Cohesive Polydensified Matrix Research Articles

Jawline Sharp Contouring With Hybrid Filler.

Having a well-defined jawline is a sign of youth and attractiveness among both men and women. Soft tissue fillers, such as calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, offer nonsurgical alternatives for rejuvenating the lower face and enhancing the jawline. The aim of this study was to investigate the use of a premixed combination of HA with cohesive polydensified matrix technology (CPM, Belotero Intense, CPM-I) and CaHA to create a sharply defined jawline. A total of 126 patients were enrolled in the study and treated with a premixed combination of CPM-I and CaHA using a retrograde fanning injection technique with cannulas. The injection volumes and product ratios were customized according to the patients' needs. The cohort consisted of 75 females and 51 males. The average injected volume of premixed CaHA:CPM-I was 5.83mL. In the majority of patients, a 1:1 syringe ratio of CaHA:CPM-I was applied (n = 81, 64.2%). No adverse events were reported during the 6-month follow-up period. The hybrid filler approach investigated in this study shows promise for achieving well-defined, long-lasting jawline contours. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The gold protocol: A combined treatment approach for neck rejuvenation with calcium hydroxyapatite, botulinum toxin, and hyaluronic acid in the same session.

The signs of aging seem to be more visible on the neck compared to other locations, especially if a patient has already gone through facial rejuvenation procedures. Treatment of the aging neck imposes a challenge to the clinician, since one single approach is usually not enough to achieve the desired result, requiring multiple injections and sessions, which apart from being painful for the patients, is time-consuming for the clinician. To describe the use of calcium hydroxyapatite, incobotulinum toxin type A and Cohesive poly-densified matrix hyaluronic acid diluted in the same syringe and injected in the same session for neck rejuvenation. Fifteen women, older than 18 years, with cervical skin flaccidity grade 1-4 in a previously validated 5-point rating scale (Dermatologic Surg, 2016; 42, S94), who sought neck rejuvenation were injected in this pilot study with a single session with a combined hybrid mixture of calcium hydroxyapatite, incobotulinum toxin type A, and Cohesive poly-densified matrix hyaluronic acid and followed up for 90-180 days. At the 4-month post injection evaluation, 93.3% of the patients presented at least 1-grade improvement in the 5-point scale as evaluated by the investigator. No serious adverse events were reported, being most mild and transient in nature. CaHA, incoBonTA, and CPM-HA have complementary mechanisms of action and may be injected from the same syringe in the same session, boosting the final outcome, with high patient satisfaction, and ease of process for both patients and clinicians.

A Prospective, Multicenter, Evaluator-Blind, Randomized, Controlled Study of Belotero Balance (+), a Hyaluronic-Acid Filler with Lidocaine, for Correction of Infraorbital Hollowing in Adults.

The infraorbital hollow (IOH) is a concavity that interrupts the smooth transition between the lower eyelid and the cheek, resulting in a fatigued and aged appearance. Injectable fillers may be used to correct volume deficit in the under-eye area, restoring a more youthful appearance. To demonstrate the effectiveness and safety of a Cohesive Polydensified Matrix® (CPM) hyaluronic acid (HA) filler with lidocaine (Belotero Balance® (+)) for correcting volume deficit in the IOH. Eligible patients with a moderate or severe rating on the Merz Infraorbital Hollow Assessment Scale (MIHAS) were randomized 2:1 to treatment or control. Controls remained untreated until Week 8 and were then treated. Touch-up injections were allowed; retreatment was offered only in the treatment group. Effectiveness was evaluated by the MIHAS. Adverse events were recorded over a 76-week period. The estimated average response rate (≥ 1 point MIHAS improvement) was 80.6% [95% confidence interval (CI): 71.4%, 87.4%] in treated patients and 1.9% [95% CI: 0.3%, 10.2%] in controls at Week 8. The difference in estimated response rates was 78.7% [95% CI: 66.3%, 85.6%], demonstrating a statistically significant, superior response rate in treated patients compared to untreated controls. A total of 88/97 (90.7%) patients who responded to treatment at Week 8 retained improvement 48 weeks after treatment. Use of Belotero Balance (+) in the IOH had a favorable safety profile, with no unexpected adverse events reported. Belotero Balance (+) is a safe and effective treatment for correcting volume deficit in the IOH.

Comparison of Hyaluronidase-Mediated Degradation Kinetics of Commercially Available Hyaluronic Acid Fillers In Vitro.

The ability to degrade hyaluronic acid (HA)-based fillers with hyaluronidase allows for better management of adverse effects and reversal of suboptimal treatment outcomes. The aim of this study was to compare the enzymatic degradation kinetics of 16 commercially available HA-based fillers, representing 6 manufacturing technologies. In this nonclinical study, a recently developed in vitro multidose hyaluronidase administration protocol was used to induce degradation of HA-based fillers, enabling real-time evaluation of viscoelastic properties under near-static conditions. Each filler was exposed to repeated doses of hyaluronidase at intervals of 5 minutes to reach the degradation threshold of G' ≤ 30 Pa. Noticeable differences in degradation characteristics were observed based on the design and technology of different filler classes. Vycross fillers were the most difficult to degrade and the Cohesive Polydensified Matrix filler was the least difficult to degrade. Preserved Network Technology products demonstrated proportional increases in gel degradation time and enzyme volume required for degradation across the individual resilient hyaluronic acid (RHA) products and indication categories. No obvious relationship was observed between gel degradation characteristics and the individual parameters of HA concentration, HA chain length, or the degree of modification of each filler when analyzed separately; however, a general correlation was identified with certain physicochemical properties. Manufacturing technology was the most important factor influencing the reversibility of an HA product. An understanding of the differential degradation profiles of commercially available fillers will allow clinicians to select products that offer a higher margin of safety due to their preferential reversibility.

Treatment of deep wrinkles with superficial application technique of hyaluronic acid

Introduction: Throughout the aging process, the skin is subject to continuous structural, cellular and molecular modifications that affect not only its mechanical properties but also its biological and physiological functions, which clinically, it manifests with dry skin, loss of elasticity and the consequent appearance of fine lines, wrinkles and creases, representing a therapeutic challenge with a difficult solution. Objective: To describe the superficial application technique of cohesive polydensified matrix hyaluronic acid (Belotero soft®) for the resolutive treatment of superficial perioral, periorbicular and lateral wrinkles and creases of the face. Conclusion: The superficial and transversal application technique showed to be ideal for the treatment of wrinkles and superficial creases, without description of important adverse effects or Tyndall effect with the cohesive polydensified matrix hyaluronic acid that was applied.

Treatment of Deep Wrinkles with Superficial Application Technique of Hyaluronic Acid

Introduction: Throughout the aging process, skin is subject to continuous structural, cellular and molecular modifications that affect not only its mechanical properties but also its biological and physiological functions, which clinically is manifested by dry skin, loss of elasticity and the consequent appearance of fine lines, wrinkles and creases, representing a therapeutic challenge with a difficult solution. Objective: to describe the superficial application technique of cohesive polydensified matrix hyaluronic acid (Belotero soft®) for the resolutive treatment of superficial perioral, periorbicular and lateral wrinkles and creases of the face. Conclusion: The superficial and transversal application technique showed to be ideal for the treatment of wrinkles and superficial creases, without description of important adverse effects or Tyndall effect with the cohesive polydensified matrix hyaluronic acid.

A split-face comparative performance evaluation of injectable hyaluronic acid-based preparations HCC and CPM-HA20G in healthy females.

Skin revitalizers are used for skin quality improvement purposes. Hyaluronan hybrid cooperative complexes (HCC, Profhilo®, IBSA Pharmaceuticals) are an anti-aging treatment with a large amount of pure hyaluronic acid (HA) based on stable, cooperative, and hybrid complexes. Cohesive polydensified matrix Hyaluronic Acid (CPM-HA20, Belotero Revive®, Merz Pharmaceuticals GmbH) is a slightly cross-linked HA (20 mg/ml) with glycerol (17.5mg/ml). To evaluate the performance of HCC and CPM-HA20G for skin quality improvement in healthy female subjects. This was a split-face, single-blinded study that enrolled 24 healthy female subjects. Injections were given on three separate occasions. HCC was injected on the right cheek, while CPM-HA20G was injected on the left cheek. A battery of skin property measurements was used to evaluate the skin. Skin properties and overall satisfaction were analyzed using mixed models with the values at baseline, at week 1, week 8, and week 14 as an outcome and a random effect of subject and fixed effects of treatment, visit, and the treatment by visit interaction. Both products showed evidence of effect relative to baseline on surface hydration (AU), elasticity (N/m) TEWL (g/m2 h), and melanin (AU). CPM-HA20G also showed significant evidence of effect relative to baseline on water content (%), and HCC on pore count (n) and hemoglobin (AU). Satisfaction reported by the subjects themselves showed positive trends of satisfaction over time for multiple skin properties. There were no significant differences between the tested products in the observed skin characteristics over time. These devices are effective and safe treatments for skin quality improvement, especially moisturization, with high patient satisfaction and generally mild and transient side effects.

Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications.

BackgroundAs the treatment indications for the Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.MethodsAn international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.ResultsConsensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.ConclusionThe recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.

Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler

BackgroundLimited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA).MethodsThe authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors’ aesthetic practices. The midface and lower face were injected. Patients’ records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded.ResultsA total of 41 patients were included, all females with a mean age of 47.5 years (range 21–63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28–1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43–0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported.ConclusionThe results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Clinical Validation of Superficial Lip Injections Utilizing Cohesive Polydensified Matrix Hyaluronic Acid-Based Soft Tissue Fillers.

A combination of optimal injection technique and dermal filler choice is key for improving lip architecture with natural and long-lasting results. To investigate the positioning of Cohesive Polydensified Matrix™ (CPM) hyaluronic acid (HA) fillers after superficial lip injections and document their tissue integration and effects on lip architecture and shape. Eligible patients underwent lip contouring and volumization using a superficial direct tissue action technique. All injections were performed with CPM-HA lip fillers using a 30G needle and retrograde microthreading. Total injected volume was 0.8-1.2 mL. High-resolution ultrasound (US) imaging, 3D surface scanning, and Global Aesthetic Improvement Scale (GAIS) assessments were performed before, and 1, 3 and 6 months post-injection to define the anatomy, positioning, longevity and patient satisfaction. Sixteen patients were injected (mean age, 33.2 years). US measurements revealed an increased skin–orbicularis oris muscle distance up to 1 month post-injection after which measurements returned to baseline values. This observation correlated with complete product integration into the surrounding tissue visualized by US at 3 months. An increased dry mucosa thickness (vermilion body) remained at 6 months, and GAIS scores revealed 70% of patients continued to experience visible lip improvements. 3D analyses revealed significantly increased total lip surface area at 3 months with increased Cupid’s bow distance, philtral height, and anterior upper lip projection. Superficial injection of CPM-HA fillers offers an effective and safe tool for improving lip architecture and volume. Results showed homogeneous dermal integration of the product and aesthetic outcomes maintained up to 6 months. J Drugs Dermatol. 2021;20(9):940-945. doi:10.36849/JDD.6011.

A Hybrid Filler: Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications

Limited data are available describing the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) in combination. The aim of this study is to investigate the safety of premixing CaHA and HA fillers before injection. The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA in the authors’ aesthetic practices. Patients records were evaluated for adverse events at 1-3 month, 5-7 month and >12-month posttreatment follow-up visits. The retrospective chart review identified 134 patients who had been treated with premixed CaHA: HA, most of whom were female (95%). Most patients were treated for multiple facial areas. Injections were subcutaneous and performed with 25G 38- or 50-mm cannulas, using a fanning injection technique. Injection volumes and product ratios depended on the number of areas being treated and severity of the aesthetic defect. Only 2 adverse events were reported which comprised slight cases of overcorrection at 1-3 months, both of which resolved with hyaluronidase. No other adverse events were reported. This combined evaluation of the published literature and retrospective examination of case reports raised no concerns about the use of premixed CaHA and CPM-HA (Hybrid) fillers for the treatment of a range of facial aesthetic indications.

The Aesthetic Concerns of Botulinum Toxin Type A in the Treatment of Neck Wrinkles: A Systematic Review.

The aged and unattractive appearance of the neck has a profound impact on the overall youthfulness and attractiveness of the face. Neck wrinkles are one of the manifestations of neck skin aging. Botulinum toxin type A (BTX-A) represents an effective means for aesthetic neck rejuvenation as novel facial rejuvenation technologies are progressively developed. The objective of this article was to review the pertinent clinical literature for descriptions of BTX-A treatments and evaluations of their efficacy and safety for neck wrinkles. The Web of Science, PubMed, EMBASE, Cochrane Library, and SCOPUS databases were searched from inception to April 30, 2020, for the existing literature, which is presented along with the authors' experience with neck wrinkles. Overall, 112 women between 24 and 65 years of age were included in 3 studies of monotherapy and 2 studies of multimodal combination therapy. BTX-A has been reported in combination with other approaches, including intensity focused ultrasound, cohesive polydensified matrix hyaluronic acid, and microfocused ultrasound. Only 1 of the 3 reports on monotherapy had a less than 50% satisfaction and improvement rate. Overall, BTX-A attained high patient satisfaction without serious and persistent side effects, notwithstanding the relatively limited sample size. The existing research cannot strongly prove the aesthetic effect of BTX-A in neck wrinkles. However, BTX-A is probably an effective technology in response to the growing demand for neck wrinkle treatment, whether in a single treatment or combined treatment.

Evaluating an incobotulinumtoxinA and Cohesive Polydensified Matrix® hyaluronic acid filler combination to treat moderate-to-severe periorbital and perioral rhytids.

To evaluate the effectiveness of treating mimetic facial lines with an incobotulinumtoxinA (INCO) and Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) combination. Subjects with moderate-to-severe lateral periorbital lines (LPL) and perioral lines at rest according to Merz Aesthetics Scales™ received 10U of INCO/eye and up to 10U to the perioral area. This was followed by intradermal injection of 1-3cc CPM-HA to the same lines. Primary outcomes were physician- and subject-rated improvement at 1month using the Global Aesthetic Improvement Scale (GAIS) and changes in line severity using the Merz Aesthetics Scales™ . The study included 10 women aged 42-74years with moderate-to-severe LPL and perioral lines at baseline. At 1month, treating physician GAIS scores indicated 45.0% of subjects were very much improved and 52.5% much improved; 75% remained at least improved at 6months. Subject GAIS results indicated 7 women rated themselves as very much improved and 3 as much improved. For LPL, improvements of ≥1-point on the Merz Aesthetics Scales™ compared with baseline were seen at 1, 3, and 6months in 86.8%, 74.3%, and 65.8% of subjects, respectively. For perioral lines, improvements of ≥1-point were observed for 89.2%, 86.5%, and 73.0% at 1, 3, and 6months, respectively. No treatment-related adverse events were observed. Combined INCO/CPM-HA filler in individuals with moderate-to-severe LPL and perioral lines was effective at improving overall appearance and reducing line severity in two highly mobile facial areas that are the first to show lines of aging.

Combination Approach to Tear Trough Deformities and Under Eye Appearance Using Microfocused Ultrasound With Visualization and Hyaluronic Acid Filler

Filler for tear trough deformities and improved under eye appearance has become a well-accepted procedure to treat fine lines, wrinkles, shadowing, darkness, and hollowness. Microfocused ultrasound with visualization–induced skin tightening can be a powerful modality to treat periocular laxity on its own. There is also considerable rationale for combining these 2 modalities for synergistic rejuvenation of the entire periocular area. This case series recruited participants with mild-to-moderate skin laxity in the periocular area and tear trough deformities. Participants received microfocused ultrasound with visualization therapy followed 3 months later by injection with Cohesive Polydensified Matrix hyaluronic acid gel. Photographs were taken at baseline, 3 months after microfocused ultrasound with visualization therapy, and 1 month after Cohesive Polydensified Matrix hyaluronic acid injection for rating by physicians and participants using the Global Aesthetic Improvement Scale. All participants also completed a satisfaction questionnaire. This pilot study enrolled 10 participants ranging in age from 35 to 55 years. After microfocused ultrasound with visualization alone, physicians rated 4 participants “much improved,” 5 “improved,” and 1 with “no change.” After participants had received both treatment modalities, physicians rated 9 participants as “very much improved” and 1 as “much improved.” Participant satisfaction was high with microfocused ultrasound with visualization alone and even higher with the combined treatment approach with all 10 participants reporting their periocular appearance “very much improved” at the end of the study. No treatment complications were observed. In conclusion, microfocused ultrasound with visualization in combination with Cohesive Polydensified Matrix hyaluronic acid gel was effective at improving appearance of the eye area in participants with periocular skin laxity and tear trough deformities.

A Randomized, Blinded, Prospective Clinical Study Comparing Small-Particle Versus Cohesive Polydensified Matrix Hyaluronic Acid Fillers for the Treatment of Perioral Rhytids.

Perioral rhytids are a bothersome sign of aging for many patients. Although multiple treatments exist, choosing an optimal modality may be difficult considering that rhytids in this region are fine and the anatomy dynamic. The authors sought to compare the efficacy and safety as well as patient satisfaction of a small-particle hyaluronic acid filler with 0.3% lidocaine (SP-HAL, Restylane Silk) and cohesive polydensified matrix hyaluronic acid filler (CPM-HA, Belotero Balance) in reducing superficial perioral rhytids. The study was double-blinded, and 48 patients with moderate to severe superficial perioral rhytids were enrolled. Patients were randomized to receive either CPM-HA in the left perioral region and SPHAL in the right or vice versa. Rhytid severity was measured by patients utilizing a linear analog scale, and by investigators utilizing a validated 5-point scale, for 180 days following treatment. Both SP-HAL and CPM-HA achieved a reduction in rhytid severity, and neither treatment group returned to baseline after 180 days. Investigator-reported scores for rhytid severity were significantly better for SP-HAL than CPM-HA and remained so at 180 days (P < .05). SP-HAL also proved significantly better for reducing rhytids according to patient scores, although this difference occurred between 120 and 180 days only. Adverse events included rash and mild acne for CPM-HA, and SP-HAL was associated with 1 postinflammatory nodule and 2 occurrences of Tyndall effect. Although both SP-HAL and CPM-HA are effective at reducing perioral rhytid severity and have similar safety profiles, SP-HAL possesses a longer duration of effect.

Interactive tissue reactions of 1064‐nm focused picosecond‐domain laser and dermal cohesive polydensified matrix hyaluronic acid treatment in in vivo rat skin

Picosecond-domain laser treatment using a microlens array (MLA) or a diffractive optical element (DOE) generates micro-injury zones in the epidermis and upper dermis. To investigate interactive tissue reactions between MLA-type picosecond laser pulses and cohesive polydensified matrix hyaluronic acid (CPMHA) filler in the dermis. In vivo rats with or without CPMHA pretreatment were treated with a 1064-nm picosecond-domain neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using an MLA or DOE. Skin samples were obtained at post-treatment days 1, 10, and 21 and histologically and immunohistochemically analyzed. Picosecond-domain Nd:YAG laser treatment with an MLA-type or a DOE-type handpiece generated fractionated zones of pseudo-cystic cavitation along the lower epidermis and/or upper papillary dermis at Day 1. At Day 21, epidermal thickness, dermal fibroblasts, and collagen fibers had increased. Compared to CPMHA-untreated rats, rats pretreated with CPMHA showed marked increases in fibroblasts and collagen fibers in the papillary dermis. Immunohistochemical staining for the hyaluronic acid receptor CD44 revealed that MLA-type picosecond laser treatment upregulated CD44 expression in the basilar epidermis and dermal fibroblasts. We suggest that the hyaluronic acid-rich environment associated with CPMHA treatment may enhance MLA-type picosecond-domain laser-induced tissue reactions in the epidermis and upper dermis.

Long-term safety and efficacy study of Cohesive Polydensified Matrix® hyaluronic acid filler for lips shape and volume correction

Long-term safety and efficacy study of Cohesive Polydensified Matrix® hyaluronic acid filler for lips shape and volume correction

Facial skin revitalization with CPM®-HA20G: an effective and safe early intervention treatment.

BackgroundHyaluronic acid (HA) fillers are popular for the treatment of signs of facial skin aging.ObjectiveThe objective of this study was to confirm the performance and safety of a new cohesive polydensified matrix HA filler ([CPM®-HA20G, Belotero Revive®, lidocaine-free], Merz Pharmaceuticals GmbH, Frankfurt, Germany) for the treatment of early signs of facial skin aging by use of biophysical measurements as well as subject and investigator satisfaction.MethodsTwenty-five healthy female subjects with signs of facial skin aging were enrolled in this open-label, rater-blinded, observational post-market clinical follow-up study, and received 20 micropuncture treatments of 50 µL CPM®-HA20G each into the lower cheek area at three injection visits 4 weeks apart. Objective biophysical assessments were conducted to demonstrate effects on viscoelastic properties of the skin, surface roughness, tone and radiance, and hydration, at baseline and at all follow-up visits up to 36 weeks.ResultsCPM®-HA20G significantly increased gross elasticity of the skin (at weeks 9 and 12), skin firmness (up to week 24), skin tone and radiance and skin hydration (all up to 36 weeks). Significant reduction of skin fatigue (up to 9 weeks), skin roughness (up to 28 weeks), and redness (up to 36 weeks) was also observed. Subjects and blinded investigator were highly satisfied with the treatment outcomes. The treating investigator reported a high level of satisfaction with the ease of injection and the clinical performance of the device. Moreover, data demonstrated a good safety profile of the device.ConclusionCPM®-HA20G is considered to be an effective and safe HA injectable for skin revitalization in patients suffering from signs of skin aging and loss of skin elasticity. It seems to be a perfect early intervention approach in patients that do not need volumizing treatment and a combination approach in older patients with more pronounced aging.

Cohesive Polydensified Matrix® cross-linked hyaluronic acid volumizing gel: a magnetic resonance imaging and computed tomography study.

BackgroundConcentrated hyaluronic acid (HA) gels with a high degree of cross-linking such as Cohesive Polydensified Matrix® (CPM) HA have been designed for long-term facial volume restoration.ObjectiveTo determine the behavior and longevity of CPM HA gel, a case series of subjects underwent magnetic resonance imaging (MRI) or computed tomography (CT) scans several years after their initial treatment.MethodsSix subjects, three from the initial CPM HA Conformité Européenne registration study and three from private practice who had received prior injection of CPM HA for facial volumizing indications agreed to undergo an MRI or CT scan at intervals ranging from 1 to 4 years after the initial treatment. The amount of HA gel originally injected was compared with the amount estimated from volumetric analysis of the MRI and CT scans. The scans were also examined for the signs of any abscess or granuloma formation and to determine the behavior of the HA gel over time.ResultsCT and MRI imaging of the six study subjects indicated CPM HA gel persisted for 2–4 years after only a single treatment. In some patients, product was evident in deeper facial fat compartments than originally injected suggesting some diffusion of product had occurred. There was no MRI or CT evidence of abscess or granuloma formation.ConclusionOur findings indicate that CPM HA volumizing gel has substantial longevity when injected subcutaneously or in deep soft tissues.

Multimodal Approach for Treating Horizontal Neck Wrinkles Using Intensity Focused Ultrasound, Cohesive Polydensified Matrix Hyaluronic Acid, and IncobotulinumtoxinA.

For the restoration of horizontal neck wrinkles, multimodal approaches using neuromodulators, intensity focused ultrasound (IFU), and fine line fillers are recommended. To evaluate the efficacy and safety of a 1-day, multimodal approach for horizontal neck wrinkles. Twelve female patients with horizontal neck wrinkles were treated with a combined treatment of IFU, cohesive polydensified matrix hyaluronic acid (CPMHA), and incobotulinumtoxinA. Therapeutic outcomes were assessed on Day 0 and 1, 2, 3, and 6 months thereafter. Horizontal neck wrinkles decreased significantly in length from a median at baseline of 269.75 mm (interquatile range [IQR], 235.35-302.94 mm) to 91.5 mm (IQR, 51.4-108.61 mm) at 1 month, 92.3 mm (IQR, 69.66-132.07 mm) at 2 months, 101.88 mm (IQR, 86-146.77 mm) at 3 months, and 109.48 mm (IQR, 85.06-148.17 mm) at 6 months after the combined treatment. The median global aesthetic improvement scale scores were 3.5 (IQR, 2-4) at 1 month, 3 (IQR, 3-3.5) at 2 months, 3 (IQR, 2-4) at 3 months, and 3 (IQR, 3-3) at 6 months. Post-treatment petechiae resolved completely within 7 days, and CPMHA-induced lumps disappeared within 1 month. The present data demonstrated that the multimodal, combined treatment used in the present study provides satisfactory and long-lasting therapeutic outcomes by targeting different pathogenetic factors of horizontal neck wrinkles.