Despite the popularity of transcutaneous lower blepharoplasty (TLB) for the correction of the aged lower lids, ectropion, scar long the incision line, persistent skin laxity with fine wrinkles remain to be a huge setback associated with the procedure. With the advance of recent technologies, scar treatment methods using various kinds of devices have been widely adopted. Among them, fractional microneedle radiofrequency (FMR) has been proven to be highly effective on the improvement of acne scars, widened pores, and skin laxity by means of soft tissue regeneration. A fractional microneedle device called the Inus TM developed in Korea exhibits unique properties of delivering bipolar radiofrequency current through specialized vacuum edge line for optimal needle insertion into highly sensitive areas such as the eyelid and the neck. Usage of the Inus TM to treat patients experiencing complications from TLB have shown remarkable improvement in various aspects not only limited to the improved appearance of ectropion, scars, wrinkles, skin thickness and laxity, but also the contour of the eyelid and the overall facial volume, and shape. The report will delineate findings from three clinical cases that suggest the efficacy and safety of FMR on the rejuvenation of the lower lids.

Background: Filler injections are commonly used to soften deep nasolabial folds (NLF) by restoring volume in the depressed parts of fold. Recently, a combination technique using hyaluronic acid filler and polydioxanone (PDO) thread significantly improves deep NLF and induced changes in smile.Objective: This study retrospectively confirmed the effects of this combination therapy, focusing on smile changes. Methods: The NLF was divided into 3 parts: the lateral folded part (LFP), medial depressed part (MDP), and central creased part (CCP). Between November and December 2021, 14 patients underwent the combination treatment; of these, 11 were enrolled, excluding 3 who were not properly followed up. On average, 5.82±0.87 (right) and 5.73±0.47 (left) PDO mesh threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and under the CCP of each NLF. Following this, an average of 1.82±0.71 ml (right) and 1.92±0.75 ml (left) of the filler was also sequentially injected into each NLF in a similar manner. They were mainly placed in the superficial and deep fat layers in the entire NLF and sub-malar areas. Smile index was measured during the fully expanded smile stage. The follow-up period was 3 months. The results were estimated using pre-and post-operative photographs.Results: Three months after the combination treatment, patients were pleased with the softening of their NLF. As indicated by the increased smile index (inter-commissural width/inter-labial gap), the old and expanded smile changed to younger and less expanded smile. The original smile type (eight and three patients with the commissure and cuspid types, respectively) remained unchanged. The contour changes in each smile varied according to the smile type. This could be explained by combination treatment's NLF correction, which restricts facial expression muscle movement. Conclusion:These results demonstrate definite evidence of softening of the NLF, a youthful smile, and an increased smile index.

Background: Fractional microneedle radiofrequency (FMR) devices are used for non-invasive facial rejuvenation, with aging lower eyelids a popular area for improvement. However, treating lax eyelid skin, particularly determining the exact depth to insert the needle, remains challenging.Objective: To evaluate Inus-an FMR device that uses a bipolar current with a specialized vacuum edge line for optimal needle insertion in lax skin-on aging lower eyelids.Methods: Eleven Korean women (22 eyes) with aging lower eyelids who visited the Seoul Cosmetic Surgery Clinic in 2017 were included. After applying topical anesthesia, an Inus disposable tip with 25 insulated microneedles was used on the lower lids and lateral canthal regions, including temporal hollows. Microneedles of depth 1.0 mm or 0.8 mm were used to apply FMR of 0.5 MHz or 2.0 MHz, respectively, to the entire lower lid during three sessions at 2-week intervals. Morphological and statistical analyses of changes in the horizontal palpebral width, canthal tilt, and distance of the lid-cheek junction were performed using pre-and postoperative photographs.Results: Improvements in lax, deflated, wrinkles on the lower eyelids with scarring, and syringoma were observed. The lower lid contour changed from round to straighter, indicating improved laxity. Decreased lid-cheek junction (p<0.05) and increased canthal tilt (p<0.05) and horizontal palpebral width (p<0.05) were estimated. The mild erythema disappeared within 1-2 days. Mild ectropion (one case) in the case of protruded eyes with thin skin and unexpected transverse wrinkles at the medial part of the lids (two cases) were observed. Conclusion:Total rejuvenation of aging lower lids without serious complications was demonstrated. Therefore, Inus is suitable for treating aging lower eyelids safely.