New trends in face rejuvenation by hyaluronic acid injections

Background Injection techniques are growing, thanks to safer and more suitable filling agents. Hyaluronic acid (HA), a biodegradable product, has become the “gold standard” for fillers. With its wide range, it not only improves wrinkles but also restores volume. Methods Since 1996, many patients have been injected for wrinkles, fine lines, and nasolabial folds. For 3 years, more viscous HAs have been launched, allowing us to restore volumes. Some new procedures are described. These can correct anomalies of the chin and of the nose, and allow a betterment of the periocular area by correcting hollow and falling eyebrows. Results The use of different HAs for each area and indication is suitable and offers real possibilities to rejuvenate the skin without downtime. Longevity of the correction depends on treated areas, HA used, and on the individual. Conclusion HAs are safe and suitable for wrinkles and volume restoration, but besides their mechanical properties, they have numerous physiological functions. With the analysis of literature about the action mechanism of HA and its receptors, it is evident that HA also has a stimulating action on different physiological process.     

注射透明质酸在促进面部年轻化应用中的研究进展

有研究表明透明质酸可通过刺激真皮胶原蛋白合成、抑制皮脂腺分泌以及收缩毛孔等促进面部年轻化。透明质酸也可与肉毒毒素、富血小板血浆及二氧化碳等联合注射治疗改善面部老化。本文对透明质酸促进面部年轻化的机制、分类及相应的疗效及持久性进行综述。     

A potential relationship between skin hydration and stamp‐type microneedle intradermal hyaluronic acid injection in middle‐aged male face

There is an increasing interest in skin rejuvenation using hyaluronic acid (HA) fillers beyond the improvement of deep wrinkles and volume deficiencies, which have been primary research foci in the past. We conducted a pilot study using a sample of six middle‐aged male subjects. Using an automatic intradermal injector with 0.020 mL of material contained in each injection point with a total of 100 points, 2 mL of non‐cross‐HA filler was injected into the entire face at every treatment session. We administered injections of HA for a total of three sessions per subject at 2‐week intervals and evaluated the results using a corneometer, TEWL, cutometer, measures of patient satisfaction, and the global aesthetic improvement scale (GAIS). Corneometer values increased steadily at each measurement, while the average value of TEWL increased in comparison with baseline after each application of the procedure. However, values returned to readings similar to those at 4 weeks after complete termination of the procedures. Cutometer values differed between the baseline and after procedures. All patients were assessed as “very much improved” or “much improved” according to GAIS, and all were pleased with the outcomes of treatment in terms of the enhancement of moisture, elasticity, and brightness.     

Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands

Background  Up to now rejuvenating treatment of the hands has been challenging and results often disappointing.
Aims  To determine whether hyaluronic acid (HA) microdroplet placement into the dorsal hands has an impact on skin physiology and clinical appearance and whether there is any difference between stabilized HA (S-HA) and nonstabilized HA (NS-HA).
Patients/methods  The intra-individual comparison in 15 volunteers involved injection sessions at week 0, 4, and 8 with random assignment of left and right hand to either S-HA or NS-HA. Skin physiology parameters cutaneous elasticity, surface roughness, hydration, and transepidermal water loss (TEWL) were measured in vivo at weeks 0 (before treatment), 4 (before subsequent treatment), 12, and 24. Clinical hand assessment was carried out at weeks 0 and 12 by a blinded dermatologist.
Results  Intradermal injection of S-HA generated significant improvement in skin elasticity and surface roughness at week 12 compared to baseline. On the hands treated with NS-HA, there was a trend for improvement (not significant). While there was no significant difference in hydration and TEWL between both hands before treatment, at week 12 hands treated with S-HA displayed a significantly higher hydration level and lower TEWL compared to NS-HA treatment. Clinically S-HA proved to be significantly superior to NS-HA. At week 24 the observed effects started to return back toward baseline, with S-HA treatment still offering better results compared to the NS-HA.
Conclusions  Skin revitalization with injectable HA can improve clinical appearance and skin physiology parameters on the back of the hands. It has been shown that S-HA has better effects when compared with NS-HA.     

Neck skin rejuvenation: Histological and clinical changes after combined therapy with a fractional non-ablative laser and stabilized hyaluronic acid-based gel of non-animal origin

Abstract

Background: The laser Affirm? (LA) is a microthermal, non-ablative fractional laser used for skin rejuvenation. Restylane Vital? Light (RVL) in the Restylane^® Injector, a formulation of stabilized hyaluronic acid-based gel of non-animal origin, is indicated for rejuvenation of delicate skin. Objectives: To assess the interaction between the LA and RVL in aging skin of the neck using clinical and histological parameters, and to determine whether combined therapy is effective. Methods: Nine female patients aged 42–62 years received four treatments, each comprising RVL followed immediately by LA treatment. Photographs and skin biopsies were taken before treatment, after the fourth session and 1 month later. Results: Improvements in fine wrinkles, tightness and skin texture were observed. Histologic evaluations showed favourable changes in cellularity, collagen and elastic fibres. Laser-induced effects (400 μm) and an inflammatory reaction (1000 μm) were seen. RVL was present at the mid–deep dermis (1000–1500 μm). Conclusions: Combined treatment with the LA and RVL improved skin appearance and structure as assessed, for the first time, with histology. The LA produced epidermal and superficial dermal changes whereas RVL acted deeper, together treating the full skin thickness.     

Ophthalmoplegia with skin necrosis after a hyaluronic acid filler injection

Hyaluronic acid filler injection is commonly used for aesthetic purposes. However, many clinicians neglect the possibility of developing vascular occlusion and its devastating sequelae. Besides visual loss after iatrogenic ophthalmic artery occlusion, ophthalmoplegia without blindness is rare but may occur. Here, we report a 23‐year‐old woman with ptosis, lateral deviation of the right eye, and skin necrosis after hyaluronic acid filler injection. After hyaluronidase injection and steroid pulse therapy, ptosis and eye movement were completely restored. Skin necrosis was treated with a human epithelial growth factor ointment, followed by Nd:YAG laser. Complete healing with minimal scar was achieved.     

外用透明质酸在皮肤科的应用

透明质酸（HA）是一种存在于人体基质内的多聚糖, 临床应用广泛,HA具有较高的生物相容性,增加了药物在皮损部位的停留时间;HA具有组织修复作用,缩短了伤口的愈合时间;HA对皮肤的屏障修复和炎症的调节也有一定作用。本文对HA的理化性质、生物性质和外用透明质酸在皮肤科的临床应用进行综述。     

Evaluation of a new hyaluronic acid dermal filler for volume restoration

Objectives: The present study aimed to evaluate the effectiveness and safety of hyaluronic acid gel for the treatment of volume loss or contour deficiency. Methods: This 6-month, open-label study recruited sixty adults aged 40–65 years with bilateral moderate to severe volume loss or contour deficiency (Facial Volume Loss Scale [FVLS] score: 2–5). Eligible subjects were treated at the baseline visit with an injection of hyaluronic acid gel in one or more of three facial subregions: the zygomatic malar region, the anteromedial cheek and nasolabial folds. Results: A significant improvement from baseline was observed in the FVLS score at each study visit up to 6 months post treatment (p < 0.0125 by Wilcoxon test). A significant improvement was also observed in the Global Aesthetic Improvement Scale (GAIS) at each visit up to 6 months. The study showed that the GAIS score improved in 100% of subjects at month 3, while at the end of the study (month 6) the percentage of improved subjects decreased to 91. Treatment effect was maintained by 100% of subjects up to month 3, while 57% of subjects showed a persistence of effect up to month 6. Conclusions: Volume loss or contour deficiency may be safely and effectively corrected using the new dermal filler.     

Comparative clinical study for the efficacy and safety of two different hyaluronic acid-based fillers with Tri-Hyal versus Vycross technology: A long-term prospective randomized clinical trial

Background

Hyaluronic acid-based fillers have an immediate volumizing effect for the treatment of dermal contour deformities and to smooth dermal depressions formed by the loss of volume. A previous study on 2016–2018 has shown the efficacy and safety of the HA-based filler ART FILLER® Volume on the midface only, but not in a comparative manner.

Methods

In this context, an 18 months prospective randomized single-blind study of the non-inferiority of ART FILLER® Volume versus the reference product Juvéderm Voluma® was performed on the midface, temple, and jawline, and non-comparative study on the chin. The efficacy and the longevity were evaluated for the selected face areas via dedicated clinical scoring systems after a single filler injection without any re-touch or re-injection. The short- and long-term adverse effects were also recorded.

Results

The observations confirmed the non-inferiority of ART FILLER® Volume versus the reference product on the different injected areas. For both fillers, the beneficial effects on volumes restoration were maintained 18 months post-injection; however, these effects were diminished among the time. Furthermore, injections of Art Filler® Volume were well tolerated by the subjects and showed less acute side effects compared with the reference product that may be explained by a lower induction of inflammation.     

A prospective multicenter clinical trial evaluating the efficacy and safety of a hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips and the perioral area

Background

Age-related changes of facial soft tissue cause clinical signs of facial aging such as lip atrophy, marionette lines, and an accentuated nasolabial fold. These changes can be modified using dermal fillers.

Aims

To evaluate efficacy, longevity, and safety of a cross-linked hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips, nasolabial folds, and marionette lines.

Materials and Methods

This prospective, multi-center trial evaluated injections of three different areas (lips, nasolabial fold alone, or with marionette wrinkles) with a soft tissue filler containing 25 mg/ml cross-linked hyaluronic acid and 0.3% lidocaine. Primary endpoint was the aesthetic correction 3 weeks after one injection session without touch-up. Follow-up was 18 months. Assessments were performed using the Global Aesthetic Score (GAS), clinical scoring based on photographic scales, high-frequency ultrasound imaging, and the Global Aesthetic Improvement Scale (GAIS).

Results

In total, 100 subjects were injected. GAS improved significantly for all treatment indications at 3 weeks (p < 0.0001). Success rates were highest for nasolabial folds (98.4%), followed by marionette lines (94.4%) and lips (73.5%). After 18 months post-injection, success was observed in 91%, 88%, and 33% of subjects injected into nasolabial folds, marionette lines, and lips, respectively. GAIS scored highest for nasolabial folds (SGAIS: 71%; IGAIS: 40%), followed by marionette lines (SGAIS: 56%; IGAIS: 33%) and lips (SGAIS: 30%; IGAIS: 22%) at 18 months follow-up.

Conclusions

The filler demonstrated high efficacy and safety in all indications. Regional differences in longevity were evident. Thus, the necessity of regional retreatments should be discussed with patients before injection.