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Botulinum toxin type A (BoNT-A) is the gold standard for moderate-to-severe facial wrinkles (MTS-FW). Although several formulations are effective and superior to placebo, direct head-to-head comparisons are limited. We conducted a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) to assess whether an optimal formulation exists.

A PRISMA-compliant systematic review was conducted in MEDLINE, Embase, Scopus, Web of Science, and Cochrane Central through October 2025. Eligible studies were head-to-head RCTs of commercially available BoNT-A formulations in adults with MTS-FW; placebo-controlled trials were excluded. The primary endpoint was responder-defined wrinkle improvement (WI); secondary outcomes were patient-reported satisfaction (PRS) and adverse events (AE). Risk of bias was assessed with RoB2. A frequentist random-effects NMA estimated risk ratios (RR) with 95% confidence intervals (CI) and SUCRA rankings.

Forty-eight RCTs (5,781 patients) were analyzed; overall Risk of Bias was predominantly low (RoB2). NMA and SUCRA ranked NTC121, an investigational non-registered neurotoxin, as most likely to be most effective for WI. League tables showed significant differences. AboBoNT-A was more effective than incoBoNT-A (RR 1.11; 95% CI 1.01–1.21), letiBoNT-A (RR 1.09; 95% CI 1.01–1.18), and onaBoNT-A (RR 1.10; 95% CI 1.01–1.20). NTC121 was superior to incoBoNT-A (RR 0.81; 95% CI 0.70–0.95), letiBoNT-A (RR 0.83; 95% CI 0.71–0.95), onaBoNT-A (RR 1.23; 95% CI 1.06–1.42), praBoNT-A (RR 1.18; 95% CI 1.01–1.38), and Prosigne (RR 1.22; 95% CI 1.03–1.46). Despite these gradients, no commercially approved formulation showed consistent superiority. PRS was high but varied by scale and follow-up, with no reproducible advantage. AE were mostly mild and transient (headache, injection-site pain, bruising, tenderness); major events such as eyelid ptosis, strabismus, or infection were rare. Safety profiles were comparable and favorable.

NTC121 had the highest probability of superior efficacy; however, among commercially approved formulations, no product consistently outperformed the others. Although measurable differences exist, all provide meaningful WI, high PRS, and favorable safety. Treatment choice should be individualized based on clinical context and product characteristics rather than presumed superiority.

Botulinum neurotoxin type A (BoNT-A) is frequently used off-label to reduce masseter hypertrophy. Varied injection techniques and outcomes across populations highlight the need for a standardized, anatomical approach. We aimed to assess the safety and efficacy of a single-entry injection targeting the middle lower part of the masseter, which corresponds to the neural arborization zone of the masseteric nerve branches.

This is a retrospective cohort study of Chinese, Caucasian, and Middle Eastern/Asian patients with benign bilateral masseteric hypertrophy treated with different types of BoNT-A at the point of neural arborization with a single-entry injection technique, by three different doctors. Clinical outcomes and adverse events (if any) during follow-up at 3- to 4-weeks, and 3-months, were noted.

Dosages averaged 24 Botox units (BU), 27 BU and 28 BU for Botox®, Dysport®/Azzalure® and Xeomin®/Bocouture® respectively. Of 131 patients, 96.2% were female; mean age was 32.8 years. Ethnic breakdown: Chinese (74.0%), Caucasian (16.8%), Middle Eastern/Asian (9.2%). Two minor complications (1.5%) were reported: mild asymmetry and lack of effect; no major complications such as infection or hematoma occurred.

The single-entry injection technique aimed at the point of neural arborization in the masseters is safe, effective, and reproducible across ethnicities.

Vaginismus, traditionally defined as an involuntary spasm of the vaginal introitus, is now recognized as a more complex disorder. Recent advances and the DSM-5 classification of Genito-Pelvic Pain/Penetration Disorder (GPPPD) challenge the reductionist view of a purely muscular or perineal condition.

Based on clinical experience, we propose a tridimensional model integrating three key components: pelvic floor hypertonicity, pain, and fear of penetration. Their dynamic interaction explains the heterogeneity of clinical presentations, including partial vaginismus, and supports a personalized.
Management is necessarily multidisciplinary. Beyond psychosexual interventions, treatment relies on two main pillars: pelvic floor physiotherapy with progressive vaginal dilatation, followed by botulinum toxin injection. The toxin acts not only by reducing pelvic floor muscle overactivity through neuromuscular blockade but also, as demonstrated in migraine, by modulating nociceptive pathways, leading to rapid pain reduction. But despite its increasing use, no consensus exists regarding optimal dosing, reflecting the lack of randomized controlled studies.
We describe our personal protocol combining guided dilatation therapy, and botulinum toxin injection under neuroleptanalgesia, often associated with hymenectomy to reduces anxiety related to losing one's virginity during first intercourse.

Using this protocol, we observed a success rate exceeding 90% but as in most studies treatment succes was defined solely by the ability to achieve vaginal penetration. We propose that this endpoint is insufficient.

The therapeutic goal should be the ability to experience sexual pleasure — an outcome never addressed in previous publications. This perspective opens new avenues for research in vaginismus.

Facial rejuvenation therapies have undergone a paradigm shift over the past decade, moving away from volume-centric correction toward approaches that prioritize tissue quality& preservation of ethnic facial identity.
The Indian population represents one such group, with distinct facial anatomy, skin biology, and aging patterns that differ substantially from those described in Caucasian cohorts.
regenerative injectable agents that act primarily through bio-revitalization and tissue remodeling rather than volumization.There remains a paucity of focused literature examining the role of polynucleotide therapy specifically in Indian faces.
This extended abstract aims to explore the rationale, methodology, and observed outcomes of polynucleotide-based facial rejuvenation in Indian patients, emphasizing anatomical considerations and clinical safety.
The objective of this clinical evaluation was to assess the role of polynucleotide therapy in facial rejuvenation among Indian patients, with specific attention to: improvement in skin quality, preservation of ethnic facial anatomy & Safety profile across varying skin types.

This clinical evaluation included Indian patients seeking non-surgical facial rejuvenation.
Polynucleotides were administered intradermally and into deep dermis using micro aliquots with tailored protocols for individual facial anatomy and skin. Treatment areas included: Midface and malar region, Periorbital skin, Lower face and jawline skin,Neck & peri-oral areas. Sessions were spaced at regular intervals,allowing adequate time for biological response and tissue remodeling. Clinical outcomes were assessed using:
Standardized clinical photography
Physician-based aesthetic evaluation
Patient-reported outcome. Followup assessment was done upto 6 months post final session.

In all treated patients, polynucleotide therapy resulted in consistent & gradual improvement in facial skin quality. The most observed changes included:Enhanced skin hydration,
Improved texture,Subtle increase in facial firmness, improvements were progressive
aligning with the regenerative nature of the treatment.

Polynucleotide therapy was well tolerated across all treated patients.The absence of volume corrections & regenerative potential likely contributed to their favorable safety profile,typically darker skin types where inflammatory responses may lead to pigmentation concerns.

To highlight over a decade of exclusive clinical experience in plasma-based rejuvenation, demonstrating its effectiveness in achieving long-lasting aesthetic improvements in facial and periorbital regions. The aim is to show how plasma can bridge the gap between conventional surgery and non-surgical approaches, providing reliable outcomes with high patient satisfaction.

A retrospective analysis was performed on patients treated with plasma-based techniques for facial and periorbital rejuvenation over a ten-year period. More than 8,000 patients were evaluated, including both aesthetic candidates and individuals with complications after surgery such as blepharoplasty or rhinoplasty. All procedures were performed using an FDA-cleared and CE-certified plasma device, ensuring compliance with international safety standards. Follow-up evaluations were conducted from six months up to five years. Outcomes were assessed through standardized clinical photography, patient-reported satisfaction, and complication rates.

Sustained improvements were observed in most patients, with visible results lasting up to five years. Periorbital rejuvenation showed high effectiveness, with 70–80% of patients reporting good to excellent outcomes. Post-surgical scars and asymmetries were improved in the majority of cases. Complications were minimal and transient, including mild erythema and edema resolving within days. No permanent adverse events were reported. Overall, patient satisfaction exceeded 85%.

Plasma-based rejuvenation provides a minimally invasive, safe, and effective option for aesthetic improvement in the face and periorbital areas. The use of an FDA-cleared and CE-certified device enhances safety and ensures global clinical acceptance. This approach offers long-lasting, natural-looking results, bridging the gap between non-surgical procedures and traditional surgery. It represents a valuable tool for modern aesthetic practice and may help reduce the burden of surgical interventions worldwide.

Dorsal hump correction is always a challenging .In surgical correction we directly remove it
whereas with Hyaluronic acid fillers we camouflage the hump.

In past 8 years we have treated 100 cases with dorsal hump.
We have used high g prime hyaluronic acid fillers

We have got good and satisfactory results with the above procedure.
Though the maximam duration of effect of the treatment is maximum one year but still patients
are much satisfied.

We have included this treatment option along with surgical correction and preservation rhinoplasties.

Gluteal harmonization is a popular aesthetic procedure, with increasing demand for minimally invasive alternatives. Injectable fillers and biostimulators have demonstrated efficacy in improving volume, contour, and skin texture. In parallel, subcision techniques have been described for the treatment of cellulite. The combination of these techniques can provide synergistic effects, enhancing the overall aesthetic results. We aim to evaluate the safety and efficacy of combined minimally invasive techniques in gluteal harmonization.

This retrospective case series included patients who underwent gluteal harmonization with subcision, calcium hydroxyapatite (CaHA) and hyaluronic acid (HA) injections, performed by a plastic surgeon over a 10-month period. Demographic data, complications, and aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) based on pre- and post-procedure photographs analyzed by a blinded evaluator. Statistical analysis was performed using IBM SPSS Statistics software.

Twenty-six patients were included, with a mean age of 41 years. One to three sessions were performed for cellulite treatment (subcision and CaHA ± HA, 86%), gluteal remodeling (CaHA + HA, 7%), or a combination of both (7%). No major complications occurred, including infection or neurovascular injury. Minor transient complications (seroma and hyperpigmentation) were observed in 27% of cases, showing a significant association with higher BMI (p=0.005), a nonsignificant trend among smokers (p=0.065), and no correlation with age. GAIS evaluation demonstrated global improvement in contour and skin irregularities.

Gluteal harmonization using subcision and CaHA and HA injections demonstrated a favorable safety profile and consistent aesthetic outcomes.

Filler-induced vascular occlusions (FIVO) resulting in acute skin ischemia are a rare but potentially severe complication of cosmetic filler injections. Rapid identification and prompt intervention are critical to prevent permanent tissue damage. Standard management includes hyaluronidase (HYAL) injections, antiplatelet therapy, vasodilators, and anti-microbial agents. Our institution is among the few centers incorporating hyperbaric oxygen therapy (HBOT) as an adjunctive modality within its FIVO protocol.

We present our institutional protocol for the management of acute skin ischemia secondary to FIVO in a Swiss university hospital setting, with an emphasis on the benefits of HBOT in such complications. A comprehensive review of the evidence supporting HBOT as an adjunctive treatment modality in FIVO was conducted.

There is growing evidence that HBOT is an effective adjunctive therapy in the management of FIVO, particularly in delayed presentations or cases with incomplete HYAL response. This is consistent with our results, demonstrating full recovery and positive outcomes in patients treated at our university hospital according to the standardized protocol.

Optimal outcomes in FIVO depend on early recognition and a tailored, multidisciplinary management based on filler type, severity of vascular compromise, and time elapsed since onset. HBOT is a safe and effective adjunctive therapy in FIVO, particularly in delayed or refractory cases.

To report a case of recurrent delayed immune-mediated hypersensitivity to cross-linked hyaluronic acid (HA) fillers across different cross-linking agents (BDDE and PEG), and its successful management using agarose gel as an alternative filler.

A 24-year-old healthy woman developed delayed-onset hypersensitivity with abrupt, painful, erythematous, pruritic lip oedema four months after the last injection to her lips, at which time she had a total of 4 mL BDDE–cross-linked HA fillers from two different brands. Management included antihistamines, corticosteroids, and staged hyaluronidase injections until complete dissolution. Re-augmentation with BDDE– and PEG–cross-linked HA fillers resulted in recurrence. Hypersensitivity to non-cross-linked HA (skin booster 18 mg/mL) was also tested. Agarose gel (1.5%) was introduced as an alternative.

Pharmacological treatment provided only partial relief, whereas complete resolution was achieved after hyaluronidase, with intermittent localized reactions occurring between staged sessions. Both BDDE– and PEG–cross-linked fillers reproducibly triggered identical day-3 reactions with painful, erythematous, pruritic oedema, consistent with delayed-type hypersensitivity. Non-cross-linked HA was well tolerated without adverse reactions. Agarose gel showed no hypersensitivity reaction, including during the previously consistent day-3 window, with stable outcomes at follow-up (3 days, 3 weeks, 3 months).

This case demonstrates a reproducible delayed hypersensitivity to cross-linked HA fillers across different cross-linking agents, suggesting a reaction to the cross-linking technology itself rather than HA as a molecule. The consistent day-3 reaction pattern and recurrence after re-exposure further support a delayed-type immune mechanism.
Tolerance to non-cross-linked HA and agarose gel highlights the role of structural properties in driving the immune response.
Agarose gel, as a non-cross-linked, biocompatible and non-immunogenic filler, may represent a safe and effective alternative in such patients. This case underscores the importance of recognizing reproducible reaction patterns and supports a more individualized approach to filler selection based on biomaterial properties rather than composition alone.