Facial Rejuvenation Procedures Research Articles

Evaluation of Facial Aging in Different Age and Gender Groups With Computed Tomography-Based Calvarium and Face Measurements.

The human face is a complex area formed by the combination of many different components and varies among individuals according to gender, age, and ethnicity. The aim of this study was to evaluate age-related changes in the facial and calvarial bones in a large sample of both genders. The retrospective study included nontraumatic brain computed tomography scans of 280 Turkish adults. Participants were divided into 7-decade groups with the age ranging from 20 to 89 years. Measurements of the face and calvaria were recorded, and calvarial volume was calculated. The relationship of these parameters with age and gender was examined. Statistically significant differences were observed in all the facial and calvarial measurements, except the transverse diameter of the head, with increasing age in both genders. Regardless of age, no significant differences were found in facial and calvarial measurements between genders. In addition, there was a significant decrease in the calvarial volume in both genders after the seventh decade of life. The structure of the face and calvarium continues to change and differentiate throughout life. Taking these changes into account during surgical and facial rejuvenation procedures can help predict outcomes and avoid the use of incorrect techniques.

Vectorial Analysis of Deep Plane Face and Neck Lift.

The vector of aging and consequently the vector of lift in rhytidectomy has aided surgeons to improve movement of tissues during facial rejuvenation procedures. To analyze the vector of lift in patients undergoing primary and revision facelift in order to achieve proper vectorial lifting. Patients undergoing deep plane facelift surgery were included for analysis. Intraoperative photographs and measurements were taken of the skin, SMAS and platysmal suture suspension with mastoid crevasse inset. Measurements were compared between patients who were undergoing primary vs secondary surgery, site of lift, age and gender. 71 patients (90% female, mean age 57.8) with a total of 142 hemi-faces were analyzed, 57 (73%) of which were primary, and 14(27%) were secondary facelifts. The average vector of SMAS lifting was 70.8 degrees. Females had a more vertical vector vs males (71.3 vs 65.4; p < 0.01). The average vector of platysmal and skin lift were 87.0, and 58.2 degrees respectively. There was intrasubject difference between hemifaces. Despite there being more inter-suture disparity in secondary cases vs primary cases (16.9 vs 4.5; p < 0.05), the mean vector of lifting was similar between them. Proper release of the deep plane helps determine the appropriate vectors of lift without relying on guidelines based on population averages. Each patient presents with a unique vector required to correct their descent. This technique provides an optimal result by directly suspending against the vectors of greatest descent.

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.

INDIVIDUAL ARTICLE: Real-World Patient Cases Using Botanical Serum-Containing Corrective Gel as an Adjunct to Aesthetic Facial Laser or Microneedling Radiofrequency (MRF) Treatment.

Integrated skin care is defined as the complementary use of topical treatments to nonsurgical facial rejuvenation procedures, such as lasers and radiofrequency microneedling devices, to produce pleasing aesthetic results. Real-world experience from expert dermatologists is invaluable in guiding patient treatment plans, as there are limited clinical trials on the efficacy of integrated skincare regimens. The SkinCeuticals (New York, NY) Phyto Corrective gel (botanical serum-containing corrective gel) contains a lightweight botanical serum that hydrates, calms, and soothes skin. It contains antioxidant and anti-inflammatory ingredients derived from plant&nbsp;and fruit extracts, making it an appealing option for adjunctive treatment of post-procedure erythema and swelling.&nbsp; J Drugs Dermatol. 2024;23:3(Suppl 2):s3-s14.

Complications of facial autologous fat grafting

Autologous fat grafting is a commonly performed procedure for facial volume augmentation and rejuvenation. While overall complication rates in the literature are low, adverse events related to fat grafting can range from minor to systemic and severe. It is crucial that the surgeon be aware of these potential complications, counsel patients appropriately, and take the necessary steps to mitigate these risks. Local graft site complications include contour irregularity, over- or under-volumization, prolonged edema and ecchymosis, fat necrosis, granuloma formation, and infection. Similar complications can also be seen at the donor sites, including contour irregularity, prolonged induration or erythema, infection, and skin pigmentation changes. Finally, the most severe complications, resulting from fat embolism due to intravascular injection, can result in vision loss or stroke. In this review, risk factors for adverse events, surgical techniques to mitigate risk, and potential treatment options for complications of autologous fat grafting are reviewed.

Prospective comparative clinical study: Efficacy evaluation of collagen combined with hyaluronic acid injections for teartrough deformity.

Tear trough filling is a popular facial rejuvenation procedure, and hyaluronic acid is typically used as the filler of choice. However, Tyndall's phenomenon, a common complication following hyaluronic acid injection, can occur, leading to skin discoloration of the lower eyelid. This single-center, prospective, comparative clinical study aimed to evaluate the efficacy of collagen and hyaluronic acid injections in treating tear trough deformity. Sixty patients were enrolled between June 2022 and January 2023. Patients were randomly allocated into three groups: Group A received hyaluronic acid, Group B received hyaluronic acid combined with collagen, and Group C received collagen alone. Baseline characteristics, including age, sex, and tear trough deformity grade were considered before therapy. Changes in tear trough deformity scores, Global Aesthetic Improvement Scores, and the presence of the Tyndall effect were analyzed at 1 and 3 months postinjection to determine differences among the three groups. Baseline profiles of the three groups were similar. In the first month postinjection, there was no difference in the Global Aesthetic Improvement Scores and tear trough deformity between the three groups. However, in the third-month postinjection, there was a significant difference in scores between patients in Group C and those in Groups A or B. The Tyndall effect manifested in three patients in Group A, which was significantly different from that in Groups B and C. The combined use of hyaluronic acid with collagen in injectable fillers corrected tear trough deformities and reduced the occurrence of the Tyndall phenomenon, which can be problematic with hyaluronic acid alone. Additionally, this combination may help overcome the disadvantage of a shorter retention period when using collagen alone.

Platelet-Rich Plasma Versus Platelet-Poor Plasma for Treating Facial Photoaging: a Double-Blind Randomized Controlled Splitting Face Study.

As the demand for non-invasive esthetic procedures to maintain a youthful appearance increases, there has been growing interest in the use of autologous platelet-rich plasma (PRP) and platelet-poor plasma (PPP) for the treatment of facial aging. However, there are few studies directly comparing the efficacy of PRP and PPP for facial rejuvenation. This study aimed to compare the efficacy of PRP and PPP for facial rejuvenation. This single-center, double-blind, randomized controlled trial was conducted from January 1, 2022, to July 31, 2022, and included ten participants who completed the follow-up. The participants were randomly assigned to receive 2.5-mL injections of PRP and PPP on different sides of the face in three sessions with 1-month intervals. The outcome was primarily determined by blinded photographic assessments and secondly by scores of the VISIA® system during the follow-up. Both PRP and PPP treatments resulted in significant improvement in the Global Aesthetic Improvement Scales and Modified Fitzpatrick Wrinkle Scale for periocular Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation wrinkles, with no significant difference between the two groups. However, no improvement was observed in the Wrinkle Severity Rating Scales for nasolabial folds in either the PRP- or PPP-treated groups. Furthermore, no severe adverse events were reported. Both PRP and PPP are effective in treating facial photoaging. PRP exhibited slightly superior efficacy in enhancing overall skin condition, while PPP was slightly more effective in improving shallow wrinkles. This study provides valuable evidence for the use of PRP and PPP in facial rejuvenation procedures. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Micro-face-lift: A novel biplanar, composite, less-invasive procedure.

Facial rejuvenation procedures have been in existence for over a century. Since its first introduction, it improved anatomical understanding and clinical implications and gave rise to numerous techniques and re-ideations of the original face-lift. The increase in popularity of face-lift procedures attracts patients of various ages and with different medical comorbidities. In this paper, we describe the less-invasive facelift procedure, termed the "Micro-Face-lift," with minimal complications, a short recovery period, and few contraindications. The authors retrospectively analyzed the medical files of 51 patients who underwent the "Micro-Face-lift" procedure between 2014 and 2019 by three independent surgeons. Fifty-one patients met the inclusion criteria for the procedure. Forty-nine patients were women (96.1%) and the remainder were men (3.9%). The mean age at the time of the procedure was 60.8 years (range 45-87). Complications were encountered in five patients (9.8%): two hypertrophic scars (3.8%), one hematoma (2%), one surgical wound infection (2%), and one edema (2%), persistent for more than 2 weeks postoperatively. All complications resolved within 6 weeks of postoperatively. Thirty-five patients (68.6%) underwent additional procedures to maximize the aesthetic outcome. Thirty patients (58.8%) underwent submental liposuction and five patients (9.8%) underwent mid-face lipo-filling. The average satisfaction score on the self-reported "Likert" scale was 4.27 (range 1-5). All patients were followed for a minimum period of 18 months. The "Micro-Face-lift" is a less-invasive procedure that can be performed under local anesthesia and sedation in the outpatient setting. Complication rates and mortality are low, contraindications are rare, and the recovery period is short. In our experience, patient satisfaction is high with the Micro-Face-lift procedure, and the learning curve for the experienced practitioner is short.

Ultrasonic Deep-Plane Neck Lift.

Ultrasonic deep-plane neck lift is a new approach for addressing both the subsuperficial musculoaponeurotic system and subplatysmal soft tissues during facial rejuvenation procedures. This innovative surgical approach utilizes 2.2, 2.9, and 3.7 stainless steel probes that are powered by high-frequency ultrasound. Using high-frequency ultrasound in the subcutaneous spaces has been accomplished for the past 20 years with a very suitable safety profile. In this technique, emulsification of the fat layer in both the superficial and deep planes is accomplished with tumescence of the soft tissues in the same fashion as subcutaneous liposuction. In ultrasonic deep-plane neck lift, the superficial and deep layers of fat are targeted for emulsification, and this creates a loosening of these spaces for lifting and repositioning. The procedure facilitates more accurate surgery, because the tissue effects include hemostasis and scalpel- and scissor-free undermining due to the emulsification of the fat layers of the face and neck. The other advantages of ultrasound-assisted facial contouring and rejuvenation include treatment of hard-to-treat areas like the perioral region and distal neck, which can be rapidly and safely undermined utilizing this technology. The third component of ultrasound- and energy-based facial rejuvenation surgery is the long-term remodeling and tightening that occurs beginning approximately 8 weeks after the procedure. When many conventional facelifts are beginning to fall at 3 to 4 months postoperatively, the energy-based facelifts are still tightening and this remodeling continues for up to a year after the procedure. Combining technology with conventional facelift procedures is a new approach to facial rejuvenation and is the result of 15 years of research and cooperation with the aesthetic device industry. The result of this merger of technology with conventional surgery is TESLA Facelifting, the facelift of the future.

Deep-Plane Rhytidectomy: Pearls in Maximizing Outcomes while Minimizing Recovery.

The deep-plane rhytidectomy was first described in 1990 and has gained traction in the past decade as supported by anatomy, embryology, and clinical evidence. Consumer dissatisfaction in facial rejuvenation procedures often occurs because procedures are too conservative and are undone. From the consumer's perspective, an outcome is a combination of the esthetic result, predictability, and the length of the recovery process. The length of the recovery process is often the limiting issue affecting the consumer's willingness to proceed with the procedure. As one of the early pioneers in deep-plane rhytidectomy, the lead author will define contemporary advances in deep-plane techniques such as dissection entry point, flap design, and flap fixation concepts that allow an aggressive approach to treating both the superficial soft tissue envelope and deeper facial aging structures. These technique modifications and insights will provide the surgeon with an understanding of how to achieve significant, natural, long-lasting results with predictable short recovery periods-maximizing outcomes and minimizing postoperative processes.

Toward facial rejuvenation; A clinical trial to assess the efficacy of nano fat grafting on wrinkles.

With increasing age, patients' facial volume decrease. For this reason, nano fat grafting has recently gained popularity as adjunctive treatment to facial rejuvenation procedures. However, few quantitative studies have been conducted to investigate the impact of nano fat on facial wrinkles. In the present study, authors aim to investigate the therapeutic effect of intradermal injection of nano fat on fine facial wrinkles and assess their changes over 7 months of follow-up. In this randomized trial, 15 patients with fine facial wrinkles were enrolled. The fat was harvested from the abdomen and processed into nano fat. Nano fat was injected into the facial wrinkles intradermally with a needle of 27 gauge. The patients were evaluated before and 7 months postinjection utilizing Visio face 1000D (CK electronic, manufactured in Germany); and four parameters of wrinkles (area, volume, depth, and percent area) were evaluated before and after the nano fat injection. Our evaluation with Visio face showed that nano fat injection was significantly reduced the volume, area, depth, and percent area of wrinkles after 7 months of follow-up without serious long-lasting adverse effects. Moreover, wrinkles with higher percent area, depth and volume loss show greater improvement after the treatment. Our results also indicate that males and females equally benefit from this treatment except for the percent area parameter that was improved more significantly in male patients. Our study showed that intradermal injection of nano fat significantly decreases the volume, area, depth, and percent area of fine facial wrinkles. Further quantitative studies with control groups and larger sample sizes are required.

Consensus recommendations on the use of injectable poly-l-lactic acid in Asian patients.

Injectable poly-L-lactic acid (PLLA) has been proven safe and effective with numerous medical applications for more than 25 years. The product has been approved in over 40 countries and is being used for soft tissue augmentation in the face and certain body parts. With the increased demand for subtle and natural-looking aesthetic treatments in the Asia-Pacific region, there is also a heightened need for consistent preparation and effective treatment methodologies to optimize outcomes for Asian patients. The body of evidence in medical literature, clinical data of presented case reports, and the collective experience of the authors are reflected in these consensus recommendations, which also take under consideration the availability of biostimulators in the Asia-Pacific region. The resulting consensus recommendations include patient selection and assessment, management of treatment expectations, appropriate preparation and storage, proper injection techniques and treatment plans, management of adverse effects, PLLA combination with other facial rejuvenation procedures, and other constructive considerations. In the above consensus recommendations, the authors shared their best practices in accordance with the updated preparation and treatment protocols of PLLA. These recommendations represent the clinical and real-world techniques utilized by authors in providing PLLA treatments for Asian patients.

Tendency to Facial Rejuvenation in the General Population: An Ecological Study

Background: Today, the solutions for skin aging and rejuvenation methods are of special importance. Objectives: This study aims to investigate the desire to perform various methods related to facial rejuvenation in Iran and the world. Methods: It is an ecological study conducted using the Google Trends (GT) database. We initially searched for users' specified search terms related to "Botox," "Gel injection," "Laser," "Facelift," "Fillers," and "COVID-19" among all searches performed using GTs in the world and Iran from January 2017 to July 2023. Results: The trend of GT shows that the search volume for laser and filler services is higher than for other services worldwide. In Iran, laser and gel injections had the highest search volume until 2022. However, from 2022 onwards, fillers have become one of the top searched services. In 2020, with the onset of the COVID-19 pandemic, the significant impact of the pandemic on facial rejuvenation procedures worldwide, including in Iran, became evident. There is a significant negative correlation between the volume of searches for COVID-19 and facial rejuvenation procedures worldwide (R2 = -0.52, P = 0.0001) and in Iran (R2 = -0.84, P = 0.0001). Conclusions: Many people worldwide and in Iran are looking for facial rejuvenation. Clinicians can enter this business with a positive outlook. GT data is a powerful tool for predicting the demand for facial rejuvenation procedures.

Decades of beauty: Achieving aesthetic goals throughout the lifespan.

Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment). To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade. This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns. Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes. Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.

Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Report.

The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively. The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.

A novel technique for repositioning facial soft tissues with barbed polydioxanone threads based on the main aging vector force of rejuvenation

Background: With the evolution of facial rejuvenation procedures, thread lifts have gained space among western patients who seek cosmetic improvement without undergo to surgeries. Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available, and in mid-lower face and mandibular jowl lift, threads are most often implanted in a diagonal vector force from medial-inferior up to lateral-superior site, near the temple. Herein, the authors introduce a new technique based on this oblique sum of anti-aging vector force to reposition and anchorage facial soft tissues, aimed for natural youth rejuvenation. Objective: Describe a novel technique for counteracting the facial ptosis and laxity skin, as well as the duration of clinical lifting result and of skin quality improvement. Methods: More than 84 patients were underwent in this thread technique once. The outcomes were assessed objectively using serial photography and subjectively based on the patients’ spontaneous satisfaction through over these 4 years. Complications were also reported. Results: Most patients considered the results satisfactory. The incidence of complications was low, and most of them were minor and temporary. Conclusion: Wedge-shaped PDO thread repositioning and anchorage soft tissue is safe and effective method for rejuvenation.

Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis.

This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure. According to our findings, 20% of the subjects had an exceptional improvement; 20%, "very improved"; and 60%, "improved." Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001). In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.

Rheology Of Hyaluronic Acid Dermal Fillers: Understanding The Science ToImprove Results In Clinical Practice

Hyaluronic acid fillers are one of the most frequently used in cosmetic procedures. They are popular because of their ability to restore volume to the face, which surgery isn’t capable of. Inside the skin, the implant is subjected to various mechanical forces that vary according to the anatomical area. Every filler has specific rheological properties which change the way it performs in the clinical environment. A sound understanding of how the anatomy of the face works, alongside the rheological properties of the filler, is vital for successful outcomes in facial rejuvenation procedures.

Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature.

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. 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 .

Benefits of topical hyaluronic acid for skin quality and signs of skin aging: From literature review to clinical evidence.

Skin aging goes beyond a chronological process and also results from extrinsic factors referred to as the exposome. Hyaluronic acid (HA) is an important component of the extracellular matrix, with loss starting at 25 years old. While many studies of HA concern topical use, few literature reviews only address the use of topical HA in dermatology. This review describes the different characteristics of HA-containing cosmeceuticals, with a focus on skin aging and the impact of exposome factors on HA synthesis and degradation. A review was performed using the terms HA, hyaluronan, topical, dermatology, cosmetic, aging treatment, exposome, and cosmeceuticals. Results are also presented from a recent randomized controlled trial (RCT), which investigated the additional benefit of using a HA epidermic filler (HA-filler serum) combined with Botulinum toxin type A (BoNTA) to treat signs of skin aging. Subjects were randomized to two groups: HA-filler serum starting 24 h after the BoNTA injection then twice daily for 24 weeks, or the control group, which received BoNTA. HA is a key ingredient used in cosmeceuticals for its hydration/antiaging properties (hygroscopic, rheological, and viscoelastic). Several clinical studies indicate that HA is both well tolerated and effective, adjuvant to both post-surgical and facial rejuvenation procedures. In the RCT, one of few studies to combine BoNTA and HA with a 6-month follow-up, the HA-filler serum lengthened the duration of BoNTA's effect in reducing wrinkles. Numerous studies support HA-based cosmeceuticals as a noninvasive, effective solution for improving skin hydration and rejuvenation.