Clinical Research

Gi-Woong Hong, MD, PhD,* Isaac Kai Jie Wong, MBBS,†Jong Keun Song, MD,‡ Jesper Thulesen, MD, PhD,§Ka Fai Wong, MBChB,∥ and Kyu-Ho Yi, MD, PhD¶

Forehead filler injections have become a popular nonsurgical approach to enhance facial aesthetics by correcting volume deficiencies and improving contours. This anatomy-based approach emphasizes the importance of understanding the complex structural components of the forehead, including fat compartments, muscles, and vascular pathways. Proper diagnosis of forehead depressions—categorized as central, bilateral, mixed, or total types—guides targeted treatment strategies using submuscular or subdermal injection planes. Submuscular injections provide structural support, minimizing risks associated with superficial placement, such as uneven distribution and vascular complications. Techniques tailored to specific anatomic features, particularly in East Asian patients who often present with narrower foreheads, ensure natural and balanced results. Fillers used in this paper are Hyaluronic Acid (Maili, Sinclair) and Polycaprolactone (Ellanse, Sinclair). Combining fillers with botulinum toxin injections can address both dynamic and static wrinkles, achieving comprehensive facial rejuvenation while maintaining natural expressions, which is especially true for Polycaprolactone biostimulator fillers. This integrated approach optimizes aesthetic outcomes and enhances patient satisfaction by delivering smooth, contoured, and youthful forehead appearances.

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Hong, Gi-Woong MD, PhD^*; Wong, Isaac Kai Jie MD^†; Byungki, Cho MD^‡; Yoon, Song Eun MD^§; Song, Jong Keun MD^‖; Haykal, Diala MD^¶; Wan, Jovian MBChB^#; Kim, Jin-Hyun MD^**; Yi, Kyu-Ho MD, PhD^**,††

Nasolabial folds significantly impact facial appearance and are a common aesthetic concern. This article reviews anatomic considerations and filler injection techniques for treating these folds, with a focus on the Korean population. The dermal filler used in this study is Maili hyaluronic acid filler (Sinclair Pharma), derived from a novel proprietary manufacturing technology known as OxiFree™ technology (Kylane Laboratoires , Switzerland).

The study analyzes various injection techniques, including needle-based and cannula-based approaches, with emphasis on safe and effective practices such as the Fern leaf and Duck walk techniques. A layered injection approach addressing both superficial and deep tissue planes is examined.

Three distinct types of nasolabial folds are identified: those caused by volume deficiency, tissue laxity, and muscular attachments. Each type requires a tailored treatment approach. It is not uncommon to find a combination of 2 of the types together in one person. The study highlights the importance of understanding anatomic variations, particularly the course of the facial artery in the Korean population, for safe injection practices.

A thorough understanding of nasolabial fold anatomy and appropriate treatment strategies is crucial for achieving optimal outcomes in aesthetic medicine. This is especially important for the nasolabial folds, which are highly mobile, and could easily cause misplaced dermal fillers to migrate. Future research on combination intervention techniques, including botulinum toxin, lipolytic agents, and thread-lifting, may further enhance overall treatment efficacy.

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Kyu-Ho Yi, Isaac Kai Jie Wong, Jovian Wan

Background
Platysmal bands contribute to neck ageing and lower-face descent. Although botulinum toxin A (BoNT-A) is approved for this indication, conventional whole-muscle dosing requires many superficial injections with attendant risks.
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Objective
To develop an anatomically guided protocol that targets motor-dense zones of the platysma, optimizing efficacy while reducing dose and complications.
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Methods
Sihler-stained dissections mapped motor versus sensory innervation. Ultrasound-guided injections were performed in 40 patients, delivering 30–60 U BoNT-A per side at 15 sites concentrated in the upper two-thirds of the platysma and along the marginal mandibular border. Outcomes included band severity, jawline definition, adverse events, and cost.
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Results
Motor end-plates clustered in the upper platysma; the lower third was largely sensory. Targeted injections produced a ≥ 2-grade reduction in dynamic bands in 92.5% of patients by week 4, maintained through week 12. Mean toxin use fell 35% versus historical whole-muscle protocols; bruising dropped to 5%, with no dysphagia or lower-face weakness. Treatment costs were proportionally lower.
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Conclusions
Concentrating BoNT-A in the motor-rich upper platysma under ultrasound guidance maximizes aesthetic improvements while minimizing dose, discomfort and adverse events. This neural distribution-based algorithm offers a safer, more economical alternative to conventional platysmal band treatment.

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Koppert, Erik MD^*; Wong, Isaac Kai Jie MD^†; Wan, Jovian MBChB^‡; Yoon, Song Eun MD^§; Song, Jong Keun MD^∥; Kim, Jin-Hyun MD^¶; Yi, Kyu-Ho MD, PhD<sup>¶,#

*Department of Surgery, Epworth Hawthorn and Epworth Eastern Private Hospitals, Melbourne, Victoria, Australia†The Artisan Clinic, Singapore, Singapore‡Medical Research Inc., Wonju, Korea§BRANDNEW Aesthetic Surgery Clinic∥Pixelab Plastic Surgery Clinic¶You and I clinic#Department of Oral Biology, Division of Anatomy and Developmental Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea</sup>

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Jovian Wan, Benjamin Ascher, Leonie Schelke, Isaac Kai Jie Wong, Peter J. Velthuis, Won Lee, Hee-Jin Kim, Kyu-Ho Yi

First published: 30 June 2025

https://doi.org/10.1111/jocd.70313

Funding: The authors received no specific funding for this work.

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The Artisan Clinic, 435 Orchard Road, #20-03, Singapore, Singapore
‍Isaac Kai Jie Wong
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‍Wlabel, Seoul, Korea
‍Olena Sydorchuk
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‍Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
‍Kyu-Ho Yi

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You and I Clinic, Seoul, Korea
‍Kyu-Ho Yi

‍Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
‍Kyu-Ho Yi

‍The Artisan Clinic, 435 Orchard Road, #20-03, Singapore, 238877, Singapore
‍Isaac Kai Jie Wong

‍Gaddiel Medical Group Limited, Tsim Sha Tsui, Hong Kong, China
‍Ka Fai Wong

‍EverKeen Medical Centre, Hong Kong, China
‍Kar Wai Alvin Lee

Goo, B., Kim, E., Yoon, S.E. et al. Efficacy and Safety of High-Intensity Focused Ultrasound (HIFU) on Reduction of Unwanted Submental Fat in Asian Patients. Aesth Plast Surg (2025). https://doi.org/10.1007/s00266-025-04890-0

Background:
Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impairs quality of life. Current therapies, including corticosteroids and calcineurin inhibitors, often provide incomplete relief or have undesirable side effects. Exosome-based therapies derived from adipose-derived mesenchymal stem cells (ADMSCs) offer a novel, multifaceted approach to addressing inflammation, skin barrier dysfunction, and pruritus, presenting a promising alternative for AD management.

Objective:
This case series evaluates the efficacy and safety of ADMSC-derived exosome-based topical formulations (ZISHEL XOMAGE; Zishel Bio Inc., Seoul, Korea), in improving clinical and barrier-related outcomes in patients with moderate-to-severe facial AD.

Methods:
Twenty adults with moderate-to-severe facial AD (vIGA-AD scores 3–4) applied ADMSC-derived exosome twice daily for 6 weeks. Clinical assessments included vIGA-AD scores, transepidermal water loss (TEWL), and corneometry for hydration. Two blinded dermatologists independently assessed outcomes. Before-and-after photographs were taken under standardised conditions. Pruritus severity was evaluated using a visual analogue scale (VAS).

Results:
Eighty-five percent of patients achieved at least a 1-point reduction in vIGA-AD scores, with 50% achieving a 2-point reduction. Corneometry indicated a 58% improvement in hydration, while TEWL measurements demonstrated a 42% reduction, reflecting enhanced barrier integrity. Pruritus VAS scores declined by 70%. No adverse events were reported, and inter-rater reliability for vIGA-AD assessments was high (Cohen kappa=0.84). Representative cases highlighted substantial improvements in erythema, lichenification, and skin texture.

Conclusion:
ADMSC-derived exosome products showed significant efficacy in reducing AD severity and restoring barrier function, with excellent safety profiles. Larger, randomised controlled trials with extended follow-up are recommended to confirm these findings and establish these products as viable treatment options for AD.

Objective:
This case series evaluates the efficacy and safety of LDE therapy combined with microneedling in patients with active acne, PIH, and atrophic scarring.

Methods:
Three patients with moderate to severe acne [Investigator’s Global Assessment (IGA) scores 2–4], visible PIH, and atrophic scarring underwent biweekly microneedling treatments followed by topical application of LDE (BLESKIN EXXO, Daeyang Medical) over 2 months. Assessments were conducted at baseline and 2-month post-treatment, utilizing the IGA scale for acne severity, the Postinflammatory Hyperpigmentation Area and Severity Index (PIHASI) for PIH, and the Goodman and Baron Scarring Grading System for atrophic scarring. Two independent, blinded dermatologists evaluated clinical photographs and scored all outcomes. Patient satisfaction was recorded on a 10-point Likert scale.

Results:
All patients exhibited significant improvements in acne severity, PIH, and atrophic scarring. IGA scores decreased from baseline values of 3 to 4 to 1 to 2 post-treatment. PIHASI scores were reduced by 4 to 6 points, and Goodman and Baron scores improved by one grade level. Patient satisfaction scores ranged from 8 to 9 out of 10. Minimal adverse events were noted, with only one instance of transient erythema observed during the study.

Conclusion:
LDE therapy combined with microneedling seems to be a promising treatment modality for active acne, PIH, and atrophic scarring, demonstrating significant clinical improvements with high patient satisfaction and minimal adverse effects. Further research with larger cohorts and controlled studies is warranted to validate these findings….”