Hyaluronic Acid Gel Injection Research Articles

Skin wound healing promoted by novel curcumin-loaded micelle hydrogel.

BackgroundThe development of biomaterials with the ability to promote skin wound healing is an important topic in the field of biomedical science. In this study, a topical curcumin (Cur) gel [Cur/hyaluronic acid (HA)] was prepared by combining curcumin-loaded PCL-b-PEG-b-PCL (PECE) nanomicelles (PCEC/Cur) and HA to effectively promote skin wound healing. Continuous drug release from PCEC/Cur can provide long-term protection and treatment of skin wounds.MethodsThe study was completed in two stages. The first stage (in vitro): PCEC/Cur were prepared by thin film hydration method. The second stage (in vivo): 36 anesthetized rats were used to prepare a round full-thickness skin defect wound with a diameter of 23 mm on the dorsal side of the spine, and the rats were randomly divided into 4 groups with 9 rats in each group.ResultsThe results showed that wounds in the Cur/HA group were restored to normal after 14 days after operation, representing 96%±3% wound healing. Hematoxylin and eosin (HE) staining showed that hair follicles in the Cur/HA group were visible and that the re-epithelialization time was earlier. Masson staining showed that Cur/HA promoted the formation of collagen fibers. Immunohistochemical observation showed that angiogenesis and subsequent healing of the wound surface was enhanced in the Cur/HA group.ConclusionsThe injectable hyaluronic acid gel complex Cur/HA is a promising candidate material for a wound dressing to promote healing.

Effect of a single-shot injection of a high-density hyaluronic acid gel in patients with symptomatic primary knee osteoarthritis: results of no-dolor study

Purpose: The main objective of this study (NO-DOLOR study) is to evaluate the evolution of pain in patients with primary knee osteoarthritis (OA), after a single injection of a high-density viscoelastic gel, which contains a high concentration of hyaluronic acid (HA) (Pronolis® HD mono 2.5%: 120 mg HA in 4.8 ml).

Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.

Minimally invasive therapy for reconstruction of lost interdental papilla by using injectable hyaluronic acid filler.

Background and Aim:Reconstruction of interdental papillae (IDP) is among the most difficult periodontal therapy. Papillary recession is multifactorial, and several surgical, nonsurgical, and minimally invasive techniques have been suggested. The purpose of this study was to evaluate the clinical application of injectable hyaluronic acid (HA) gel for the reconstruction of IDP in Nordland and Tarnow's Class I and II papillary recession cases.Materials and Methods:In the present in vivo clinical trial, 7 patients (2 males, 5 females) with 25 defects were selected. A volume of 0.2 ml HA gel was injected at the respective areas and massaged for 2–3 min. Photographs were obtained, and the assessment of the data was performed clinically (CP-GM, interproximal width [IPW]) and by Image analysis software (black triangle height [BTH], black triangle width [BTW]). Comparison of mean values was performed using the analysis of variance, followed by Post hoc Bonferroni test. Value of P ≤ 0.05 was considered statistically significant.Results:Application of HA gel for the reconstruction of IDP was successful in 6 months. CP-GM, BTH, IPW, and BTW showed a statistically significant difference from baseline to 3 and 6 months interval (P = 0.01). Post hoc Bonferroni test for CP-GM, BTH, BTW, and IPW revealed a statistically significant difference from baseline to 3 months (P ≤ 0.05) and 6 months (P ≤ 0.05) and a nonsignificant difference at 3–6 months (P ≥ 0.05).Conclusion:Injectable HA gel is a promising minimally invasive therapy for enhancing papillary esthetics.

Commentary on: Spreading Pattern and Tissue Response to Hyaluronic Acid Gel Injections in the Subcutis: Ultrasound Videos, Ultrasound Measurements, and Histology.

Commentary on: Spreading Pattern and Tissue Response to Hyaluronic Acid Gel Injections in the Subcutis: Ultrasound Videos, Ultrasound Measurements, and Histology.

The influence of different concentration of proFLEX® INTRA on clinical progression and dynamics of laboratory test values in different age patients with knee osteoarthrosis

Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.

VYC-25L Hyaluronic Acid Injectable Gel Is Safe and Effective for Long-Term Restoration and Creation of Volume of the Lower Face.

BackgroundJuvéderm Volux (VYC-25L; Allergan plc) is an injectable hyaluronic acid gel designed to restore and create facial volume.ObjectiveThe aim of this study was to evaluate the safety and effectiveness of Volux for chin retrusion over 18 months and after repeat treatment.MethodsThis prospective, single-blind, controlled study enrolled subjects aged ≥18 years with chin retrusion (glabella-subnasale-pogonion facial angle 145°-165°). Subjects were randomized (3:1) to Volux at study onset or 3 months later (control group), and could receive a single repeat treatment during months 18 to 24. Assessments included mean facial-angle change from baseline, Global Aesthetic Improvement Scale (GAIS) responder rates (improved/much improved), improvements in 3 subject-reported FACE-Q scales, and safety.ResultsOf 132 enrolled subjects, 119 received initial Volux treatment and 89 received repeat treatment. Mean changes (95% confidence interval) in glabella-subnasale-pogonion angle from baseline for treatment and control groups, respectively, were: 1.15° (0.75°, 1.56°) and 1.16° (0.57°, 1.75°) at month 18, and 3.14° (2.68°, 3.61°) and 2.72° (1.78°, 3.66°) 1 month after repeat treatment. Investigators rated 52.5%/60.0% of treated/control subjects at month 18 and 96.9%/100% after retreatment as GAIS responders; subject-reported rates were 62.0%/64.0% and 93.8%/100%. Durable improvements in Satisfaction with Chin, Satisfaction with Lower Face and Jawline, and Psychological Well-Being were reported in 82.1%, 78.2%, and 60.3% of subjects, respectively, at month 18, and 92.3%, 93.8%, and 67.7% of subjects after retreatment. The safety profile was as expected.ConclusionsVolux injectable gel is a safe, effective, and durable alternative to surgical treatments for increasing chin projection and jaw volume, and results in high patient satisfaction.Level of Evidence: 2

Spreading Pattern and Tissue Response to Hyaluronic Acid Gel Injections in the Subcutis: Ultrasound Videos, Ultrasound Measurements, and Histology.

BackgroundDespite the popularity of hyaluronic acid (HA) filler treatments, few publications focus on their effects on adipose tissue.ObjectivesThe authors assessed the deposition pattern in the subcutis of injected HA, the tissue response at short and intermediate term, and the effects of remodeling the filler by strong finger pressure immediately after the treatment.MethodsTwo brands, specifically developed by the industry for deep injection, were compared. The gels were injected subcutaneously in 5 candidates for abdominoplasty or breast reduction, in the area of excision, 6 to 98 days before surgery. Ultrasound measurements and films were compared with postoperative histological findings. Tissue response was scored semi-quantitatively.ResultsReal-time ultrasound showed a slightly different deposition pattern of the 2 brands. Histologically, both were present in large pools of the same magnitude and looked the same. Linear retrograde injection sometimes resulted in a globular deposit due to elastic recoil of septae. After remodeling and over time, HA deposits became difficult to detect by ultrasound. Firm remodeling of the tissue immediately after injection or time had no significant effect on filler spread or tissue response. Except for 1 zone of granuloma formation, tolerance for both fillers was good.ConclusionsHA deposition in adipose tissue occurs in much larger pools than in the dermis. Ultrasound examination is useful during and immediately after the injection but less reliable after filler remodeling or over time. Filler deposition can be less precise, and reshaping by finger pressure can have less effect than expected.Level of Evidence: 4

Derma Fillers: Ray of Light in Black Triangles - A Pilot Study.

Background and Aim:Open gingival embrasure often poses complex functional and esthetic problems. Interdental papilla reconstruction is among the most challenging periodontal treatments. Hyaluronic acid (HA) gel injection, a noninvasive technique with immediate papilla reconstruction, has been recently proposed. This minimally invasive therapeutic procedure has shown predictable esthetic outcome, thus, gaining rapid acceptance as an esthetic treatment modality in dentistry. The aim of the study is to evaluate the clinical application of derma fillers (HA gel) for the reconstruction of the interdental papilla in the esthetic zone.Materials and Methods:Six patients were included with interdental papilla deficiency. After the induction of local anesthesia, 0.2 ml of 0.2% HA injection was given at baseline, 3 weeks and 3 months. Measurements of the black triangle were done clinically using acrylic stent as a reference. The application of HA gel for the reconstruction of interdental papilla was found successful at a 6-month period.Results:The study showed a significant gain in papillary volume, and esthetics improvement was notable. A statistically significant result was obtained in context to papilla fill.Conclusion:Interdental papilla reconstruction with injectable HA gel is a promising minimally invasive treatment option for interdental deficiency in small areas.

Periorbital Injection of Hyaluronic Acid Gel in Patients With Deep Superior Sulcus.

Hyaluronic acid gel (HAG) fillers provide a versatile and safe correction method for a sunken superior sulcus (SS) resulting from soft tissue volume loss occurring with aging, previous surgery, or enophthalmos related to trauma or phthisis bulbi. The purpose of this study was to report the long-term clinical outcomes of filler injection for soft-tissue augmentation in patients with a deep SS. Retrospective, interventional case series METHODS:: The medical records of 27 patients (32 eyes) with deep superior sulci were reviewed. Twenty injections of hyaluronic acid fillers (Restylane; Q-med AB, Uppsala, Sweden) were performed in the retrobulbar (RB) area, and 15 injections were performed in the SS. Pre- and post-treatment photographs were taken. Visual acuity for seeing eyes, intraocular pressure, exophthalmos measurement, marginal reflex distance 1, interpalpebral fissure, tarsal platform show, and SS hollowing depth grade RESULTS:: Enophthalmos corrections were 1.3 ± 0.8 mm (P < 0.001) and the SS hollowing grade decrease was 1.2 ± 0.9 (P < 0.01) after 1 month of RB injection. Enophthalmos corrections were 0.1 ± 0.4 mm (P = 0.317) and the SS sunkeness grade decrease was 1.7 ± 0.8 (P < 0.001) after 1 month of SS injection. The amount of filler to correct enophthalmos of 1 mm was 0.83 ± 0.53 mL using the RB injection. Using Kaplan-Meier survival analysis, the mean period of maintenance for deep SS correction was 9.1 months for RB injections and 8.5 months for SS injections. Retrobulbar (RB) hyaluronic acid gel (HAG) injections corrected enophthalmos and a deep SS, while SS injections corrected only a deep SS. These 2 techniques of RB and direct sulcus injection are safe and effective methods for the correction of a deep SS.

Hyaluronic acid for lower eyelid and tear trough rejuvenation: review of the literature

Periorbital aging has been identified as one of the most important aesthetic concerns of the face, so that lower eyelid rejuvenation has become a topic of major interest. Not every patient requires surgical blepharoplasty and selected lower eyelid problems and defects due to the aging process have been treated with hyaluronic acid (HA) gel injections since 2004. With this as the premise, the current work serves to review the published medical literature on the use of HA for lower eyelid and tear trough rejuvenation. A PubMed search was carried out in May 2020 using the search terms: “Tear trough [and] HA [and] filler”; “Tear trough [and] HA”; “HA [and] lower eyelid [and] filler”; “HA [and] lower eyelid”. A large number of relevant studies were identified. Surgical management remains the gold standard for lower eyelid rejuvenation but increasingly, non-surgical correction of selected deformities with HA injection may provide a reliable option based on the available evidence. Further, prospective randomized controlled studies and systematic reviews of the literature are nevertheless desirable and a standardized, widely accepted grading system of the deformity and its treatment outcomes will allow us to codify this procedure better.

Experimental study of hyaluronic acid gel fillers biodegradation in orbit

Recently, hyaluronic acid gel (HAG) fillers were proposed as an effective alternative treatment option for surgical orbital volume augmentation. Several authors reported about long-standing effect of the filler. To assess the features of HAG biodegradation after intraorbital injection in experimental environment. In the course of the experiment, 7 chinchilla rabbits (14 eyes) received a single 1ml intraorbital HAG injection (Restylane SubQ, Galderma, Sweden) using a cannula. The animals' orbits were examined by ultrasound scan after the injection and at 1, 3, 6, 9, 12 and 18 months. The animals were subsequently sacrificed for morphological study of orbital tissue containing the HAG filler. The HAG filler persisted in the orbit of experimental animals during the whole follow-up period. The volume of HAG depot and its density diminished gradually till the 18th month, after which the particles of HAG could still be detected with the morphological study and ultrasound. The HAG filler persisted in the orbit of experimental animals up to 18 months. Incomplete biodegradation explains the longstanding duration of the injection effect.

Hyaluronic acid gel injection in rectovaginal septum reduced incidence of rectal bleeding in brachytherapy for gynecological malignancies

PurposeThe purpose of this study was to report our initial clinical results of hyaluronic acid gel injection (HGI) in the rectovaginal septum (RVS) to reduce the incidence of rectal bleeding in vaginal brachytherapy for gynecologic malignancies. Methods and MaterialsSince 2008, CT based image-guided adaptive brachytherapy (IGABT) was initiated, and since 2015, HGI in the RVS was introduced in our institution. Vaginal cylinder with or without tandem or additional interstitial needles were applied for patients with gynecologic malignancies. Rectum dosimetric parameters and incidence of late rectum bleeding were compared between patients with and without HGI in the RVS. ResultsBetween May 2008 and October 2017, 83 patients with gynecologic malignancies were treated with IGABT involving vaginal cylinder. Eleven patients who were treated for palliative intention were excluded, and 72 patients were subjected to the analysis. Of the total 72 patients 46 were with uterine cervical cancer, 19 uterine corpus cancer, five vaginal cancer, one vulvar cancer, and one ovarian cancer. Fifteen and 57 patients were irradiated with and without HGI in the RVS, respectively. With a median follow-up period of 57.7 (4.7–123.1) months, 30 (41.7%) patients suffered from radiation-related rectal bleeding. Patients with HGI in the RVS had a statistically significant lower incidence of rectal bleeding compared with those without it (13.3% vs. 49.1%, p = 0.01). ConclusionsHGI in the RVS reduced the incidence of late rectal bleeding for patients with gynecologic malignancies treated by vaginal cylinder and was not associated with HGI-procedure-related adverse events.

Efficacy Evaluation of Hyaluronic Acid Gel for the Restoration of Gingival Interdental Papilla Defects

This clinical study aimed to evaluate the long-term efficacy of reconstruction of the gingival interdental papilla via injection of hyaluronic acid gel. Eight female participants with Class I or II gingival papilla loss in anterior sites were included in this study. The gingival biotype was evaluated previously. Hyaluronic acid gel was injected into the base of the deficient papilla, which was repeated twice at 3 and 6weeks after the initial injection. The height of the gingival papilla and the area of papilla loss were examined on clinical photographs before treatment and 3, 6, and 12months after treatment. The data were tested for a normal distribution and analyzed by the Wilcoxon signed rank test. P<.05 was considered significant. The height of the gingival papilla increased 0.311, 0.45, and 0.4mm from baseline at 3, 6, and 12months, respectively, after treatment (P<.05), whereas the area of the black triangle was reduced by 0.31, 0.41, and 0.36mm2 at the same time points (P<.05). In addition, patients with a thick gingival biotype showed a better effect of treatment on the increase in the height of the gingival papilla and decrease in the area of the black triangle. Our study verified a remarkable effect of hyaluronic acid gel injection in restoring the deficient gingival papilla of the natural teeth, especially in patients with a thick gingival biotype.

Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial.

BACKGROUND:Various techniques have been implemented to reconstruct the deficient interdental papilla.AIM:The present trial was conducted to assess the effect of injection of hyaluronic acid gel for the reconstruction of deficient interdental papilla.MATERIAL AND METHODS:Thirty-six deficient interdental papilla sites in ten patients were randomly allocated into two equal groups; intervention group who received the injection of hyaluronic acid (HA) gel and control group who received the injection of saline solution as a placebo. Each deficient papilla received three injections. The first injection was given one week following the re-evaluation period (four weeks after performing full mouth supra-gingival scaling and sub-gingival debridement). The second and third injections were given after three and six weeks, respectively. The height and surface area of black triangles were recorded at baseline before the injection procedures. The participants were recalled after three and six months from the first injection for re-measuring the recorded parameters. At 6 months, patients’ satisfaction was also assessed.RESULTS:After three and six months from baseline, the results revealed a statistically significant higher mean decrease in height and surface area of black triangles in favour of the HA group. From three to six months, there was no statistically significant difference between the two groups in both parameters. At 6 months, the HA group showed a statistically significant higher mean satisfaction score than the saline group.CONCLUSION:The use of hyaluronic acid gel for the reconstruction of interdental papillary deficiency was effective with promising levels of patients’ satisfaction.

Evaluation of physician volumetric accuracy during hyaluronic acid gel injections: An observational, proof-of-concept study.

Findings indicate that standard injection techniques for hyaluronic acid (HA) soft tissue fillers result in considerable variations in the applied boluses. Furthermore, despite the knowledge that the varying biophysical properties of HA fillers (eg, G', cohesivity, viscoelasticity) can affect their ease of injection, the impact of device attributes on an injector's volumetric accuracy is currently unknown. (a) Evaluate the ability of aesthetic physicians to accurately inject a specific amount of HA filler; (b) investigate the effect of physician experience on injection accuracy; and (c) investigate the impact of different HA gel properties on an injector's performance. Thirteen physicians with aesthetic experience were recruited. Subjects were blindfolded and asked to deposit 0.2cc of four HA fillers under two conditions: (a) onto a scale and (b) into a porcine membrane. The amount of gel deposited/injected was then measured. An accurate injection was defined as 0.2cc±15%. Subjects were rarely able to dispense accurate amounts of injectate (42/208 injections or 20.19%) and often underestimated their injection quantities. Variations in the accuracy distributions between groups were observed. An injector's experience, the conditions under which injections were performed and the product choice were all variables found to affect the accuracy distributions. The findings of this study provide evidence that the use of visual and/or audible stimuli is necessary for dispensing accurate volumes. This has clinical implications for treatment efficacy and patient satisfaction during free hand injections. To ensure more accurate and reproducible results, the investigators propose a possible modification to the standard injection technique.

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction.

PurposeThe purpose of this study was to report our initial experience of hyaluronic acid gel injection (HGI) in the vesicovaginal septum (VVS) for bladder dose reduction in brachytherapy (BT) for uterine cervical carcinoma.Material and methodsBetween September 2016 and May 2018, 15 uterine cervical cancer patients received HGI in the VVS as a part of their definitive radiotherapy (RT) treatment consisting of external beam radiation therapy (EBRT) with additional BT. Of those, 9 patients received BT both with and without HGI, and remaining 6 patients were excluded because these 6 patients received HGI in the VVS for all BT fractions. All 9 patients received HGI in the rectovaginal septum. For these patients, the dosimetric parameters bladder D2cc, HR-CTV D90, and rectum D2cc were selected, and two groups were generated (BT with vs. without HGI in the VVS) for dosimetric comparison.ResultsThe median cumulative EQD2 for HR-CTV, rectum D2cc, and bladder D2cc for the 9 patients were 73.3, 52.8, and 67.1, respectively. While no statistical difference could be detected for rectal dose reduction, bladder dose was significantly less in the group with HGI in the VVS compared to that without (449 cGy [range, 416-566, 1SD = 66.1] vs. 569 cGy [range, 449-647, 1SD = 59.5], p = 0.033), with no compromising of target coverage. Although it did not reach statistically significance, there was a trend toward better HR-CTV D90 in the group with HGI compared to that without HGI in the VVS (713 cGy vs. 706 cGy, p = 0.085). No severe bleeding, hematuria, bladder wall injury, or urethral injury requiring hospitalization was experienced in association with HGI in the VVS.ConclusionsHGI in the VVS can be performed safely and can effectively reduce the bladder dose in BT for uterine cervical cancer patients.

An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment.

BackgroundPectus excavatum (PE) is sometimes associated with psychological and physiological difficulties influencing a patient’s quality of life. Treatment with a hyaluronic acid (HA)-based gel may benefit patients and be an alternative to other more invasive treatments.ObjectivesThe authors sought to evaluate the effectiveness in terms of satisfaction, duration, and safety of HA gel treatment for PE including impact on quality of life.MethodsMales ≥18 years having PE without functional problems received HA gel injections (50 – 150 mL) at the site of deformity and in some cases at the medial pectoralis muscle borders to optimize the aesthetic result. Follow-up visits were performed after 1, 3, 6, 12, and 24 months with optional retreatment at the 24-month visit including a 1-month follow-up. Evaluations included Pectus Excavatum Evaluation Questionnaire, patient satisfaction, magnetic resonance imaging, and safety assessments.ResultsThe treatment significantly improved patients’ self-esteem (P < 0.001) and psychosocial function (P ≤ 0.038) throughout the study, as assessed by Pectus Excavatum Evaluation Questionnaire. Patients were satisfied with the aesthetic outcome and considered the treatment mild in terms of level of pain during injection. Treatment effects were maintained up to 24 months and 58% of the HA gel remained at this visit, shown by Magnetic Resonance Imaging measurements. The treatment was well tolerated.ConclusionsTreatment of PE with HA gel improved patient quality of life related to self-esteem and psychosocial functioning including aesthetically pleasing results. The treatment may also offer benefits in terms of safety and tolerability compared with other treatments.Level of Evidence: 4

Effectiveness and Safety of Acne Scar Treatment With Nonanimal Stabilized Hyaluronic Acid Gel.

Acne scarring affects most patients with acne and have a negative impact on quality of life. New effective treatment options offering minimal downtime are therefore needed. To evaluate improvement in overall facial appearance after hyaluronic acid (HA) treatment of atrophic acne scars. Twelve subjects with moderate-to-severe acne scars were treated at 3 sessions 4 weeks apart. At each session, up to 2-mL HA gel was injected into each side of the face. Acne scar severity, global facial aesthetic improvement, and subject satisfaction were assessed up to 36 weeks after treatment. Safety assessments included subject diaries and adverse events. The overall facial appearance and the appearance of atrophic acne scars improved after treatment. Scar severity and subject satisfaction with the overall facial appearance and with the sensation and perception of the skin improved in most subjects. Subjects' self-esteem and self-confidence also improved. Adverse events were typically mild to moderate, expected, and procedure-related. Hyaluronic acid gel injections were effective and safe for treatment of moderate-to-severe atrophic acne scars. The treatment effect developed gradually over time with the highest improvement observed at the end of the study.

Nonsurgical correction of epiblepharon using hyaluronic acid gel

To report a single-center experience with nonsurgical correction of epiblepharon using hyaluronic acid gel. The medical records of consecutive patients with symptomatic epiblepharon treated over a 3-year period with hyaluronic acid gel injection were reviewed retrospectively. Hyaluronic acid gel was injected transcutaneously into the suborbicularis plane to obliterate the abnormal skin fold or evert the eyelid margin. Successful treatment was defined as eversion of the eyelid margin as assessed by lash-cornea touch. Ten eyelids of 8 patients (7 girls [88%]) underwent transcutaneous hyaluronic acid gel injection for correction of epiblepharon. Average age at presentation was 16.5months (range, 1-72months). Two patients had bilateral involvement. Of 10 eyelids, 8 had a distinct skin fold with a "valley" above it. Nine of 10 eyelids had lash-cornea touch in the primary gaze; 1 in downgaze. All 10 eyes had punctate corneal epitheliopathy on fluorescein staining. An average of 0.19ml (range, 0.1-0.3ml) of hyaluronic acid gel was injected per eyelid. After injection, 9 of 10 eyelids showed no lash-cornea touch in downgaze, and all 10 eyelids showed resolution of symptoms and epitheliopathy. Patients remained symptom-free for an average final follow-up of 19.1months (range, 5-42months). No procedure-related complications were noted. In our small case series, transcutaneous hyaluronic acid gel injection into the lower eyelid effectively corrected symptomatic epiblepharon; the effect was long lasting.