Pakistan Journal of Medical and Surgical Aesthetics
The Pakistan Journal of Medical and Surgical Aesthetics (PJMSA) is a prestigious, peer-reviewed, quarterly research journal dedicated to advancing knowledge and fostering innovation in the fields of medicine, surgery, and aesthetic sciences. PJMSA serves as a dynamic platform for academics, researchers, clinicians, and practitioners to share groundbreaking research, clinical studies, and insightful reviews that shape the future of medical and surgical aesthetics.
ASSOCIATION OF AESTHETIC PHYSICIANS OF PAKISTAN
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Hyaluronic acid skin boosters in aesthetic medicine: A comparative review of RRS Hyalift 75 syringe, Jalupro SuperHydro, Profhilo, and Monalisa skin in the Egyptian market
Hyaluronic acid (HA) skin boosters have become integral to modern aesthetic medicine as demand grows for minimally invasive, regenerative, and natural looking rejuvenation therapies. This review examines four widely utilized HA based products available in the Egyptian market; RRS Hyalift 75 syringe, Jalupro SuperHydro, Profhilo, and Monalisa Skin, focusing on their biochemical properties, mechanisms of action, clinical evidence, injection protocols, safety, and therapeutic indications. By comparing their composition, rheological characteristics, biostimulatory potential, and longevity, the article provides a clinically relevant guide to optimizing brand specific selection in aesthetic practice. Despite variations in formulation, all reviewed products demonstrate strong safety profiles and efficacy in improving hydration, elasticity, and dermal quality. Continued comparative research, especially head to head trials, is needed to standardize treatment pathways and expand their therapeutic applications.
Copyright (c) 2026 Pakistan Journal of Medical and Surgical Aesthetics https://creativecommons.org/licenses/by/4.0
The secret beauty of the beard: Between the insight of God and the insight of a dermatologist
Double rhomboid skin flap in near basal cell carcinoma
The rhombic flap is a local geometric transposition flap and offers significant versatility in reconstructive surgery. This flap is most often used to fill skin cancer defects in the head and neck area. Basal cell carcinoma (BCC) is the most common cancer in humans. For many subtypes of BCC, the gold standard treatment is surgical excision. For low aggressive BCC, alternative treatments such as cryosurgery, curettage and cryosurgery, photodynamic therapy (PDT) and topical Imiquimod can be used. A case of BCC with adjacent lesions was reported and was treated by surgical excision using a modified double rhomboid flap technique.
Multimodal aesthetic dermatological treatment of a nasal laceration managed without sutures: A case report
Facial lacerations are typically managed with primary suturing to achieve optimal cosmetic outcomes. However, when patient refuse surgical closure it may necessitate alternative approaches. We report a case of nasal laceration managed conservatively using topical adhesive, followed by multimodal dermatological interventions to optimize long-term cosmetic results. A young male presented with a fresh lacerated wound on the nose following a roadside accident. The patient electively refused surgical closure. The wound was initially approximated using topical skin adhesive after achieving hemostasis. Early outcome was suboptimal, with poor cosmetic satisfaction at one week. Subsequently, the patient underwent a staged dermatological rehabilitation plan including fractional CO₂ laser resurfacing, Q-switched laser sessions for post-traumatic pigmentation and microneedling. Over a 4-month follow-up period, the patient demonstrated marked improvement in scar texture, pigmentation, and overall cosmesis, exceeding initial expectations. This case underscores the potential of multimodal dermatological therapies in enhancing cosmetic outcomes of traumatic facial wounds, especially when surgical closure is not an option. It highlights the evolving role of dermatologists in post-trauma scar modulation and aesthetic rehabilitation.
Copyright (c) 2025 Pakistan Journal of Medical and Surgical Aesthetics https://creativecommons.org/licenses/by/4.0
Regenerative aesthetics: The role of stem cells and growth factors in skin rejuvenation
Regenerative aesthetics is an emerging paradigm that prioritizes tissue repair and biological rejuvenation over temporary correction of age-related change.1 Stem-cell-based approaches, especially adipose-derived mesenchymal stem cells (ADSCs), can stimulate fibroblast activity, enhance collagen synthesis and support angiogenesis, contributing to improved dermal quality and scar remodeling.2,3 In parallel, growth-factor strategies, e.g. fibroblast or MSC-derived growth-factor formulations and platelet-rich plasma (PRP) have shown clinically meaningful improvements in photoaging and acne scars, particularly when paired with procedures like microneedling or lasers.4,5 Early human data also suggest that topical platelet-derived exosomes can reduce cellular senescence markers and up-regulate extracellular-matrix pathways in aged skin.6 However, translation is limited by variability in preparation protocols, lack of standardization and evolving regulatory guidance for human cell/tissue-based products and exosome-containing products.7,8 This review summarizes current evidence for stem cells, PRP/ growth factors and exosomes in aesthetic practice and highlights future directions for standardized, evidence-based use.9
Non-scarring diffuse hair loss in females (18-45 years) of age
Objective: To evaluate the etiology and severity of diffuse non-scarring hair loss in Iraqi females of the reproductive age. Methods: The study is a prospective observational study conducted at the Dermatology Center, Medical City Teaching Hospital, Baghdad, Iraq from March 2021 to September 2022 on a convenient sample of 100 female patients 18-45 years of age who presented with non-scarring diffuse hair loss, decrease in hair density or both for at least 1 year. Full history, general and local scalp examination, hair pulling test, 24 hour hair count, hair density count, Dermatology Life Quality Index and relevant blood investigations were done for all patients. Results: The highest proportion of study patients were in the age < 25 years (46%). Regarding hair pull test, it ranged from 3-20 hairs with a mean of 5.7 hairs and 24 hours hair count shed ranged from 21-700 hairs with a mean of 157.22 hairs/24 hours, hair density in the vertex was 80.47±19.05 hair/cm2, left temporal area 82.23±18.85 hair/cm2 and right temporal area 83.19±18.8 hair/cm2. By investigations Hemoglobin was < 12 G/dl in 45% and serum ferritin was <40µG/l in 54% of patients. Conclusion: The most common diagnosis for hair loss in females of 18-45 years of age was telogen effluvium followed by androgenetic alopecia. Young females (less than 25 years) constituted the majority. Detailed history, general examination, local scalp examinations and investigations are important in diagnosing, evaluating and finding the etiology of diffuse non-scarring alopecia in young females.
Knowledge, perception and attitude towards aesthetic medicine among medical residents in Pakistan: A cross-sectional study
Aesthetic medicine is a rapidly expanding specialty that blends clinical science with artistry, and patient centered care. While the Global demand for minimally invasive procedures is rising, its integration into medical education and structured training remains limited in many developing countries, including Pakistan. Objective: To explore the knowledge, perception, and attitude of medical residents in Pakistan regarding aesthetic medicine, including its training requirements, and role in clinical practice. Methods: A descriptive cross-sectional survey was conducted among 89 medical residents from public and private hospitals in Pakistan using a structured questionnaire assessing demographics, prior exposure, knowledge, perception, and attitude toward aesthetic medicine. Data was analyzed using descriptive statistics. Results: The mean age of participants was 30 years; 43% were male and 57% female. Only 11% had attended a private course or workshop in aesthetic medicine. While 94% correctly identified botulinum toxin, fillers, and lasers as central to the field, 16% expressed uncertainty about its evidence base. A majority (62%) supported recognition of aesthetic medicine as a separate specialty with more than 83% agreed that aesthetic procedures improve psychological well-being.3,6 Patient inquiries about cosmetic procedures were reported by 69% of residents, and 60% acknowledged cultural influences on patient preferences. Despite positive perceptions, 74% had never performed an aesthetic procedure. Conclusion: Medical residents in Pakistan show strong interest and favorable perception towards aesthetic medicine, but exposure and structured training remain limited. Formal integration of aesthetic medicine as a distinct specialty could help bridge knowledge gaps and prepare physicians to meet growing patient demand.
Q-TIER: A structured, anatomy-guided framework for advanced facial profiling with fillers
Hyaluronic acid (HA) fillers dominate non-surgical facial rejuvenation, yet outcomes hinge on precise plane selection, product rheology, and injection strategy. The TIER framework (Face profiling framework based on inverted triangle of beauty) systematically sequences treatment from the upper to lower face: top foundation (forehead and temples), infraorbital core (under-eyes and cheeks), essential midface (nasolabial and piriform), and refining apex (chin and jawline). Here, we synthesize literature from 2019-2024 to defend TIER’s anatomical logic, safety, and efficacy, illustrating how its inverted-triangle lens aligns with facial thirds and optimizes aesthetic harmony.
Dermabrasion of acne scarring using continuous fractional carbon dioxide laser versus heat dermabrasion using diathermy needle in patients with dark complexion
Objective: The objective of the study is to compare the efficacy and safety of fractional CO2 laser compared with heat dermabrasion using diathermy needle in the treatment of different types of acne scars. Methods: One hundred and forty patients with different types of acne scars were divided into two groups: Group A (CO2 laser): Forty patients, 30 (75%) females and 10 (25%) males were treated with one session of CO2 dermabrasion using continuous fractional CO2 laser. Group B (heat dermabrasion): One hundred patients, 60 (60%) females and 40 (40%) males were treated with one session of heat dermabrasion using diathermy needle. Scoring was done during follow-up period to assess the reduction in the scars. Results: Group A (CO2) laser: Severity of scars: mild in 10 (25%) cases, moderate in 20 (50%), and severe in 10 (25%). Reduction rate: 4 weeks post CO2 laser session; the reduction was moderate (5%), marked (90%) and excellent (5%). Group B (heat dermabrasion): Severity of scars: mild in 23 (23%) patients, moderate in 49 (49%), and severe in 28 (28%). Reduction rate: 4 weeks post heat dermabrasion session, the reduction rates were moderate (5%), marked (52%) and excellent (43%). Conclusion: Overall, while both heat dermabrasion and CO2 laser are effective in reducing scar severity, single session of heat dermabrasion may offer superior outcomes in terms of achieving higher levels of scar reduction with minimal side effects.
Clinical Evaluation of Mesenchymal Stem Cell-Derived Exosome Therapy Combined with PRP for Skin Rejuvenation: A Prospective Study
Background: Exosomes derived from mesenchymal stem cells (MSCs) are gaining prominence in regenerative dermatology due to their ability to mediate intercellular communication and stimulate tissue repair. When combined with platelet-rich plasma (PRP), they may enhance dermal remodeling and skin rejuvenation. Objective: To evaluate the efficacy of MSC-derived exosomes combined with PRP in improving skin texture, pigmentation, and acne scars in adult female patients. Methods: Fourteen female patients (aged 21–46 years) received four sessions of intradermal injection of 2.5 billion exosomes every six weeks using a Hydrapen device. PRP was administered at the 3-week midpoint between exosome treatments. Exosomes were enriched with growth factors, cytokines, nucleic acids, and structural proteins. Post-care included avoidance of washing for 3 hours, no cosmetics for 48 hours, delayed sunscreen use, and icing after 2 hours. Results: Marked improvements were observed in skin texture, tone, pore size, pigmentation, and radiance. Three of four patients with acne scarring experienced near-complete resolution. No adverse events were reported. Conclusion: MSC-derived exosome therapy, when combined with PRP and microneedling, demonstrates significant potential in non-invasive skin rejuvenation with high patient satisfaction and safety. However, larger controlled studies are necessary to confirm findings.
A systematic review of the efficacy of chemical peeling in active acne and acne scars
Chemical peeling is a widely used dermatological procedure for managing acne and acne scars. This article evaluates existing studies on the efficacy and safety of chemical peels in treating active acne and post-acne scarring. A systematic search was conducted on PubMed and other databases for clinical trials from 2000 to 2025 using the keywords “chemical peels, acne, acne scars.” A total of 18 studies were identified, out of which 10 prospective clinical trials were included. Studies involving animal models or other facial dermatoses and those without prospective clinical trials were excluded. The results of the reviewed studies suggest that chemical peels are a safe and effective treatment option for acne and post-acne scars. Different types of peels, including glycolic acid, salicylic-mandelic acid, Jessner’s solution, lactic acid, and trichloroacetic acid, have demonstrated varying degrees of success in reducing active acne, post-inflammatory hyperpigmentation, and superficial scarring. Combination therapies and higher-concentration peels show promise for deeper scars, though they require careful application to minimize adverse effects such as erythema and post-inflammatory hyperpigmentation.
Techniques of using botulinum toxin for forehead wrinkles: A narrative review
The use of botulinum toxin extracted from bacteria Clostridium Botulinum for obliteration of forehead wrinkles has proven to be exceptionally efficient. Injection techniques are based on muscle groups targeted with minimal adverse effects when executed by a professional. Outcome is determined by a grading scale and differs based on the type of wrinkles. It is judged on day 1-4 post injection and peak effects are noticed around 1-4 weeks. It was seen that wrinkle reduction was dependent on dilution criteria and dose of the toxin. Bruising and hematoma formation are common local complications. Adverse effects are seen with concomitant use of other medications like Aminoglycosides, muscle relaxants and Anticholinergic drugs.
Copyright (c) 2025 Nabeela Shahzadi, Saumara Atif, Ammara Arshad (Author) https://creativecommons.org/licenses/by/4.0
Audit of 75 patients of hirsutism treated with Intense Pulse Light (IPL) in Dermatology Department, Mayo Hospital Lahore
Objective: Hirsutism is a common issue in dermatology affecting 5- 10% of females during their reproductive years and is characterised by excessive terminal hair in male pattern. It causes significant psychological and emotional stress in females. The objective of the study is to evaluate the percentage of patients achieving satisfactory outcomes and to determine incidence of side effects. Methods: This clinical audit was done at dermatology unit II Mayo Hospital, Lahore over a period of 3 months, on 75 patients of hirsutism, all treated with intense pulse light (IPL). Data of 75 patients was retrospectively analyzed. Variables extracted including age, association with Poly Cystic Ovarian syndrome (PCOs), number of sessions done and power range. Results: The study population had a mean age of 28.48±8.09 years with a wide range spanning from 16 to 64 years. After evaluation it was noticed that 58.67% (n=44) of patients experienced a satisfactory response to intense pulse light and the majority of patients reported no side effects (n=64). Conclusion: This audit revealed that IPL appears to be a safe and effective treatment option for hirsutism with a significant proportion achieving satisfactory outcomes.
Copyright (c) 2025 Madiha Sanai, Zunaira Arshad, Asma Shakir, Wajeeha Nusrat, Mahwish Zahoor, Muhammad Tariq (Author) https://creativecommons.org/licenses/by/4.0
Ultrasound devices powered by artificial intelligence: The future of aesthetic dermatology
A heavy price for a hollow fix: Complications of under-eye fillers
This case report discusses a 35-year-old female patient who presented with complications following the administration of dermal fillers in the under-eye region. The patient received the fillers from an aesthetic clinic, leading to swelling, unevenness, and Tyndall effect. It was decided to dissolve the filler using hyaluronidase, and the patient's subsequent response to the treatment is documented.
Copyright (c) 2025 Aisha Ghias, Wajeeha Nusrat, Zunaira Arshad (Author) https://creativecommons.org/licenses/by/4.0
Efficay of 308-mm Excimer Laser in patients with alopecia areata
Objective: Alopecia areata (AA) is characterized by patchy non-scarring hair loss involving the scalp and other hair-bearing surfaces. This study aims to determine the effectiveness of 308-nm Excimer laser in patients with alopecia areata. Methods: A total of 168 patients with alopecia areata (within 12 months) were included in the study in a consecutive manner and subjected to 308-nm Excimer laser. Baseline and follow up Severity of Alopecia Tool (SALT) scoring was done to determine the effectiveness of the therapy. Results: The mean baseline SALT score was 26.4±13.3 which increased to 75.6±12.7 (p <0.001). The mean difference between baseline and follow up SALT score was 49.2±12.7. According to categories of difference between baseline and follow up SALT scoring, 41.7% were in fair category (11-50) and 58.3% were in excellent category (SALT 51-74). Effectiveness (minimum 50 improvements in SALT from baseline) was recorded in 58.3% of patients. Erythema was the only side-effect noted in our study. Conclusion: 308-nm Excimer laser is effective in the treatment of alopecia areata and is significantly associated with improvement in baseline SALT score.
Copyright (c) 2025 Irfan Ullah Afridi, Mehran Khan, Sehrish, Mah Rukh, Sarbjeet Singh (Author) https://creativecommons.org/licenses/by/4.0
Facial ultrasound in aesthetic dermatology: A revolutionary approach
Aesthetic dermatology has seen tremendous advancements over the last few decades, with innovations aimed at improving patient outcome and safety. One such groundbreaking technology is facial ultrasound, which has transformed the way aesthetic procedures are performed. In 1979 ultrasound was introduced in dermatology clinical parctice and much later in aesthetic dermatology.1 Traditionally used in medical imaging, ultrasound is now an indispensable tool in aesthetic dermatology, offering real-time visualization of the skin layers, fat compartments, and vascular structures. This article explores the role, benefits, applications, and future prospects of facial ultrasound in aesthetic dermatology
Copyright (c) 2025 Shehla Shaukat, Zahida Rani (Author) https://creativecommons.org/licenses/by/4.0
Plant exosomes products in the Egyptian market: Innovation, regulatory gaps, and scientific controversy
Plant derived extracellular vesicles (PDEVs), often marketed as plant based exosomes, have gained attention in regenerative medicine and aesthetic dermatology due to their biocompatibility and bioactive cargo. This narrative review critically examines commercially available PDEV based products in the Egyptian market, focusing on their reported composition, proposed mechanisms of action, regulatory status, and current clinical evidence. Products including V-Tech Serum® (Promoitalia, Italy), Rx Elysee Exosome PDRN Ampoule® (Dermafirm, South Korea), Glow Exosome® (Louisderma, France), and ExoLure VISAGE® (Hyalure, Italy) are discussed. Available data suggest potential roles in skin rejuvenation, wound healing, and hair restoration; however, product specific clinical evidence remains limited. Significant gaps persist regarding standardized manufacturing methods, transparency of bioactive components, and regulatory oversight. Future well designed clinical trials and standardized characterization protocols are essential to validate safety, efficacy, and reproducibility of PDEV based therapies in aesthetic and therapeutic dermatology.
Polynucleotide injectables in aesthetic medicine: A review of mechanisms, clinical uses, and comparative products with insights from the Egyptian market
Polynucleotides (PNs), derived primarily from purified trout or salmon DNA, have recently emerged as injectable biostimulatory agents in regenerative and aesthetic medicine. By enhancing hydration, stimulating fibroblast proliferation, modulating inflammation, and promoting collagen synthesis, PNs support tissue repair and skin rejuvenation. Several formulations including; Rejuran®, Nucleospire®, PhilArt®, and Plenhyage XL® have been introduced, each differing in composition, clinical applications, and market presence. This review provides a comparative overview of these products, emphasizing their mechanisms of action, clinical indications, regulatory status, and safety profiles. Beyond their use in dermatology and aesthetics, PN-based injectables show promise in dentistry, ophthalmology, and orthopedics, highlighting their expanding role in regenerative therapies. While accumulating evidence supports their efficacy, gaps remain in standardization, comparative clinical trials, and long-term safety evaluation.
An innovative multilayered neurotoxin injection technique for the mentalis muscle: A comparative study with superficial and deep approaches
Background: The mentalis muscle critically influences chin contour and lower facial aesthetics. Conventional botulinum toxin injections, targeting either superficial or deep layers, often produce variable results in muscle relaxation, skin smoothness, and facial harmony. A multilayered injection strategy may improve outcomes by addressing multiple muscle depths while preserving natural facial movement. Objective: To compare the aesthetic outcomes and safety of superficial, deep, and multilayered botulinum toxin injection techniques in the mentalis muscle. Methods: Thirty Middle Eastern female participants were allocated into three groups (n=10 each): superficial, deep, and multilayered injections. Muscle activity was assessed via electromyography, while aesthetic improvements were evaluated using standardized photographs and patient satisfaction scores. Adverse events were systematically recorded. Results: The multilayered injection group demonstrated superior outcomes, including balanced chin contour, smoother skin texture, and higher patient satisfaction (p<0.05) compared to single-depth techniques. This approach minimized excessive relaxation and asymmetry, preserving natural lower facial dynamics. Minor transient effects were observed in other groups, but no major complications occurred. Conclusion: Multilayered botulinum toxin injections in the mentalis muscle provide enhanced aesthetic outcomes with minimal complications, suggesting a refined and effective alternative to conventional single-depth techniques. Further studies with larger cohorts are warranted to validate these findings.
Efficacy of Lipolytic Injections with Dietary Modifications in Weight Management: A Comparative Study
Abstract: This study investigates the efficacy of lipolytic injections alone versus lipolytic injections combined with dietary modifications in weight management. A total of 22 participants (aged 32-48 years) with a starting weight of 67–89 kg were randomly assigned to two groups: Group A received lipolytic injections only, while Group B received lipolytic injections alongside a high-protein, low-refined carbohydrate, and low-fat diet. Measurements of waist circumference and weight were taken at baseline, 6 weeks, and 10 weeks. Results revealed that Group B experienced significantly greater reductions in both waist circumference and body weight compared to Group A, with notable improvements at both 6 and 10 weeks. These findings suggest that combining lipolytic injections with dietary changes provides a more effective approach for weight loss and waist reduction than injections alone.
Lipolytic injections, weight loss, dietary changes, waist circumference
Copyright (c) 2025 Areej Haroon (Author) https://creativecommons.org/licenses/by/4.0
The N Point technique: A Next-Gen approach to natural under eye restoration
Objective: Under-eye rejuvenation with hyaluronic acid (HA) fillers remains a challenging aesthetic procedure due to the anatomical complexity and risk of complications. Various techniques have been proposed to address tear trough deformity, each with its advantages and limitations. This study presents a modified single-entry injection technique using a 23G 30 mm microcannula to enhance safety and aesthetic outcomes. Methods: This prospective study included 60 Middle Eastern female patients who presented to our clinic seeking under-eye rejuvenation. A single entry point was established at the base of the V-shaped deformity, aligned with the mid-pupillary line. A 23G 30 mm cannula was introduced to administer HA filler at three strategic locations: (1) the sub-orbicularis oculi fat pad, (2) the orbital retaining ligament, and (3) multiple aliquots along the inferior orbital rim. This was followed by a superficial linear retrograde deposition along the tear trough. Patient satisfaction score, infraorbital improvement score and complications were assessed preoperatively and postoperatively at 14 days, 3 months, and 6 months. Statistical analysis was conducted to evaluate outcome measures. Results: No major complications, including vascular occlusion, Tyndall effect, or delayed-onset nodules, were observed. All patients reported high satisfaction at the 14-day follow-up, which was sustained throughout the 6-month evaluation period. Statistical analysis confirmed a significant improvement in patient-reported outcomes (p-value and significance levels to be inserted). Conclusion: The N-Point Technique for under-eye filler injection provides an effective and minimally invasive approach to treating infraorbital hollowness. By addressing both deep and superficial anatomical layers, this method enhances aesthetic outcomes while minimizing adverse effects. The technique offers a safe alternative for achieving natural and long-lasting under-eye rejuvenation.
Copyright (c) 2025 Noury Adel (Author) https://creativecommons.org/licenses/by/4.0
The Lip Exo-S technique: Synergistic bioregenerative lip boosting with PDRN, Exosomes, HA Skin Boosters, and a Hyaluronic Acid Rejuvenating complex
Objective: The purpose of this study is to assess the effects of injecting the lips with a mixture of polydeoxyribonucleotide (PDRN), non-cross linked hyaluronic acid (HA) skin booster, exosomes and a hyaluronic acid rejuvenation complex vial to increase lip hydration, elasticity and rejuvenation in Middle Eastern patients. Methods: Thirty female Middle Eastern patients who seeked a lip rejuvenation treatment at our clinic were included in the study. Using a micro cannula, a single syringe containing a combination of PDRN, non-cross linked HA skin booster, exosomes and a hyaluronic acid rejuvenation complex vial was injected in the lips of each patient. Statistical analysis was performed to evaluate the patient satisfaction score prior to and post the injection procedure through different intervals. Results: All patients reported a marked improvement in satisfaction immediately after the injection despite the moderate swelling; we also noted an improvement in lip texture, elasticity along with a decrease in the depth of the fissures in addition to a hypopigmentation effect on the lips. Conclusion: For lip boosting, a combination of PDRN, non-cross linked HA skin booster, exosomes and a hyaluronic acid rejuvenating complex vial can improve the quality of the lip tissue without adding volume, giving the lips a smoother texture. For lip hydration purposes, this hybrid approach yields better outcomes than the use of each product alone, which was described in our previous studies.