties and the well-organized arrangements. Overall, it was a great learning experience.
Stay connected: The journey towards Excellence in Aesthetic Dermatology Education continues! Keep an eye out for the upcoming AESTHETICCON Mumbai 2025 event, where innovation and expertise come together!
@AESTHETICCON @Excellence in Dermatology @Aesthetic Innovation.
Dermoscopy Can Effectively Predict the Outcome of Cryotherapy Treatment.
A novel study investigated dermoscopy as a predictive tool for cryotherapy outcomes in the treatment of cutaneous warts. While dermoscopy is commonly used for diagnosing warts, especially to assess papillary capillaries, its role in predicting treatment response has not been explored. Patients underwent cryotherapy over four months, with warts analysed for features such as vascularity, surface scales, papillary structures, background colour, and margin characteristics. Treatment responses were classified as complete, partial, or no response. Warts with marked surface scales, well-defined margins, and dots were more likely to achieve a complete response. Haemorrhage, crusting, and skin crease breakage did not impact treatment efficacy. Significant differences were observed between common and plantar warts, with vascularity, dots, and surface scales more frequent in common warts, and a red or pink background in plantar warts. Despite the study's retrospective design and small sample sizes, the results suggest dermoscopy could be a valuable tool in predicting treatment outcomes, enabling a more personalized approach to wart management.
Regenerative Medicine Demonstrates Effectiveness in Vitiligo
Treatment: Cell Therapy and Platelet-Rich Plasma Show Positive Repigmentation Outcomes
A recent systematic review evaluated the efficacy and safety of regenerative medicine for vitiligo, highlighting cell therapy and platelet-rich plasma (PRP) as the most effective treatments. Other methods, including platelet-poor plasma, melanocyte and keratinocyte transplantation, and melanocytekeratinocyte suspension in PRP, also showed significant repigmentation. Autologous melanocyte-keratinocyte transplantation led to substantial repigmentation, especially when combined with narrowband UVB (NB-UVB). PRP injections and their combination with CO2 laser or microneedling also improved outcomes. Hair follicle-based cell transplantation demonstrated good results when combined with other therapies. Adverse effects were generally mild, with no serious complications. The review suggests that while regenerative therapies are promising, further research is needed to explore additional methods, long-term outcomes, and their impact on quality of life.
The Evolution of Cosmetic Dermatology in the Digital Era
Cosmetic dermatology is increasingly influenced by technological advancements and the digital landscape, with tools like artificial intelligence (AI), augmented reality, and high-resolution imaging transforming patient care. While these innovations empower patients by offering realistic visual expectations, they present challenges in fully capturing the complexity of human skin and treatment responses. The rise of social media, although making cosmetic dermatology more accessible, has introduced risks, with influencers promoting unqualified advice and potentially harmful products. Telemedicine has expanded access to care, but some conditions and procedures still require in-person consultations to ensure safety and accuracy. As digital beauty standards shape patient expectations, dermatologists play a crucial role in educating patients on the risks of self-administered treatments, emphasizing the importance of licensed professionals and advocating for regulatory oversight to ensure patient safety. Furthermore, the influence of digital platforms on mental health and self-esteem underscores the need for ongoing research to better navigate the intersection of technology, ethics, and beauty in the digital age.
An electrical stimulation device may help prevent facial muscle atrophy associated with repeated botulinum toxin treatments.
A recent study assessed the use of a device combining monopolar radiofrequency and high-intensity facial electrical stimulation to mitigate facial muscle atrophy associated with repeated botulinum toxin (BT) injections. While BT is effective for wrinkle reduction, its prolonged use can lead to muscle weakening and atrophy, especially in elevator muscles, resulting in a sunken appearance in areas such as the cheeks and temples. Participants who had received recent BT treatment underwent multiple sessions of combined radiofrequency and electrical stimulation. Follow-up evaluations showed significant improvements in wrinkle severity, cheek volume, and facial expression dynamics, particularly during smiling, with no
adverse events. These results indicate that this combined approach is a safe and effective adjunct to BT therapy, enhancing aesthetic outcomes while preserving facial muscle function.
Nail Surgery and Lasers in Nail Disorders Part-III
Dr. S. Manjula Nagarajan D.D., M.D., (Dermatology) Consultant Dermatologist, Erode
4. Nail plate avulsion
Nail plate avulsion is performed to expose the nail bed and matrix for diagnostic and therapeutic purposes. Diagnostically, it allows exploration of the nail bed and matrix, facilitating biopsies when needed. Therapeutically, it precedes chemical or surgical matricectomy and is used in conditions like ingrown nails, onychogryphosis, chronic onychomycosis, traumatic nail injuries, chronic paronychia, retronychia, pincer nails, and nail apparatus tumors. Nail plate avulsion can be partial or total based on severity of nail condition.8
• Partial nail plate avulsion:
- Partial nail plate avulsion involves selectively removing or lifting a portion of the nail plate to expose underlying structures, which helps in minimizing postoperative discomfort and complications when compared to total nail removal. Sub-types of partial
nail avulsion include distal avulsion which is used to access the distal nail bed, primarily for procedures like foreign body removal. Proximal avulsions expose the nail matrix, facilitating surgical access and potential replacement of the nail plate. Longitudinal avulsions target the lateral or central aspects of the nail bed, while window nail plate avulsion creates a circular opening for localized treatments. The trap door technique extensively exposes the nail bed or matrix, making it particularly suitable for performing biopsies or addressing specific nail conditions. These techniques are tailored to the clinical needs, aiming to optimize therapeutic outcomes while preserving as much of the nail structure as possible.8
• Total nail avulsion: - Total nail avulsion is a surgical procedure that completely removes the entire nail plate due to severe nail pathology
resistant to conservative treatments or requiring thorough examination. Techniques include chemical matricectomy, using agents like phenol or sodium hydroxide post-nail removal to prevent nail regrowth in conditions such as ingrown nails or chronic infections. Surgical matricectomy involves precise excision of the nail matrix when chemical methods are unsuitable, ensuring complete removal while protecting surrounding tissues. Permanent nail removal irreversibly excises the entire nail apparatus, including matrix, nail bed, and surrounding tissues, appropriate for cases of recurrent infections or severe trauma where preventing nail regrowth is necessary.8
• Nail bed management:Following nail plate avulsion, proper management of the nail bed is crucial for optimal healing and prevention of complications. This includes thorough cleaning and disinfection of the exposed nail bed to reduce the risk of infection. Depending on the underlying condition, additional treatments such as antibiotic ointments, antifungal medications, or corticosteroid injections may be prescribed to promote healing and prevent recurrence.8
5. Germinal matricectomy combined with surgery, electrocautery, chemical
phenolisation
Germinal matricectomy performed surgically is a specialized procedure aimed at addressing persistent nail conditions by selectively removing the actively growing part of the nail matrix responsible for nail production. This surgical intervention is typically indicated for challenging cases such as chronic ingrown nails, severe nail deformities, or recurring infections originating from the nail matrix itself. The procedure begins with meticulous preparation and local anaesthesia to ensure patient comfort. After gently lifting or removing the nail plate, the surgeon precisely excises the germinal matrix tissue using surgical instruments, aiming to completely remove the portion responsible for the problematic nail growth while preserving surrounding healthy tissue. Hemostasis techniques are employed to control bleeding, followed by wound closure either with sutures or allowing healing by secondary intention.8
Electrocautery is a crucial tool in nail surgery, where it serves multiple purposes such as tissue cutting, hemostasis, and coagulation. This technique involves applying a high-frequency electrical current through a specialized electrode tip to precisely cut tissue and
simultaneously seal blood vessels, thereby controlling bleeding effectively. In nail surgeries, electrocautery is employed for procedures like matricectomies, where it helps in excising the nail matrix or treating conditions such as ingrown nails and chronic infections. The device's ability to provide swift hemostasis reduces operative time and enhances surgical precision. However, proper training and technique are essential to avoid thermal injury to surrounding tissues. Modern electrocautery units offer adjustable settings to customize the electrical output, ensuring optimal outcomes tailored to the specific needs of nail surgery procedures.8
Chemical phenolisation represents a significant advancement in the treatment of ingrown toenails, providing an effective solution for patients who suffer from chronic discomfort or recurrent issues. By targeting the nail matrix with phenol, this procedure disrupts the growth of the ingrown portion, thereby reducing the likelihood of future nail abnormalities. Its minimally invasive nature allows for quicker recovery times compared to traditional surgical methods, often enabling outpatient treatment in a clinic setting. However, careful application and neutralization of phenol are
critical to avoid potential side effects such as irritation or burns.8
6. Cryosurgery
Cryosurgery represents a specialized technique in nail surgery that utilizes low temperatures to precisely target and eradicate diseased nail tissues. This approach is particularly advantageous in managing various nail pathologies by effectively addressing key clinical features: pain, secondary infection, excessive granulation tissue, and prominent nail plate folds. A significant benefit of cryosurgery is its capacity to induce reversible alterations in peripheral nerves, thereby providing effective pain control during treatment procedures. The application of liquid nitrogen in cryosurgery also exhibits potent bactericidal effects, crucial for reducing the incidence of secondary infections that could impede post-operative recovery. Additionally, cryogenic temperatures aid in the elimination of surplus granulation tissue, commonly encountered in chronic inflammatory conditions such as pyogenic granuloma. This comprehensive therapeutic strategy not only alleviates symptoms but also targets underlying tissue abnormalities, fostering optimal healing outcomes and sustainable resolution of
nail infections. Cryosurgery thus emerges as an invaluable therapeutic modality in nail surgery, offering patients significant pain relief, mitigated infection risks, and restoration of normal nail structure and function.9
7. Electro-surgery
Electrosurgery of the nail stands out as a versatile and highly effective technique in modern nail surgery, adeptly addressing a wide range of conditions with precision and efficiency. By utilizing specialized electrosurgical instruments that deliver highfrequency electrical currents, surgeons can perform precise tissue management. This includes the exact removal of tissue in cases such as ingrown nails or nail tumors through electrosurgical cutting, while coagulation capabilities effectively control bleeding, particularly crucial in procedures involving the delicate structures of the nail bed. Additionally, electrosurgery allows for the removal of excess tissue and reshaping of nails, effectively managing abnormalities like hypertrophic tissue or deformities. Beyond its technical capabilities, electrosurgery supports comprehensive postprocedure care strategies focused on meticulous wound management to prevent infection and tailored pain management to ensure patient
comfort. Regular monitoring for potential complications such as infection or delayed healing further ensures optimal recovery. The adaptability of electrosurgical techniques not only minimizes damage to healthy tissue but also enhances surgical efficiency, ultimately promoting faster healing and restoration of normal nail function. Overall, electrosurgery stands as a cornerstone in modern nail surgery, providing patients with effective treatment options and favorable longterm outcomes.10
TRANSUNGUAL DRUG DELIVERY
•
Iontophoresis:
Iontophoresis involves the application of a low-level electrical current to facilitate the penetration of charged molecules, such as drugs, through the nail plate. This technique exploits the principles of electro-migration (movement of charged particles in an electric field) and electro-osmosis (movement of solvent molecules), effectively enhancing drug penetration into the nail. By applying an electrical gradient, iontophoresis can drive medications deeper into the nail bed, overcoming the barrier posed by the dense keratin structure of the nail plate. It is particularly useful for delivering drugs that have difficulty permeating the nail on their own.11
• Ultrasound-Assisted ...
Drug Delivery: Ultrasoundassisted drug delivery utilizes low-frequency sound waves to enhance the permeability of the nail plate. The ultrasound waves create micro-channels or temporary disruptions in the nail structure, facilitating the diffusion of drugs into the underlying nail bed. This method improves the absorption and distribution of medications, thereby enhancing their therapeutic efficacy. Ultrasound not only increases the penetration of drugs but also improves the circulation within the nail bed, aiding in the delivery of nutrients and removal of metabolic wastes, which can further support healing.11
• Nanoparticles and Transferosomes: .......
Nanoparticles and transferosomes are advanced carrier systems that encapsulate drug molecules, facilitating their targeted delivery into the nail unit. These nano-sized carriers can penetrate the nail barrier more effectively than free drug molecules due to their small size and specialized composition. Nanoparticles can be designed to release drugs gradually over time, prolonging their therapeutic effect. Transferosomes, on the other hand, are lipidbased vesicles that can deform and pass through the tight junctions of the
nail layers, enhancing drug absorption. These carrier systems ensure efficient drug delivery and improve therapeutic outcomes by maximizing drug availability at the target site.11
• Nail Lacquers: Nail lacquers are topical formulations specifically designed to penetrate the nail plate and reach the underlying nail bed. These formulations often contain therapeutic agents along with permeation enhancers or nail penetration enhancers to improve drug absorption. The lacquer forms a protective film over the nail surface, prolonging contact time and allowing for sustained drug release into the nail unit. Nail lacquers are commonly used for treating fungal infections of the nails (onychomycosis) and other localized nail disorders, providing localized therapy without systemic side effects.12
• Emulsions and Gels: Emulsions and gels are topical formulations that enhance drug delivery into the nail unit by improving the solubility and permeability of drugs. These formulations provide a suitable vehicle for delivering medications to the nail bed and surrounding tissues. Emulsions consist of dispersed oil droplets in an aqueous phase, whereas gels are semi-solid systems that provide a stable matrix
for drug incorporation. Both formulations can contain penetration enhancers or chemical agents that temporarily disrupt the nail structure, facilitating deeper drug penetration. Emulsions and gels are versatile delivery systems used for various nail conditions, including inflammatory disorders and localized infections.11
• Printing Techniques: Printing techniques, such as 3D printing, offer a novel approach to fabricate customized drug delivery systems tailored to the specific shape and size of the nail. This technology allows for precise deposition of medications onto the nail surface, optimizing drug delivery and therapeutic efficacy. 3D printing can create layered structures that release drugs in a controlled manner, ensuring sustained release over time. Customized drug delivery systems can be designed to target specific areas of the nail affected by diseases or injuries, enhancing treatment outcomes and patient compliance.13
• Micro-Drilling: Microdrilling involves creating tiny pores or channels in the nail plate using microneedles or laser technology. These micro-channels enable enhanced penetration of drugs into the nail bed by temporarily disrupting the dense keratin structure.
Nail Surgery and Lasers in Nail Disorders Part-III
Micro-drilling techniques allow for controlled delivery of medications directly to the target site, overcoming the natural barrier posed by the nail plate. This method is particularly beneficial for delivering high molecular weight drugs or those with poor nail permeability, improving therapeutic efficacy and patient outcomes.14
• Chemical Methods: Chemical methods utilize enhancers or softening agents to disrupt the structure of the nail plate temporarily, making it more permeable to drug penetration. These methods include the use of solvents, surfactants, or keratolytic agents that dissolve or soften the keratin matrix, allowing drugs to penetrate more effectively. Chemical enhancers can modify the physicochemical properties of the nail surface, enhancing drug absorption and distribution into the nail bed. This approach is often combined with other delivery techniques to optimize drug delivery and therapeutic outcomes for various nail disorders.8
Figure 13: Transungual drug delivery
Indications
and
Considerations
for Nail Surgery
Nail surgery is crucial for managing various conditions with absolute indications, such as solitary pigmented streaks that may indicate malignancy, and a spectrum of tumors including glomus tumors, onychomtricoma, keratoacanthoma, fibroma, subungual exostosis, hemangioma, chondroma, pyogenic granuloma, and malignant tumors like subungual melanoma and squamous cell carcinoma. Additionally, surgical intervention is necessary for addressing tumor mimickers such as mucoid cysts and epidermoid cysts, as well as severe
cases of ingrown nails (Stage 3), panaritium, traumatic injuries to the nail organ, and chronic retronychia. Relative indications for nail surgery encompass conditions like onychogryposis, nail mycoses, discolorations due to chromogenic bacteria, subungual warts, large subungual hematomas, longitudinal split nails, and recalcitrant chronic paronychias, where surgical options may be considered based on individual patient factors and clinical severity.8
Contraindications
Contraindications include malformed nails due to matrix diseases and large scarring of the nail bed, which may complicate surgical outcomes and necessitate alternative management strategies. Careful evaluation and consideration of these factors are essential to ensure effective treatment and optimal outcomes in dermatological nail surgery.8
NAIL LASERS
Nail lasers are a novel dermatological treatment based on selective photothermolysis. They use specific wavelengths of light to target tissues like blood vessels and pigmented lesions while sparing healthy skin. This precision allows for effective treatment of conditions such as warts, tumors, scars, and vascular lesions with minimal risk of
side effects.15
Pulsed dye lasers are utilized for treating vascular lesions including hemangiomas, telangiectasias, arteriovenous malformations, and lymphangiomas. By emitting pulses of light that target hemoglobin in blood vessels, pulsed dye lasers effectively reduce or eliminate these vascular lesions, improving both cosmetic appearance and functional outcomes for patients.16
UV-C lasers emit light between 222 nm to 254 nm, effectively treating onychomycosis by penetrating the nail plate to target fungal organisms while sparing healthy tissue. Lunula cold lasers utilize low-level laser therapy for onychomycosis, targeting fungal infections in the nail bed without causing damage. Fractional CO2 lasers play a crucial role in treating onychomycosis and trachyonychia (rough nails), delivering precise laser energy to improve nail texture and appearance. These advancements highlight the versatility and efficacy of laser technology in enhancing dermatological care for various nail conditions.15
Long pulsed Nd:YAG laser are instrumental in addressing nevus, pigmentation issues, onychomycosis (fungal nail infections), and chronic paronychia (nail
inflammation). These lasers deliver targeted pulses of light (typically around 1064 nm) that penetrate deeply into the skin, selectively targeting pigmented lesions or fungal infections by generating heat that disrupts the fungal cells' metabolism and structure while preserving surrounding tissues. One of the key advantages of using the Nd laser for onychomycosis treatment is its non-invasive nature.15
Excimer Laser
Vitiligo arises from the destruction of melanocytes, cells essential for melanin production that determines skin color. Excimer lasers are particularly effective in treating conditions like psoriasis and vitiligo by emitting UV light at a wavelength of 308 nm. This specific wavelength is absorbed by the DNA within melanocytes, stimulating these cells to initiate melanin production once more through a process called melanogenesis. By encouraging repigmentation, excimer lasers help restore color to depigmented patches of skin, thereby alleviating symptoms associated with vitiligo.17
Ablative CO2 Laser
Ablative CO2 lasers have emerged as a valuable tool in dermatology for various conditions, including those affecting the nails. It is particularly effective in treating
a spectrum of conditions such as periungual and subungual warts, pyogenic granulomas, glomus tumors, hypertrophic scars, angio keratomas, fibrokeratomas, and calluses. When used in partial nail removal procedures, such as for ingrown nails or severe nail disorders, CO2 lasers offer distinct advantages over traditional surgical methods. The CO2 laser operates by emitting high-energy light that heats and vaporizes tissue layers, allowing precise removal or reshaping of affected nail areas. This process is effective for conditions requiring targeted tissue destruction, such as severe nail infections or persistent growths. One of the primary benefits of using a CO2 laser for partial nail removal is its precision. The laser can target and remove specific areas of the nail or nail bed without damaging surrounding healthy tissues.18
Low-Level Cold Laser Therapy (LLLT)
Low-level cold laser therapy (LLLT) employs specific wavelengths of light at low intensities. This approach targets fungal infections in the nails by disrupting genetic material within fungal cells, impairing their ability to grow and survive. LLLT for nail conditions is recognized for its non-destructive nature, promoting therapeutic benefits without causing
significant tissue damage or discomfort to patients. Cost considerations are notable in the use of both ablative and LLLT approaches. This methods is considered safe and non-carcinogenic, advancing dermatological treatment for nail disorders effectively.15
Take home points
The nails provide valuable clues to underlying systemic diseases, serving as a diagnostic window in dermatological assessments. Onychoscopy has emerged as a standard investigative tool, enabling detailed examination of nail morphology and pathology to aid in diagnosing various nail disorders and systemic conditions. Concurrently, nailfold capillaroscopy plays a crucial role in predicting the prognosis of connective tissue disorders by assessing microvascular changes in the nail bed. In dermatological surgery, nail surgery and laser treatments have become integral techniques, offering precise interventions that are efficient and less invasive than traditional approaches. These advanced procedures complement conventional treatments effectively, allowing dermatologists to provide comprehensive care for a wide range of nail conditions. As these technologies continue to evolve, they enhance diagnostic accuracy,
therapeutic outcomes, and patient satisfaction in dermatological practice, highlighting their essential role in modern dermatology.5, 15
Discussion
Nail disorders can manifest at any age. About half of all nail disorders are infectious in origin, 15% result from inflammatory or metabolic conditions, and 5% stem from malignancies and pigment disturbances.1 The nail plate is a hardened structure primarily composed of cornified keratin, organized into dorsal, intermediate, and ventral layers with a width ratio of approximately 3:5:2. The dorsal layer consists of densely packed keratin cells, forming a smooth surface. In contrast, the intermediate layer, accounting for 75% of the plate's thickness, has a fibrous structure perpendicular to nail growth, held together by cysteinerich proteins with disulphide bonds.2 The ventral layer is thin and attaches the nail plate to the underlying nail bed. Individuals' nail growth rates vary significantly, with fingernails averaging 3 mm per month and toenails 1 mm per month. A normal fingernail takes approximately 6 months to fully grow out, while a toenail requires about 10-12 months.1, 2
Nails serve as a crucial indicator of systemic health conditions, providing valuable
insights into overall bodily function. Variations in nail shape, size, and color often mirror underlying systemic disturbances that impact their natural growth patterns. Minor discolorations such as white spots, pinkish hues, or alterations in texture can potentially signal hidden illnesses, such as those affecting the liver, lungs, or cardiovascular system.2 Exploring these nuances can reveal significant clues about one's health status. Nail health reflects diverse physiological functions and manifests a spectrum of disorders. The nail matrix, positioned between the distal interphalangeal joint and adjacent nail fold, initiates essential growth processes, forming the lunula and containing melanocytes. Surrounding soft tissues like nail folds protect the nail plate edges, especially the anterior fold guarding against trauma and UV exposure. Conditions like leukonychia (white spots), Beau lines (indentations), and koilonychia (spoon-shaped nails) often indicate systemic issues or nutritional deficiencies Structural abnormalities such as ridges, black lines (splinter hemorrhages), and periungual warts pose challenges, while issues like peeling nails, dystrophic nails, and eggshell nails highlight environmental, genetic, or health-related factors affecting nail health.
Disorders such as hangnails, melanonychia (pigmentation), onychophagy (nail biting), and onychorrhexis (brittle nails) underscore the diverse manifestations of nail health issues. Inflammatory conditions like nail pterygium, plicatured nails (ingrown nails), and splinter hemorrhages can result from trauma or underlying health conditions. Infections like paronychia (bacterial infection) and onychomycosis (fungal infection) underscore the susceptibility of nails to microbial agents. 2, 3, 4
Treatment options for nail disorders encompass various approaches, from drug therapies to supportive treatments.5 For instance, the diseased nail can be surgically removed, and oral medications like terbinafine, itraconazole, or fluconazole may be prescribed. However, onychomycosis infections embedded within the nail can pose challenges for topical treatments, rendering them ineffective. Oral terbinafine has demonstrated efficacy with fewer side effects compared to other oral agents, proving beneficial even for highrisk patients such as those with type 2 diabetes or HIV infection. Itraconazole may be more suitable for non-dermatophytic mold onychomycosis, while fluconazole is effective against yeast infections. However,
the beneficial effects of oral therapies may take 12 to 18 months to become evident, and long-term recurrence rates of onychomycosis vary between 20% and 50%.5
For conditions like nail psoriasis, comprehensive treatment involves assessing the severity of the nail and skin involvement, along with any joint complications. Behavioral strategies that minimize triggers like footwear choices, nail care practices, and strenuous manual tasks are crucial. Topical or intralesional corticosteroids and vitamin D3 analogs are commonly recommended. Research suggests that using 0.05% clobetasol propionate in gel or cream form around the periungual region can modestly impact patient symptoms due to its low absorption rates. Hydroxypropyl-chitosan nail lacquer has shown promise in clinical studies, resulting in significant reductions in nail pitting and onycholysis.3, 5
Additionally, nutritional considerations play a vital role in supporting nail health. Avoiding potential food allergens, consuming a balanced diet rich in omega-3 fatty acids, probiotics, and L-glutamine, and staying hydrated with purified water are essential. Herbs like tea tree oil, green tea extracts, and reishi mushroom can also aid in nurturing
the body. Homeopathic remedies tailored to individual constitution, such as pot marigold and sulphur, are recommended by skilled practitioners. Furthermore, complementary therapies like acupuncture, which supports immune function and digestive health, along with massage to enhance blood circulation to the nails, and hydrotherapy involving alternating hot and cold foot baths, can contribute to comprehensive treatment plans for nail disorders.3, 5
Conclusion
Advanced therapeutic strategies for nail disorders, including surgical interventions and laser technologies, represent promising avenues in modern dermatology. Surgical approaches such as nail avulsion or excision are effective for conditions like severe onychomycosis or ingrown nails, offering long-term relief and cosmetic improvement. Laser technologies, including fractional laser therapy or laser treatment for onychomycosis, show significant potential in targeting fungal infections and promoting nail health without systemic side effects. These advancements underscore a shift towards minimally invasive treatments that enhance patient outcomes, reduce recovery times, and address challenging nail conditions comprehensively. As research and technology
Nail
continue to evolve, integrating these innovative approaches into clinical practice holds considerable promise for improving the management and quality of life for individuals affected by diverse nail disorders.
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