Facial fillers for facial feminization in transgender women
Today’s report also covers research into dental dams in dermatology, the link between prenatal exposure to nickel and atopic dermatitis and more (1450 words, 7 minutes)
The Women in Dermatology e-newsletter is supported by unrestricted support from Galderma Canada
Good morning and welcome to this edition of the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations or suggestions. You can email them to us at health@chronicle.org.
During their transition process, many transgender individuals opt for facial procedures that help them match their self-image. For transgender women, minimally invasive procedures (MIP) such as facial fillers are efficient because changes can be fast and impactful for the patient yet reversible.
A study published in Clinical, Cosmetic and Investigational Dermatology (July. 2022; 15:1333–1345) reported five cases of facial feminization in transgender women. The report showcased minimally invasive facial remodelling procedures for male-to-female transition. To analyze results and changes, the researchers photographed the subjects at baseline, immediately after injection, and after a follow-up period. The minimum time to follow-up was 60 days; the longest was 140 days. Two-dimensional and three-dimensional images were used. Patients also rated the overall improvement after treatment using a four-point scale.
The five patients enrolled in the study were between 28 and 38 years of age, with no significant medical history. Only one patient did not report the use of hormonal therapy, while one used topical estrogen, and the other three used oral cyproterone acetate. None of the patients had facial surgery, used permanent fillers or had any injectable procedure performed within 12 months of the study. All patients were treated with botulinum toxin, followed by calcium hydroxyapatite injection after 15 days. One month later, they received a hyaluronic acid injection. The injection sites included the upper, middle and lower face, focusing on the forehead, the creases along the sides of the nose and the lower jaw to achieve a more feminine contour. All patients rated the overall improvement after the treatment as good or excellent during their final evaluation.
The researchers write that clinicians should be aware there are several stages to the transition process, and the demands and expectations of the patients may differ at each phase. For example, changes in facial structure, soft tissue distribution and skin quality can be different in patients who have not started hormone therapy compared to those who have been on hormone therapy. The authors also note that beauty standards are often linked to culture, which needs to be considered. They state that treatment should be tailored to each patient’s needs and transition phase.
Finally, the authors note that clinicians must understand that transgender women cannot be treated the same way as cisgender women. The treatment goals are often different between these two groups. According to the study, individuals assigned male at birth usually have greater muscle mass than individuals assigned female, along with differences in bone structure.
Bottom line
Facial fillers are a quick and effective way to achieve facial feminization in transgender women. Clinicians must understand the differences between transgender beauty standards and the aesthetic approach of cisgender women. The goals in transgender patients involve rejuvenation or beautification and acquiring feminine features that best align with the patient’s identity. Health care providers must be well trained to care for this population.
An article published in the International Journal of Women’s Dermatology was designed to increase awareness and knowledge of dental dams as an effective method to prevent sexually transmitted infections (STIs) and to provide information that may be helpful to dermatologists. The authors note that dental dams effectively prevent STIs with complex mucocutaneous manifestations such as anogenital warts, gonorrhea, chlamydia, herpes and syphilis. The dental dam, which was initially designed for oral surgery, is a thin square sheet of latex or nitrile that can be used to prevent the transmission of STIs primarily during oral sex.
According to the research, dental dams are an underutilized barrier protection method that could be effective in high-risk populations where STIs are more common. The article proposes there is a lack of knowledge and awareness about dental dams, which is why they are not a commonly used method of protection against STIs. There are also some myths surrounding dental dams, such as the belief that they are not as widely available as condoms.
An article published in the Journal of the European Academy of Dermatology and Venereology analyzed whether maternal nickel exposure affects the development of atopic dermatitis and immune abnormalities in children. The authors found that the development of childhood atopic dermatitis at three years of age was not associated with maternal nickel exposure. They also found maternal nickel exposure was associated with increased serum levels of IL-1β, IL-2, TNF-α, and leukemia inhibitory factor (LIF). At the same time, maternal nickel exposure was associated with decreased serum levels of matrix metalloproteinase-1 (MMP-1), IL-2R, and eotaxin-1. Additionally, the authors noted that while the development of childhood atopic dermatitis was not associated with maternal nickel exposure, it was significantly associated with the child’s serum levels of IL-2R, a receptor involved in immune responses.
For this birth cohort study, the researchers analyzed 140 mother-child pairs from Taiwan recruited between 2012 and 2015. The maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma-mass spectrometry.
Evaluation of skin biophysical parameters and angiogenesis in older diabetic women treated with radiofrequency
A study in the journal Clinical, Cosmetic and Investigational Dermatology evaluated the effects of radiofrequency (RF) therapy on the biophysical parameters and angiogenesis of facial skin in older women with diabetes. The authors report RF treatment is an effective and non-invasive method of facial skin rejuvenation in older women with type 2 diabetes mellitus (t2DM). The treatment has a relatively short post-procedure recovery time and low potential for severe adverse effects.
For this study, 45 female patients with Fitzpatrick skin types II or III were subjected to six treatments with an RF skin rejuvenation device on facial skin. All patients had a t2DM diagnosis and had been prescribed metformin. The RF treatment significantly improved facial skin hydration and enhanced the skin’s epidermal barrier without any side effects.
Melanoma in women of childbearing age and during pregnancy
This study in the Journal of the European Academy of Dermatology and Venereology determined California’s characteristics and survival rate of women with pregnancy-associated melanoma. The authors determined that postpartum melanoma was associated with increased tumour thickness, but pregnancy status did not affect survival after a melanoma diagnosis. They also found that race, ethnicity, socioeconomic status and health insurance significantly impacted survival, highlighting the importance of reducing health disparities in the state.
The researchers analyzed data from the California Cancer Registry for this population-based cohort study between 1994 and 2015. They identified 13,108 female patients of childbearing age diagnosed with melanoma between 1994 and 2015. According to the findings, pregnancy-associated melanoma was more prevalent in Hispanic women than in non-Hispanic white women. Additionally, race, social status, tumour site, greater tumour thickness, and lymph node involvement were associated with a low survival rate, but not pregnancy.
VIDEO: Coast-to-Coast with CDA President Dr. Catherine McCuaig featuring Dr. Kerri Purdy
In an interview with CDA President Dr. Catherine McCuaig, Dr. Kerri Purdy talks about why she chose dermatology as a career, what brings her the most satisfaction in her work, and some of the biggest challenges of her career and tips for aspiring new dermatologists.
A complication due to hyaluronic acid in four female patients
A case study published in the Journal of Cosmetic Dermatology reported on four women who presented non-inflammatory, hard facial bumps that appeared in sites previously treated with hyaluronic acid (HA). The authors said the adverse reaction occurred when the HA in two syringes from the same batch hardened when injected. According to the study’s abstract, while using HA as a dermal filler is generally considered safe, reports of adverse events are becoming more common.
“My sense of curiosity was piqued by Klaus Wolff in his famous lectures, where he taught us diagnostic clues to skin diseases in a most vivid manner. He depicted skin diseases, not only as organ restricted but also as symptoms of systemic diseases. In addition, I was fascinated by the overt possibilities of connecting research and clinical work.”
— Dr. Beatrix Volc-Platzer, a Vienna-based dermatologist and professor, in an interview with the Journal of The European Academy of Dermatology and Venereology.
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