Hyaluronic Acid-based Fillers Research Articles

Treatment of the Nasolabial Fold Using a Hyaluronic Acid-Based Filler with eXcellent Three-Dimensional Reticulation (XTR™) Technology: A Retrospective Study.

The physicochemical characteristics of hyaluronic acid (HA) fillers can affect the outcome of minimally invasive aesthetic treatments. The effect of a novel HA-based filler manufactured with a novel 3D structure (XTRTM technology) was assessed in the nasolabial fold. We performed a retrospective study of patients who underwent treatment of the nasolabial fold with a novel HA filler in our clinic. Treatment outcome was assessed at 3 and 6 months with wrinkle score, GAIS, and VAS. Eighteen patients were injected with the novel HA filler in the nasolabial fold. At six months, mean wrinkle scores were improved on both sides compared to baseline. GAIS and VAS were high at three and six months. The HA-based filler manufactured with XTRTM technology is safe and effective in treating the nasolabial fold. Good aesthetic results were seen for up to 6 months. Patient satisfaction was high during the entire follow-up.

Investigating the impact of added Profhilo mesogel to subcision versus subcision monotherapy in treating acne scars; a single-blinded, split-face randomized trial.

Acne scar is an inflammatory condition, which commonly occurs in patients with acne vulgaris, especially in adults. Mesogels have been reported effective in improving atrophic acne scars. We investigated the efficacy of adding Profhilo (a hyaluronic acid-based filler) to subcision as a new treatment method. Twelve patients aged 18-45 years with atrophic acne scars on both sides of the face participated in this single-blinded, split-face, randomized controlled trial. Each side of the face was randomly assigned to one of the treatment methods, including subcision alone and subcision + Profhilo. Patients in the Profhilo arm received mesogel (1 cc) in addition to the subcision procedure. Both methods were carried out two times at 1-month intervals. Assessments were done based on the sonographic depth of scars, and two blinded observers examined photographs at baseline and 3 months after the final session and the results were reported based on an exclusively made formula as the total score. The Global Improvement Scale and Visual Analogue Scale (VAS) (for patient satisfaction) were also used. The VAS score of patient satisfaction was statistically significant in the Profhilo arm, with a mean improvement of 528.08 and 219.06 in the subcision arm (p = 0.02). No significant difference was seen in total acne scar reduction comparing the two methods (29.74 in the Profhilo arm and 22.27 in the subcision arm, p = 0.56). Sonographic depth reduction was also non-significant, with a mean of 29.21 in the Profhilo arm and 28.53 in the subcision arm (p = 0.4). The mean global improvement was reported as four in both arms, and no statistical significance was observed (p = 0.89). The best response to treatment belonged to the rolling subtype in both methods (p = 0.029 for the Profhilo arm and p = 0.001 for the subcision arm). Despite no significant difference between the methods, Profhilo is more effective due to a higher satisfaction rate and better physiologic effects.

High-resolution ultrasound in diagnosing complications after facial contouring injections. A clinical case.

The development of new techniques of procedure and line extensions of products for facial contouring injections leads to an increase in the incidence of facial soft tissue complications and adverse reactions. The article presents a clinical case of complications after previous facial contouring injections with hyaluronic acid-based fillers. In high-resolution ultrasound the signs of inflammatory changes in the facial soft tissues were found, which affected the further treatment strategy.

MANDIBULAR FILLING

Context: Mandibular contouring is important for facial appearance and maintaining youth, as well as being key to defining masculine versus feminine facial features. Dermal fillers, for the most part, are non-invasive and temporary procedures, and may be a choice for correcting mild to moderate lack of definition in the mandibular contour of individuals who seek a less invasive treatment when compared to surgery or who have not yet decided to make permanent changes. in your facial appearance. Objective: To evaluate the effectiveness of the highly crosslinked hyaluronic acid-based filler, Restylane@LyftTM, for treating the mandibular line using the MD Codes technique. Methods: A brief literature review on jaw augmentation using injectable fillers, as well as a case report. Results: Observed through a quantitative evaluation method, obtained through stereophotogrammetry with the Vectra software, quantified through a metric scale of motion vectors and a metric scale of relief observed during treatment. Conclusions: There is high efficacy in the use of highly crosslinked hyaluronic acid filler, Restylane@LyftTM, using the MD Codes technique for volumization and redefinition of the mandibular contour.

VASCULAR COMPLICATION AFTER LATERAL TEMPORAL LIFTING TECHNIQUE: A CASE REPORT

Vascular complication after lateral temporal lifting technique with hyaluronic acid-based fillers may result from arterial occlusion by direct injection into the artery or embolization with the product, which is usually immediately manifested by acute pain and scarlet-red spots due to hemorrhagic blisters. Vascular complication can also result from venous occlusion caused by external compression of the vessel with soft tissue filler. Vascular occlusion requires immediate treatment as the risk of tissue damage and skin necrosis increases with time. In this paper we consider a clinical case of vascular complication after the technique of lateral temporal lifting of hyaluronic acid, manifested by painfulness of the area of hyaluronic acid injection, Livedo reticularis, alopecia, and treatment of this patient for 3 months.

Spontaneous and induced degradation of dermal fillers: A review

Abstract Dermal fillers are among the most versatile tools in esthetic medicine. A broad range of temporary, semipermanent, and permanent filler products is on the market. We performed a narrative review on spontaneous and induced degradation of dermal fillers in vitro and in vivo. Hyaluronic acid-based fillers are the most frequently used temporary fillers. The products differ in their hyaluronic acid content, cross-linking, and rheological parameters. Endogenous hyaluronidase and reactive oxygen species are responsible for the spontaneous degradation of these fillers. Hyaluronidase digests the filler material by cleavage of the β-1,4 glycosidic linkage between N-acetyl-glucosamine and d-glucuronic acid. The enzyme can be used for treatment of medical and cosmetic adverse events due to hyaluronic acid-based filler. Higher hyaluronidase content and higher degree of cross-linking are major factors contributing to filler persistence over time. Semipermanent fillers are poly-(d),l-lactic acid and calcium hydroxylapatite. These filler types are decomposed by hydrolysis and osteoclastic enzymes. They usually persist up to 2 years, in single patients even more than 5 years. Sodium thiosulfate can stimulate degradation of calcium hydroxylapatite, but it is slow acting and not effective in case of emergency. Permanent fillers may show some kind of modification in situ, but spontaneous or induced degradation has not been documented. Once implanted the permanent fillers remain lifelong. Intralesional laser treatment supports the removal of permanent filler material as an alternative to surgery. Besides biocompatibility and toxicity, filler materials should also be assessed for degradation to improve patient safety.

Hyaluronic acid-based fillers properties and its importance in the practice of Orofacial Harmonization

Injectable fillers based on hyaluronic acid are now frequently used to correct tissue volume loss when facial rejuvenation is sought. The way in which these commercially available HA fillers are manufactured has direct implications for the properties of the gel and the clinical applications of these products. These properties can be described using the science of rheology, which describes the flow and deformation of matter, allowing researchers to understand how these fillers act under mechanical stress, either at the time of injection or after implantation of the gel. It is important to note that the mechanical forces exerted on each anatomical region of the face vary in intensity and frequency, causing the filler to deform in different ways. The aim of this study was to review the literature on the rheological properties of hyaluronic acid gels and to emphasize the importance of knowing these properties when selecting fillers, so that harmonizing professionals can achieve the desired results.

Selected aesthetic medicine treatment in patients with autoimmune diseases - a literature review


 
 
 Introduction Interest in cosmetic procedures has been increasing. Data on practices for correcting aesthetic deficits, including those caused by autoimmune diseases are limited. There are fears of disease reactivation and exacerbation of inflammation after surgery. Aim of the study The aim of the study was to investigate the potential influence and safety of aesthetic medicine treatment - hyaluronic acid, botulinum toxin and breast augmentation with implants in patients with autoimmune diseases. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: autoimmune disease, immunogenicity, inflammation, connective tissue, aesthetic medicine. Results Hyaluronic acid is considered the best filler for cosmetic procedures, mainly due to its lack of immunogenicity. No clinical studies have identified contraindications to the administration of hyaluronic acid-based dermal fillers in patients with inflammatory diseases. Botulinum toxin is essential in alleviating involuntary functions currently associated with dystonia, spasticity, and autonomic disorders. The long-term safety of implants should be assessed concerning genetic and environmental factors and whether the autoimmune disease is in remission.Conclusion With the increasing number of aesthetic procedures using hyaluronic acid, there are more reports of potential adverse events. Most side effects are associated with hypersensitivity reactions. The use of hyaluronic acid products in patients with autoimmune diseases is controversial. However, no clinical studies have identified contraindications to the administration of hyaluronic acid-based fillers. Botulinum toxin is used for healing and pain control in patients with systemic sclerosis who have suffered phalangeal ulcers. Despite epidemiological studies conducted to assess the association between breast implants and autoimmune diseases the results remain inconclusive
 
 

An Interim 6-Month Analysis of the Dermatologic Effects and Midface Volume Correction With XTR CL Filler in a Prospective, Single-Center Study.

Hyaluronic acid-based filler injections with parenteral anesthetics have become the standard in treating midface volume deficits. There are currently limited data on the effects of these types of fillers on skin density, thickness, and firmness. This study aimed to assess the efficacy of XTR CL filler in improving skin quality and tissue volume in women with midface volume loss. In this prospective, noncomparative, single-center study, 50 women aged between 40 and 60 years with midface volume loss were recruited. The primary endpoint was the improvement in investigator-assessed Global Aesthetic Improvement Scores (GAIS) 1 month after treatment. Secondary endpoints include objective measurements of skin density, thickness, and quality measurements, facial and/or cheek volume augmentation, subjective GAIS, and device evaluation from after the first injection until 6 months, and the documentation of injection site reactions and adverse events. XTR CL use led to significant improvement in midface volume deficits, and skin quality and skin thickness. Injector and subject satisfaction with the treatment were documented and only mild-to-moderate adverse reactions were reported. XTR CL was shown to be effective in improving volume loss and skin quality at 6 months.

A practical guide to selecting facial fillers.

Dermal fillers have created a multi-billion-dollar industry. They are the second most popular form of injectable, as they primarily address volume loss, augmentation, and provide immediate results. The most popular form includes hyaluronic acid-based fillers, however, alternatives exist. To create clinical charts to help with filler selection, injection, and addressing common complications. The current literature and expert opinions form our two senior authors were used to create a numerical and color-coded chart based on G-prime for filler selection, as well as an anatomical table with current recommendations and pearls. We have also included a safety table with current clinical recommendation to deal with common filler-related complications. Fillers are a safe and reliable method to achieve augmentation. Filler selection in various anatomical planes plays a significant role in achieving favorable results.

Commentary on "Comparison of 2 Hyaluronic Acid-Based Fillers for the Treatment of Acne Scars: Structural Lifting Versus Biostimulatory Effect".

Aesthetic Medicine Department Institut Dra Natalia Ribé, Passeig De Gràcia, Barcelona The author has indicated no significant interest with commercial supporters.

Hyaluronic acid-based fillers in patients with autoimmune inflammatory diseases.

The use of hyaluronic acid (HA)-based aesthetic therapies is growing steadily, and according to the International Society of Aesthetic Plastic Surgery, more than 4.3 million aesthetic procedures using HA were performed in 2019, an increase of 15.7% than 2018. More people are offering these types of services, often without proper training or qualifications. Therefore, there is an increasing number of reports in the literature relating to possible adverse events, with subsequent therapeutic problems and more or less serious consequences for patients. The aim of this research is to carry out a review of the literature in order to evaluate the impact of hyaluronic acid-based fillers in patients with autoimmune inflammatory diseases, in particular scleroderma and Systemic Lupus Erythematosus (SLE). Although HA plays a central role in the inflammatory process, the use of HA-based fillers in patients with autoimmune inflammatory diseases is still controversial. HA, in fact, in inflamed tissues helps to propagate the inflammatory response and, injected in the form of a dermal filler, could potentially promote reactivation of the underlying disease. For this reason, many specialists do not perform HA-based aesthetic treatments in patients with scleroderma or SLE. However, recent scientific evidence suggests that the use of HA-based fillers in patients with scleroderma can lead to improvement of skin lesions, with satisfactory results. In the literature, there are no clinical studies that contraindicate the administration of HA-based dermal fillers in patients with inflammatory disease.

Comparison of 2 Hyaluronic Acid-based Fillers for the Treatment of Acne Scars: Structural Lifting Versus Biostimulatory Effect.

Hyaluronic acid (HA)-based fillers are effective at mitigating acne scars due to their filling effect. Complexes of high and low molecular weight HA demonstrated a delayed biostimulatory effect. The authors sought to compare the results of acne scar treatment using a filler composed of complexes of high and low molecular weight HA versus a traditional cross-linking HA filler. Thirty patients with moderate-to-severe atrophic acne scarring were included in this prospective, split-face, double-blinded, randomized controlled study. Each underwent 3 monthly injections of a novel formula of combined high and low molecular weight HA (P) to the base of acne scars on 1 side of the face and traditional cross-linking HA (JV) filler on the other. Patients were evaluated 6 months after their last treatment for objective and subjective improvements. For JV, statistically significant reductions were observed in the acne scar volume but nearly no change in elasticity and stretch during early treatments. For P, no significant differences were observed in early treatments; however, statistically significant improvements were observed in later visits. Although the traditional JV filler demonstrated an earlier impact than P, the latter produced delayed positive changes that were more pronounced than the traditional filler.

Rheological properties of hyaluronic acid-based fillers for facial cosmetic aesthetics

Hyaluronic acid-based dermal fillers are the most used materials in cosmiatry, and their clinical implications are linked to their viscoelastic properties. This study aimed to determine the rheological behavior of HA products used in Brazil by changing specific physicochemical characteristics under different test frequencies. Laboratory analyses of 0.9 mL of samples were performed in a TA-Instruments AR-1500ex Rheometer at 25 °C, at oscillation frequencies of 100, 10, 1, and 0.1 radians/second, considering the measurements of G′, G′′, and Tan δ. The value of G' increased as the oscillation frequencies were increased. In parallel, the changes in G" were the ones that varied the most for frequencies 0.1 and 1 radian/second. The maximum G' was observed with Hialurox Ultra Lift® 26 mg/g (793.45; 554.06; 423.44 Pa, 100, 10 and 1 rad/s, respectively). While the lowest G' values were obtained with Rennova Ultra Deep® (43.01; 19.75; 10.75 and 10.42 Pa at 100, 10, 1, 0.1 rad/sec, respectively). The changes that occurred in the investigated properties indicated that hyaluronic acid-based fillers vary when subjected to different conditions of shear rate, which should be considered in their clinical indication for choosing the most appropriate material according to the region to be treated.

Применение объемообразующих препаратов для коррекции стрессового недержания мочи у женщин

The problem of stress urinary incontinence (SUI) has become particularly important in recent years. Increasing life expectancy and the desire to improve the quality of life have led to a greater emphasis on these complaints and early referral to specialist care. There are various treatment options for SUI in women that aim to prevent involuntary urination when intra-abdominal pressure increases during physical activity, coughing or sneezing. Among these options, bulking agents occupy a certain niche. Objective. To study the efficacy of bulking agent injections depending on the angle of urethral mobility and to analyze the longterm results of treatment. Patients and methods. This prospective study included 35 women with SUI who experienced failure of behavioral therapy. Patients were divided into two groups depending on urethral mobility: group 1 (n = 15) included patients with a Q-tip angle <30°, group 2 (n = 20) – patients with a Q-tip angle ≥30°. The injection of bulking agent was performed in all patients, and a viscoelastic hyaluronic acid-based filler for contour plasty was used for peri-urethral injections. Treatment results were assessed after 3, 6, 12 and 24 months. Results. The most pronounced positive dynamics was observed in group 1 (with a lower Q-tip angle). Significant improvement at 3 months after injection was noted in 66.7% of patients (n = 10). In group 2 with urethral hypermobility, improvement was noted only in 45% of women (n = 9), which is 21.7% less. After 12 months, the effect in group 1 (with a Q-tip angle <30°) was 26.9% higher than in group 2, and after 24 months it was 20% higher. Conclusion. Peri-urethral injections of bulking agents are most effective at a lower angle of urethral mobility. Further research in this area is needed. Key words: stress urinary incontinence, bulking agents

The Dutch Hyacorp® filler catastrophe: new EU legislation will prevent this from happening again

In 2014, the hyaluronic acid-based fillers, Hyacorp-1000 and Hyacorp H-S (H-800), were withdrawn from the Dutch market after concerns about their safety To determine the most plausible factors for the increased number of adverse events, either patient-related factors or those inherent to the filler itself. We also assessed how new European legislation will affect the approval process for new fillers and improve related safety issues A total of 42 patients–37 women (88%) and five men (11%)–were included. Patients were separated into three groups: 13 patients injected with Hyacorp-1000 and Hyacorp H-S (H-800) who had reported inflammatory adverse events; 12 injected with Hyacorp-1000 and Hyacorp H-S (H-800) who had not reported inflammatory adverse events; and 17 injected with other HA fillers who had reported inflammatory adverse events Patients treated with Hyacorp-1000 and Hyacorp-S (H-800) who reported adverse events were significantly older than those in the Hyacorp-1000 and Hyacorp-S (H-800) group without adverse events, and the filler remained in situ for significantly longer than in patients who had adverse events related to another HA filler Hyacorp-1000 and Hyacorp-S (H-800) filler is associated with an increased chance of developing adverse events compared to other HA fillers, probably because it remains in the body for a longer period of time. The upcoming legislative EU update of the Medical Device Regulation (MDR) will prevent unsafe filler from entering the EU market and will enable issues related to safety to be identified much earlier

Comparative Preclinical Study of Lidocaine and Mepivacaine in Resilient Hyaluronic Acid Fillers

Background: Hyaluronic acid-based filler injections are now well-established aesthetic procedures for the correction of skin tissue defects and volume loss. Filler injections are becoming increasingly popular, with a growing number of injections performed each year. Although classified as a minimally invasive procedure, the introduction of a needle or a canula may remain painful for the patient. A major improvement was achieved with the incorporation of local anesthetics into the formulation for pain relief. Methods: In this study, two well-known anesthetics, lidocaine and mepivacaine, were systematically compared to assess their influence on filler mechanical and biological features. The impact of each anesthetic was monitored in terms of gel rheological properties, stability, durability, and degradation. The release profiles of each anesthetic were also recorded. Finally, the pharmacokinetics of each anesthetic in rats were assessed. Results: For all the rheological and biological experiments performed, lidocaine and mepivacaine influences were comparable. The addition of either anesthetic into a soft-tissue filler showed no significant modifications of the stability, durability, and degradability of the gel, with similar release profiles and pharmacokinetics at an equivalent concentration. Conclusions: Substituting lidocaine with mepivacaine does not impact the properties of the gels, and thus both can be equally incorporated as anesthetics in soft-tissue fillers.

PC15. A TEN-YEAR REVIEW OF DERMAL FILLER ADVERSE EVENTS ASSOCIATED WITH VACCINATION

PURPOSE: Following the authorization of two mRNA COVID-19 vaccinations in December 2020, there was increased media attention surrounding reactions to vaccination associated with dermal filler use. Dermal filler adverse events are reported as medical device reports (MDRs) to the United States Food and Drug Administration (FDA). This project seeks to characterize reporting for dermal filler adverse events associated with vaccination over a 10-year period. METHODS: The FDA database was queried for dermal filler MDRs from 1/1/2011 through 6/30/2021. Reports discussing vaccination were identified and screened. RESULTS: There were 10,137 dermal filler MDRs identified for this period. Sixty-two MDRs mentioned vaccination. After excluding duplicates, literature, and reports with other known mechanisms, 19 reports were included. Of these, six reports were received prior to the pandemic. Twelve of 19 are related to COVID vaccination, with the other 7 covering other vaccinations. Eighteen of the reports were associated with hyaluronic acid-based fillers, and one was associated with PLLA. Timing of reaction ranged from immediate to over 1 month after injection. Anatomic locations varied on the face. The most common complication was swelling. Other adverse events included nodules, redness and numbness. CONCLUSION: While the pandemic has brought attention to dermal filler adverse events related to vaccination, this study demonstrates that this phenomenon has been reported with other vaccines in the past. Injecting providers must be aware of concurrent therapies that may interfere with dermal filler use, and ensure that patients are appropriately screened and counseled prior to injection.

A New Korean Highly Concentrated and Cohesive Hyaluronic Acid Gel: Global Facial Rejuvenation In 97 Brazilian Patients

Hyaluronic acid-based fillers are the most used dermal fillers today. Due to its safety, several types of products are on the market with different rheological properties. Recently a new Korean filler with high hyaluronic acid concentration was launched in Brazil. The rheological properties of this new filler caught our attention and encouraged its use for global facial rejuvenation. We report our clinical experience with these highly concentrated and cohesive hyaluronic acid gels, which have three different presentations according to the degrees of reticulation. All 97 patients had marked improvement sustained for at least six months of follow-up, with excellent patient satisfaction. Any significant side effect was noticed.

Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review

Among the various therapeutic options for the treatment of tear trough deformities, the use of hyaluronic acid-based fillers has constantly been increasing. The aim of this research is to conduct a systematic review of the published literature related to the use of hyaluronic acid-based dermal fillers for the treatment of tear trough deformities and possible related complications. A search of the published literature was conducted following the PRISMA guidelines, including PubMed, Cochrane Library, and Ovid databases. Text words and Medical Search Headings (MeSH terms) were used to identify nine articles included in our analysis. The most used filler was Restylane (Galderma). The injection technique was performed through the use of a cannula or, more frequently, with a needle, through the execution of boluses or retrograde release. The injection plane was predominantly the supra-periosteal layer. The most observed side effects were mild and included redness, edema, contour irregularities, bruising, and blue-gray dyschromia. The degree of patient satisfaction was high, with an optimal aesthetic result that was maintained for 6 to 12 months. Although the duration of treatment of tear trough deformities with HA fillers is not comparable to surgical treatment, this is a minimally invasive, safe procedure, quick to perform, and with a high degree of patient satisfaction.