Hyaluronic Acid Dermal Fillers Research Articles

Midface Rejuvenation Using Juvederm Fillers in Male Patients.

In the recent years, there has been a significant rise in the number of men seeking rejuvenating procedures. The development of minimally invasive, non-surgical, office-based procedures without minimal downtime has stimulated a fresh interest among men who may seek cosmetic treatment to increase competitiveness and appear youthful in the workplace. It is important to understanding the differences in facial features in men and women to achieve more natural results and to reduce the risk of feminizing the male's face. The purpose of this study was to present our experience of midface rejuvenation using hyaluronic acid (HA) fillers in men. The authors discuss the anatomical considerations, pathophysiology of aging, gender considerations, and their injection technique for midface rejuvenation in male patients. Midface rejuvenation was successful in male patients using HA dermal fillers while maintaining the masculine features. The treatment was well tolerated and resulted in high level of satisfaction. Use of injectable HA dermal fillers is a safe, effective, and well-tolerated non-surgical treatment modality for midface rejuvenation in men. A thorough knowledge of the midface anatomy, injection techniques, and properties of individual fillers along with an understanding of the considerations in facial features of men can make injectable dermal fillers a rewarding treatment even in male patients.

Bioactive PCL microspheres with enhanced biocompatibility and collagen production for functional hyaluronic acid dermal fillers.

Polymeric microspheres containing magnesium hydroxide (MH) and a bioactive agent (BA), such as apocynin (APO) and astaxanthin (ATX), have been prepared as functional dermal fillers with enhanced physicochemical and biological performance. In this study, polycaprolactone (PCL)-based microspheres were produced with a uniform size of about 30-40 μm by utilizing a membrane emulsification device. MH from the PCL/MH microspheres effectively neutralized acidic products from PCL degradation. For in vitro cell experiments, when acidic degradation products (6-hydroxycaproic acid, HCA) were treated with MH, the acidic pH was neutralized to induce wound healing and suppress inflammation. The microspheres comprised of BA had a sustained release of the BA, without an initial burst release. Remarkably, the ATX added into the microspheres was maintained for 16 weeks and displayed positive attributes, such as tissue regeneration and collagen production improvement, as noted by in vivo testing. Overall, these results suggest that the bioactive PCL microspheres containing ATX have excellent potential as a functional dermal filler for skin aesthetics and facial plastic surgery.

Biological Efficacy Evaluation of a Non-Cross-Linked Hyaluronic Acid Dermal Filler for Biomedical Application in Inflammatory Scalp Conditions.

(1) Background: The dysbiosis of some cutaneous commensal microorganisms is the trigger factor for the activation of the inflammatory cascade by keratinocytes in many skin disorders. Mesotherapy is an innovative technique for many scalp disorders, with the function of restoring the physiology of the skin. (2) Methods: the antimicrobial, antibiofilm and anti-inflammatory activity of the non-cross-linked HA formulation (Hydro Deluxe, Matex Lab S.p.a., Brindisi, Italy) was investigated against the most common microorganisms of the scalp (Staphyloccoccus epidermis, Staphyloccoccus aureus, Cutibacterium acnes and Malassezia furfur). Anti-inflammatory activity was evaluated on an internal 3D model of Reconstructed Human Epidermis (RHE) inserts infected with the strains as pro-inflammatory stimulus. (3) Results and Conclusions: the data collected showed a good antimicrobial and antibiofilm activity against all selected strains. The HA-based formulation did not show cytotoxicity on RHE, either alone or in presence of the infectious stimulus. The analysis of the expression of Interleukin (IL)-8 levels showed an excellent ability to reduce this pro-inflammatory marker. Overall, the efficacy assessment of the formulation supported its potential effectiveness in mesotherapy for the treatment of scalp disorders.

Postmarket Safety Surveillance of Delayed Complications for Recent FDA-Approved Hyaluronic Acid Dermal Fillers.

To review postmarketing data for delayed (≥14 days post-treatment) adverse events (AEs) of interest (inflammatory and noninflammatory nodules, hypersensitivity, granulomas) for newer hyaluronic acid (HA) fillers FDA-approved within the last 5 years (2016-2020). Reports from the Manufacturer and User Facility Device Experience (MAUDE) database were extracted for HAREF, HADEF, HAKYS, HAVER, HAVLR, HAVOB, HARH2, HARH3, and HARH4 from January 2016 to January 2021. Keywords from event narratives were used to identify and categorize AEs and then verified through inclusion/exclusion criteria. Percentages are based on the total combined events of interest to provide an overall perspective of the events reported during the search period. Of 585 MAUDE reports, there were 195 (33.3%) delayed AEs of interest. Of those, 71.8% were nodules (42.1% inflammatory and 29.7% noninflammatory), 21.5% hypersensitivity, and 6.7% granulomas. The combined total events of interest, ordered by frequency reported, were HAVLR (74.4%), HAVOB (12.3%), HADEF (5.1%), HARH4 (3.6%), HAREF (2.6%), and HARH2 (2.1%), with no reports for HARH3, HAVER, and HAKYS. Although delayed nodules and inflammatory events are rare, reports for these events were extracted from the MAUDE database from 2016 to 2020 for HAVLR, HAVOB, HADEF, HARH4, HAREF, and HARH2 (most to least frequent).

452 Dermal Filler Injection Leading to Facial Cellulitis: A Case Report

Abstract Background Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention. Case description We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures. Conclusions Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.

Periorbital Filling With The MD Codes™ Algorithm: A Narrative Review and a Practical Guide.

The hyaluronic acid dermal fillers are employed to bring balance and facial harmony, improving the proportions and asymmetries of the structures, besides acting to reverse the signs of facial aging. The periorbital region is one of the first to show the signs of aging with periocular wrinkles, deepening of the nasojugal and palpebromalar folds, prolapse of the fat bags, excess palpebral skin, ptosis of the eyelashes, disappearance of the upper eyelid crease due to excess skin and hollowing of the upper eyelid. To describe the lines and grooves of the periorbital region and present a practical guide to the MD CODES™ algorithm for filling this region based on a narrative review of the literature. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. MD CODES™ algorithm maps anatomical points of the face (anatomical codes) that, when treated with fillers, promote instantaneous lifting and rejuvenation. In addition to defining the points for treatment, this method identified the order of the points to be treated, that is, which points should be prioritized to cause greater aesthetic impact. The MD CODES aim to standardize facial rejuvenation and is of particular interest for young as well as more experienced physicians. Was presented in detail the regions, the aesthetic effects of the application, the technique, the volume, and the target structure undertaken in the remodeling of the tear trough, periorbital, temporal, brow, and frontal regions.

Providing Optimal Rejuvenation to the Jawline and Perioral Area Using Neuromodulators and Hyaluronic Acid Dermal Fillers.

Including the jawline in aesthetic assessment has become increasingly popular when using both surgical and nonsurgical techniques. Facial aging processes include bone resorption, fat pad atrophy, and a breakdown of the quality of collagen and elastin in the skin. To provide optimal treatment of the jawline using nonsurgical techniques, it is important to consider all of these aspects before planning treatment. Men and women have different facial aging processes and ideal facial ratios that must be respected. The objective of this article is to discuss the use of botulinum toxin A and hyaluronic acid filler injectable treatments, deoxycholic acid injectable treatments, and cryolipolysis treatments and explain how these treatments can be utilized for optimal rejuvenation of the jawline and perioral area.

Comparative Physicochemical Analysis among 1,4-Butanediol Diglycidyl Ether Cross-Linked Hyaluronic Acid Dermal Fillers.

(1) Background: Injectable hyaluronic acid (HA) dermal fillers are used in several chirurgical practices and in aesthetic medicine. HA filler stability can be enhanced through different cross-linking technologies; one of the most frequently cross-linker used is 1,4-butanediol diglycidyl ether (BDDE), also present in the HA-BDDE dermal filler family of the company Matex Lab S.p.A. (Brindisi, Italy). Our overview is focused on their characterization, drawing a correlation between matrix structure, rheological and physicochemical properties related to their cross-linking technologies. (2) Methods: Four different injectable HA hydrogels were characterized through optical microscopic examination and rheological behavior investigation. (3) Results: The cross-linked HA dermal fillers showed a fibrous “spiderweb-like” matrix structure and an elastic and solid-like profile. (4) Conclusions: The comparative analysis represents a preliminary characterization of these injectable medical devices in order to identify their best field of application.

Combination of hyaluronic acid fillers and personalized skincare as a perfect tool in aesthetic medicine.

Nowadays the desire to look younger has increased. The most popular noninvasive rejuvenation method is hyaluronic acid (HA) filler injection. However, aging of the skin involves multiple pathological processes, which can be managed by using topical formulations with sophisticated active agents addressing problems such as extracellular matrix degradation, textural variances, and dyschromias. A single site experience trial was conducted to assess the efficacy of HA dermal filler injections combined with personally prepared, bespoke formulations on epidermis and dermis condition. A total of 15 female participated in the study. Mid and lower face were treated with Saypha® HA fillers injection with volume chosen by the investigator performed with 25G/50mm cannula. The formulations for topical skincare consisted of substances chosen from 19 active agents, which were scientifically proven. The subjects were supposed to use them for 6 weeks. Fourteen subjects completed the study, and one subject was lost to follow-up. The age of the study population ranged from 36 to 58 years. The average amounts of Saypha volume plus, Saypha volume, and Saypha filler used per subject were 2.8ml, 2.25 ml and 1.7ml, respectively. The most typical skin dysfunctions were loss of elasticity (12 subjects), hyperpigmentation (nine subjects), erythema (eight subjects), and hyperseborrhea with enlarged pores (five subjects). After completing the study all subjects were satisfied. Combined therapies based on HA fillers and personalized skincare with Universkin™ products show promising results in patients with skin problems due to aging.

A study of combined microfocused ultrasound and hyaluronic acid dermal filler in the treatment of enlarged facial pores in Asians.

Enlarged facial pores are a common cosmetic complaint in practice. Microfocused ultrasound with visualization (MFU-V) and low-degree crosslinked hyaluronic acid filler (L-HA) injection has recently become a popular procedure for skin rejuvenation. The effectiveness of the combined MFU-V and L-HA injection in the treatment of enlarged pores has not been evaluated. To compare the efficacy of MFU-V monotherapy (single technique) and MFU-V combined with L-HA injection (combined technique) for the treatment of enlarged facial pores in Asians. We conducted a randomized, single-blinded, split-face study on participants with enlarged facial pores. Each side of the face was randomly assigned to treatment with one session of single technique or combined technique. Pore volume was objectively measured by an Antera 3D® system. Subjective assessment was evaluated by one-blinded physician using a pore grading score (0-4). Patients rated the improvement in terms of satisfaction using the visual analog scale (VAS, 0-10). Forty-six participants completed the study. The mean pore volume of both sides declined with statistical significance at every visit compared to baseline, with the lowest mean at 4months post-treatment. The combined technique showed a lower mean pore volume than single technique throughout the follow-ups. Physician's subjective evaluation showed no statistically significant difference between the two techniques. The patient satisfaction score showed a similar trend to the mean pore volume, with a statistically significant difference at 4 and 6months post-treatment. Both techniques are effectively minimize enlarged facial pores. The combined technique resulted in more patient satisfaction.

Effects of basic fibroblast growth factor combined with an injectable in situ crosslinked hyaluronic acid hydrogel for a dermal filler

Hyaluronic acid (HA) has been applied as a biomaterial for injectable dermal filler due to the unique viscoelastic property. Although HA derivatives are promising dermal filler materials, poor durability by degradation is the limitation of HA dermal filler. The chemical crosslinking of HA hydrogel is necessary to restrain the degradation rate. Herein, we present an injectable in situ HA hydrogel containing basic fibroblast growth factor (bFGF) crosslinked via a visible light-induced thiol-ene reaction. The thiol-ene reaction between thiolated HA (SH-HA) and methacrylated HA (MA-HA) is triggered by riboflavin phosphate with blue light (BL) exposure. The mechanical property, matrix degradation, and protein release of HA hydrogels were evaluated regarding SH-HA and MA-HA ratio. The HA hydrogels improve NIH/3T3 fibroblast proliferation and migration, and the bFGFs incorporated in HA hydrogel additionally induce the cell proliferation and scratch closure rate. In addition, the HA hydrogel precursor solution under a porcine skin forms hydrogel by transmitted BL through the skin, so the gelation can occur under the skin after injection. According to the results, the in situ crosslinked HA hydrogel is a promising injectable and long-lasting dermal filler that can deliver therapeutic factors.

222 Simulation Training in Aesthetic Medicine; A Safe, Effective and Ethically Sound Modality to Teach Basic and Advanced Aesthetic Interventions

Abstract Introduction The role of high-fidelity prosthetic simulation models for Botulinum Toxin Type A (BoNT-A) and cross-linked Hyaluronic Acid dermal fillers (HA) was evaluated and its efficacy and safety discussed in addition to its ethical and cost-effective advantages. Method The experiment group (N = 26) included a high-fidelity simulation silicone head to inject as part of dexterity training prior to injecting live adult voluntary models. The control group (N = 8) had only live adult voluntary models for the practical session. Pre-test and post-test of self- assessment of procedure competence and confidence to perform the procedure unaided was evaluated using a modified reflective CEX. Results The average competency and confidence pre-test for score for students was (mean±SD) 7.2±4.6 and 2.9±2.9 respectively. The post-test scores rose to 15.8± 2.5 and 7.8±1.5. The improved competency and confidence score were statistically significant (p < 0.05). There was no statistically significant difference of pre-test or post-test scores between the experimental and control group. Conclusions High fidelity synthetic simulation models allow novice practitioners to improve pre-procedure counselling, technical skills, management plan and follow up as well as confidence to perform the procedure effectively. We therefore recommend this method as a first-line training model in aesthetic medicine.

Non‐surgical rhinoplasty using hyaluronic acid dermal fillers: A systematic review

Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years. This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications. A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias. Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma. Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.

Hypersensitivity reaction to Hyaluronic Acid Dermal filler following novel Coronavirus infection – a case report

The incidence of hypersensitivity reactions to hyaluronic acid dermal fillers is between 0.3 and 4.25%, mediated by T‐lymphocytes. Flu‐like illness can trigger immunogenic reactions at the site of filler placement. Cases of SARS‐CoV‐2 are significant and pose a possible risk of inducing hypersensitivity. This case report is of a delayed‐type hypersensitivity after hyaluronic acid dermal filler treatment of the nose and subsequent infection with SARS‐CoV‐2. Risk factors for the development of such symptoms were identified as the presence of hyaluronic acid combined with flu‐like illness and repeated treatment of one area. The case resolved without intervention. Clinicians should be mindful of the risk posed by the interaction of hyaluronic acid dermal filler with SARS‐CoV‐2 in light of the pandemic.

Providing Optimal Rejuvenation to the Jawline and Perioral Area Using Neuromodulators and Hyaluronic Acid Dermal Fillers.

Including the jawline in aesthetic assessment has become increasingly popular when using both surgical and nonsurgical techniques. Facial aging processes include bone resorption, fat pad atrophy, and a breakdown of the quality of collagen and elastin in the skin. To provide optimal treatment of the jawline using nonsurgical techniques, it is important to consider all of these aspects before planning treatment. Men and women have different facial aging processes and ideal facial ratios that must be respected. The objective of this article is to discuss the use of botulinum toxin A and hyaluronic acid filler injectable treatments, deoxycholic acid injectable treatments, and cryolipolysis treatments and explain how these treatments can be utilized for optimal rejuvenation of the jawline and perioral area.

Toward Physicochemical and Rheological Characterization of Different Injectable Hyaluronic Acid Dermal Fillers Cross-Linked with Polyethylene Glycol Diglycidyl Ether.

(1) Background: Injectable hyaluronic acid (HA) dermal fillers are used to restore volume, hydration and skin tone in aesthetic medicine. HA fillers differ from each other due to their cross-linking technologies, with the aim to increase mechanical and biological activities. One of the most recent and promising cross-linkers is polyethylene glycol diglycidyl ether (PEGDE), used by the company Matex Lab S.p.A., (Brindisi, Italy) to create the HA dermal filler PEGDE family. Over the last few years, several studies have been performed to investigate the biocompatibility and biodegradability of these formulations, but little information is available regarding their matrix structure, rheological and physicochemical properties related to their cross-linking technologies, the HA content or the degree of cross-linking. (2) Methods: Seven different injectable HA hydrogels were subjected to optical microscopic examination, cohesivity evaluation and rheological characterization in order to investigate their behavior. (3) Results: The analyzed cross-linked dermal fillers showed a fibrous “spiderweb-like” matrix structure, with each medical device presenting different and peculiar rheological features. Except for HA non cross-linked hydrogel 18 mg/mL, all showed an elastic and cohesive profile. (4) Conclusions: The comparative analysis with other literature works makes a preliminary characterization of these injectable medical devices possible.

Hyaluronic acid dermal fillers and autoimmune disorders: a case report and discussion of a late-onset complication

Hyaluronic acid dermal fillers and autoimmune disorders: a case report and discussion of a late-onset complication

Subject and partner satisfaction with lip and perioral enhancement using flexible hyaluronic acid fillers.

The injection of hyaluronic acid (HA) dermal fillers is a popular minimally invasive approach to improve lip volume and contour, and with improved techniques has gained popularity because full lips are often associated with beauty and youth. Patient satisfaction is a key driver for successful aesthetic procedures, influencing individual treatment plans and future recommendations. To evaluate subject and partner satisfaction with the hyaluronic acid (HA) dermal filler HARK for lip enhancement at 8weeks after the last treatment. Subjects in this open-label study all received HARK in the lips, and an additional group also received HARR and/or HARD in nasolabial folds (NLFs) and marionette lines (MLs). Satisfaction was assessed at Weeks 4 and 8 after the last treatment using questionnaires (FACE-Q™ [subjects] and KISSABILITY [subjects and partners]). Nineteen subjects received HARK only; 40 also received HARR and/or HARD . Subjects reported a high level of satisfaction with their lips following treatment. Increases from baseline in the mean total satisfaction score were statistically significant at Weeks 4 and 8 (P≤.001). Most subjects (≥89%) reported satisfaction on all FACE-Q questions at Week 8. Both subjects and partners were satisfied with the kissability, appearance, and natural look and feel of the post-treatment results. This study demonstrated that HARK resulted in lip enhancement with high levels of subject and partner satisfaction, when used alone or in combination with HARR / HARD in NLFs and MLs.

The evidence behind the biophysical properties of hyaluronic acid dermal fillers

With the breadth and variety of hyaluronic acid hydrogels available, it can be challenging to understand the evolving product characteristics and associated terminology. Similarly, different hyaluronic acid hydrogels can share the same indication, and yet consist of different rheological and physiochemical properties. In this paper, hyaluronic acid biophysical properties, such as molecular weights, stabilisation (crosslinking), modification and hyaluronic acid concentration, are explored in relation to findings from current literature. The significance for these specific properties is explored in relation to specific indications and anti-ageing benefits.

Lay rater evaluation of naturalness and first impression following treatment of lower face wrinkles with hyaluronic acid fillers.

Hyaluronic acid (HA) dermal fillers formulated with XpresHAn TechnologyTM were subjectively assessed by investigators and subjects. To test whether treatment with HA dermal fillers (HARR and HARD ) deemed natural by injectors and subjects are considered natural by the public and receive positive first impressions. Videos of open-smile expressions of subjects at baseline to Day 42 were assessed by "lay raters" (n=3004) who indicated agreement with "Face looks natural" and first impressions using Likert-type scales. Naturalness of facial appearance was noninferior at Day 42 compared with baseline. Assessments of first impression demonstrated statistically significant changes from baseline in overall first impression, social skills, dating success, attractiveness, and athletic success. Rater gender and age did not affect scores. Subgroup analysis found three groups had significant positive changes: those aged≤55years, subjects with natural outcome, and those that received more than 4mL of filler. Subjects without a natural outcome had a significant negative change. Treatment with HA facial fillers, HARR and HARD , produces outcomes deemed natural by injectors, subjects, and the public. While subjective, this study demonstrates that clinicians should aim for a "natural outcome" that receives optimal first impressions from the public.