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Fisher SM, Borab Z, Weir D, Rohrich RJ. The emerging role of biostimulators as an adjunct in facial rejuvenation: A systematic review. J Plast Reconstr Aesthet Surg 2024; 92:118-129. [PMID: 38518624 DOI: 10.1016/j.bjps.2024.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Facial aging has long been an area of focus in esthetic surgery. It is the consequence of physiologic and environmental factors, with a trend toward non-surgical modalities. Although volume augmentation has long been a focus of non-surgical facial rejuvenation, there is emerging interest in the use of biostimulators to induce physiologic changes in the skin. This article aimed to provide an overview of this class of therapies. METHODS A systematic review regarding the clinical use of biostimulatory agents including platelet-rich plasma (PRP), platelet-rich fibrin (PRF), poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) in facial rejuvenation was performed using PubMed databases. The protocol was developed following the preferred reporting for items for systematic reviews-protocols guidelines. Included studies matched predetermined criteria according to the employed intervention and outcomes. RESULTS The systematic review was performed in September 2023, with the primary search yielding 464 articles. Abstract review resulted in 73 articles of potential relevance. Comprehensive review of the articles and manual reference checks were performed, independently, by 2 authors. This yielded a total of 45 articles that met the inclusion criteria. CONCLUSIONS There is an increasing role for non-surgical modalities in facial rejuvenation. Biostimulatory agents may be used as an alternative, or act as an adjunct, to other non-surgical modalities. These agents induce physiologic changes that mitigate facial aging. There is limited, quantifiable data, which fully illustrate the effect in these products. Although these agents are known to illicit inflammatory changes, more controlled studies are needed to better elucidate the biostimulatory capacity of such non-surgical treatments.
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Affiliation(s)
- Sean M Fisher
- Dallas Plastic Surgery Institute, 9101 N Central Expy, Dallas, TX 75225, USA
| | - Zachary Borab
- Dallas Plastic Surgery Institute, 9101 N Central Expy, Dallas, TX 75225, USA
| | - David Weir
- Dallas Plastic Surgery Institute, 9101 N Central Expy, Dallas, TX 75225, USA
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute, 9101 N Central Expy, Dallas, TX 75225, USA.
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Zhao Q, Ogino S, Lee S, Kato Y, Li Y, Sakamoto M, Yamanaka H, Nakano T, Sawaragi E, Morimoto N. Development of new bioabsorbable implants with de novo adipogenesis. Regen Ther 2023; 24:311-317. [PMID: 37638279 PMCID: PMC10448420 DOI: 10.1016/j.reth.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/06/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Poly-L-lactic acid (PLLA) mesh implants containing collagen sponge (CS) were replaced with autologous adipose tissue regeneration in vivo. Herein, we investigated the optimal external frames and internal fillings using poly (lactic-co-ε-caprolactone) (P (LA/CL)), PLLA, and low-molecular-weight PLLA (LMW-PLLA) as the external frame and polyglycolic acid (PGA) nanosheets and CS as the internal filling. We prepared six implants: P (LA/CL) with PGA nano, PLLA with PGA nano, PLLA with CS, PLLA with 1/2 CS, PLLA with 1/4 CS, and LMW-PLLA with CS, and evaluated adipogenesis at 6 and 12 months using a rat inguinal model. The internal spaces in the P (LA/CL) and LMW-PLLA implants collapsed at 6 months, whereas those in the other four implants collapsed at 12 months. Adipose tissue regeneration was not significantly different between the PLLA-implanted groups at 6 and 12 months and was greater than that in the P (LA/CL) with PGA nano and LMW-PLLA with CS groups. The PGA nanosheet inside PLLA was comparable to the CS inside PLLA in the regeneration of adipose tissue and macrophage infiltration. In summary, PLLA is a promising external frame material in which the internal space can be replaced with adipose tissue. Thus, PGA nanosheets are an alternative internal filling material for adipose tissue regeneration.
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Affiliation(s)
- Qiannan Zhao
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Sunghee Lee
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Yuki Kato
- Gunze QOL Research Center Laboratory, 1 Zeze, Aono-cho, Ayabe, Kyoto 623-8511, Japan
| | - Yuanjiaozi Li
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Hiroki Yamanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Takashi Nakano
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Eiichi Sawaragi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyou-ku, Kyoto 606-8507, Japan
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Chandan N, Puyana C, Haber R. Combination Approaches to Hand Rejuvenation: A Review of the Literature and Discussion. Dermatol Surg 2023; 49:164-170. [PMID: 36728067 DOI: 10.1097/dss.0000000000003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Various noninvasive/minimally invasive modalities for hand rejuvenation exist, and the efficacy and safety of these procedures as both monotherapy and same-day procedures is increasingly being studied. OBJECTIVE To review data on the efficacy and safety of hand rejuvenation modalities and suggest a practical combination approach for these procedures. METHODS The PubMed database was queried for peer-reviewed articles regarding hand rejuvenation techniques, including chemical peels, laser and light sources, sclerotherapy, autologous fat transfer, and injectable volumetric fillers. RESULTS Chemical peels have been studied the least, with most studies evaluating the use of fillers and laser/light-based devices. Most studies reported overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with other modalities. Transient erythema, edema, or pain after procedures was common; most studies did not report serious postprocedure complications. Importantly, there was no significant increase in adverse effects after same-day procedures. CONCLUSION Using same-day procedures allows practitioners to address hand rejuvenation from different aspects, seems to improve outcomes, and reduces time spent in the office for patients. The authors suggest a practical framework for combining cosmetic approaches to achieve the most optimal outcome for hand rejuvenation.
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Affiliation(s)
- Neha Chandan
- All authors are affiliated with the Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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Li G, Yang T, Liu Y, Su H, Liu W, Fang D, Jin L, Jin F, Xu T, Duan C. The proteins derived from platelet-rich plasma improve the endothelialization and vascularization of small diameter vascular grafts. Int J Biol Macromol 2023; 225:574-587. [PMID: 36395946 DOI: 10.1016/j.ijbiomac.2022.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Vascular transplantation has become an ideal substitute for heart and peripheral vascular bypass therapy and tissue-engineered vascular grafts (TEVGs) present an attractive potential solution for vascular surgery. However, small diameter (Ф < 6 mm) vascular do not have ideal TEVGs for clinical use. Platelet-rich plasma (PRP), a key source of bioactive molecules, has been confirmed to promote tissue repair and regeneration. In this study, we prepared PRP-loaded TEVGs (PRP-TEVGs) by electrospinning, investigated the characterization of TEVGs, and verified the effect of PRP-TEVGs in vivo and in vitro experiments. The results suggested that PRP-TEVGs had good biocompatibility, released growth factors stably, promoted cell proliferation and migration significantly, up-regulated the expression of endothelial NO synthase (eNOS) in functional vascular endothelial cells (VECs), and maintained the stability of the endothelial structure. In vivo experiments suggest that PRP can promote rapid endothelialization and reconstruction of TEVGs. Overall, this finding indicated that PRP could promote the rapid vascular endothelialization of small-diameter TEVGs by improving contractile vascular smooth muscle cells (VSMCs) regeneration, and maintaining the integrity and functionality of VECs.
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Affiliation(s)
- Guangxu Li
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Tao Yang
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yanchao Liu
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Hengxian Su
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Wenchao Liu
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Dazhao Fang
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Lei Jin
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Fa Jin
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Tao Xu
- Tsinghua-Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen 518055, China; East China Institute of Digital Medical Engineering, Shangrao 334000, China.
| | - Chuanzhi Duan
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
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Angelo-Khattar M. Objective Assessment of the Long-Term Volumizing Action of a Polycaprolactone-Based Filler. Clin Cosmet Investig Dermatol 2022; 15:2895-2901. [PMID: 36597519 PMCID: PMC9805706 DOI: 10.2147/ccid.s385202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/30/2022] [Indexed: 12/29/2022]
Abstract
Background The polycaprolactone-based filler, (PCL-1, Ellansé-S), forms part of the recently growing portfolio of biodegradable collagen-stimulating fillers. It is comprised of a suspension of 25-50 micron diameter microspheres of polycaprolactone (PCL) (30%) in a carboxymethyl cellulose (CMC) gel carrier (70%) and has gained popularity due to its long-term volumizing action. Objective This study outlines a retrospective case series of nine patients injected with the PCL-1, for volume augmentation in the mid-face. Objective volume calculations were performed with the Canfield Vectra 3D Imaging System at two time points post-implantation, with the objective of determining the longevity of the volumizing effect of the bio-stimulating substance. Results A clear increase in volume, between 50-150%, was found in all of the patients at two years, over and above the volume initially injected. All the patients were satisfied with the longevity of the results. Discussion The PCL-based filler is believed to afford immediate volume restoration due to the CMC gel component and a long-term action due to neo-collagenesis, induced by the PCL microspheres. The CMC gel is known to dissipate within 6-8 weeks, only to be replaced by new collagen induced by the PCL particles. Thus soft-tissue formation induced by the PCL particles, ultimately leads to a sustained volumizing effect. Conclusion The PCL-based filler is shown to have a sustained volumizing effects of at least 2 years duration with clear evidence of increase in volume over and above the volume injected, in all of the cases studied. This is indicative of significant neo-collagenesis induced by the PCL microspheres.
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Affiliation(s)
- Maria Angelo-Khattar
- American Academy of Anti-aging Medicine, Dubai, United Arab Emirates,Altaderma Clinic, Dubai, United Arab Emirates,Correspondence: Maria Angelo-Khattar, Tel +971506245494, Email
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O’Daniel TG, Kachare MD. The Utilization Of Poly-L-Lactic Acid As A Safe And Reliable Method For Volume Maintenance After Facelift Surgery With Fat Grafting. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojac014. [PMID: 35662905 PMCID: PMC9153375 DOI: 10.1093/asjof/ojac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background For age-related volume loss, fat grafting is now recognized as an integral adjunctive procedure with facelift surgery. However, when there is continued and unpredicted volume loss postoperatively, the surgeon has limited options for restoring this lost volume. Objectives Poly-l-lactic acid (PLLA) is a proven biostimulator that creates volumetric enhancement. This study is undertaken to demonstrate that PLLA is a safe and efficacious option for maintenance of post-facelift volume loss. Methods A retrospective review was conducted to identify all patients who underwent facelift surgery with fat grafting and postoperative PLLA injections from 2010 to 2018 by a single surgeon. Demographic and clinical data were collected and analyzed. Results This review identified a total of 241 patients who had undergone a facelift with fat grafting and PLLA injections. Of these, 190 patients were treated with PLLA after facelift and fat grafting, while 51 patients received PLLA injections before their operation. We identified 5 common indications for use of PLLA after facelift surgery and fat grafting. These included unexplained early fat graft loss, significant weight loss in the postoperative period, normal aging process, and patients who had a high perioperative lean body mass. Additionally, PLLA was found to be an effective volumizer for site-specific areas that did not undergo fat grafting during the initial operation. There were no complications reported from the PLLA injections related to nodule formation, papules, or granulomas. Conclusions The high degree of variability in the survival of fat grafts with facelift surgery is an accepted reality. PLLA represents a safe and highly effective solution to restore volume loss in patients who have undergone facelifts with fat grafting.
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Affiliation(s)
| | - Milind D Kachare
- University of Louisville Department of Surgery (Plastics), Louisville, KY, USA
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Zhang Y, Liang H, Luo Q, Chen J, Zhao N, Gao W, Pu Y, He B, Xie J. In vivo inducing collagen regeneration of biodegradable polymer microspheres. Regen Biomater 2021; 8:rbab042. [PMID: 34408912 PMCID: PMC8364987 DOI: 10.1093/rb/rbab042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 12/26/2022] Open
Abstract
Biodegradable polymer particles have been used as dermal fillers for pre-clinical and clinical trials. The impact of material properties of polymers is very important to develop products for aesthetic medicine such as dermal fillers. Herein, eight biodegradable polymers with different molecular weights, chemical compositions or hydrophilic-hydrophobic properties were prepared and characterized for systematical study for aesthetic medicine applications. Polymer microspheres with 20-100 μm were prepared. The in vitro degradation study showed that poly (L-lactic-co-glycolic acid) 75/25 microspheres degraded the fastest, whereas poly (L-lactic acid) (PLLA) microspheres with intrinsic viscosity of 6.89 ([η] = 6.89) with the highest molecular weight showed the slowest degradation rate. After these microspheres were fabricated dermal fillers according to the formula of Sculptra®, they were injected subcutaneously into the back skin of rabbits. In vivo results demonstrated that the degradation rate of microspheres strongly correlated with the foreign body reaction and collagen regeneration was induced by microspheres. The microspheres with faster degradation rate induced inflammatory response and the collagen regeneration maintained in shorter time. PLLA ([η] = 3.80) microsphere with a moderate molecular weight and degradation rate could strongly regenerate Type I and III collagen to maintain a long-term aesthetic medicine effect. These properties of size, morphology and degradation behavior would influence the foreign body reaction and collagen regeneration.
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Affiliation(s)
- Yixin Zhang
- School of Smart Health, Chongqing College of Electronic Engineering, Chongqing 401331, China
| | - Hanwen Liang
- School of Laboratory Medicine, Sichuan Provincial Engineering Laboratory for Prevention and Control Technology of Veterinary Drug Residue in Animal-origin Food, Chengdu Medical College, Chengdu 610500, China
| | - Qian Luo
- School of Laboratory Medicine, Sichuan Provincial Engineering Laboratory for Prevention and Control Technology of Veterinary Drug Residue in Animal-origin Food, Chengdu Medical College, Chengdu 610500, China
| | - Jianlin Chen
- School of Laboratory Medicine, Sichuan Provincial Engineering Laboratory for Prevention and Control Technology of Veterinary Drug Residue in Animal-origin Food, Chengdu Medical College, Chengdu 610500, China
| | - Nan Zhao
- Puliyan (Nanjing) Medical Science & Technology Co. LTD, Nanjing 211500, China
| | - Wenxia Gao
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou 325027, China
| | - Yuji Pu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Bin He
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Jing Xie
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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Ray S, Adelnia H, Ta HT. Collagen and the effect of poly-l-lactic acid based materials on its synthesis. Biomater Sci 2021; 9:5714-5731. [PMID: 34296717 DOI: 10.1039/d1bm00516b] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Collagen is an important protein in various biological functions such as providing elasticity and waterproofing to the skin, structural stability to the cells in connective tissues (e.g. tendons, and bone) and stabilisation of atherosclerotic plaques. Collagen as a peptide with a peculiar triple helical structure is majorly composed of glycine and proline amino acids and is synthesised by fibroblasts via intracellular and extracellular mechanisms. Collagen plays an important role in wound healing, bone repair and plaque build-up during atherosclerosis. Various factors such as interleukins, insulin-like growth factor-I, nicotine, and glucose have been shown to influence collagen synthesis. This paper provides an overview of collagen structure, synthesis mechanisms, and the parameters that stimulate those mechanisms. Poly-l-lactic acid as a well-known biocompatible and biodegradable polymer has proved to stimulate collagen synthesis in various physical forms. As such, in this review special emphasis is laid on the effects of poly-l-lactic acid as well as its mechanism of action on collagen synthesis.
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Affiliation(s)
- Subarna Ray
- Queensland Micro- and Nanotechnology Centre, Griffith University, Brisbane, 4111, Queensland, Australia.
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Better Results in Facial Rejuvenation with Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2763. [PMID: 33173655 PMCID: PMC7647625 DOI: 10.1097/gox.0000000000002763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
Facial rejuvenation is a rapidly advancing field in aesthetic medicine. Minimally invasive techniques represent a powerful tool for rejuvenation, and fillers are a popular modality with which to restore and optimize facial proportions. Currently, our filler armamentarium is characterized by products with an increasing variety of biochemical compositions warranting tailored injection approaches. An intimate knowledge of anatomy, product characteristics, and appropriate injection techniques is essential to achieve optimal results while maintaining patient safety. Here, we review facial anatomy, structural changes secondary to aging, appropriate filler selection, safe injection techniques, and complications.
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Cabral LRB, Teixeira LN, Gimenez RP, Demasi APD, de Brito Junior RB, de Araújo VC, Martinez EF. Effect of Hyaluronic Acid and Poly-L-Lactic Acid Dermal Fillers on Collagen Synthesis: An in vitro and in vivo Study. Clin Cosmet Investig Dermatol 2020; 13:701-710. [PMID: 33061510 PMCID: PMC7533910 DOI: 10.2147/ccid.s266015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
Abstract
Purpose Skin ageing is marked by structural and functional changes in epidermis and dermis, which result clinically in wrinkles, loss of elasticity, and rough-textured appearance. In this context, different dermal fillers have been used to overcome these negative effects associated with skin ageing, such as hyaluronic acid (HA) and poly-L-lactic acid (PLLA). Despite their low immunogenicity, these materials can cause an inflammatory reaction after application. Materials and Methods Considering high demand of HA and PLLA as filler material, this study aimed to evaluate their in vitro and in vivo effects. For the in vitro study, human dermal fibroblast cell cultures were supplemented with HA or PLLA for 24, 48, and 72 h. The following parameters were assayed: 1) cell proliferation, 2) cell viability, and 3) quantification of type I collagen by ELISA. For the in vivo study, HA or PLLA was injected in the dermis of Wistar rats and the tissues were collected after 15, 30, and 60 days for histologic evaluation and for quantification of type I collagen by Western blotting. The quantitative data were statistically analyzed using an ANOVA two-way. The significance level was set at 5%. Results At 72 h, high cell proliferation was observed for HA compared to control (p<0.05). Cultures exposed to PLLA exhibited a reduction in both cell proliferation and viability compared to control in all time points (p<0.05). Type I collagen expression was greater in cultures exposed to HA or PLLA compared to control (p<0.05). Histologic analysis showed the presence of multinucleated cells only in the PLLA group in all experimental time points. Western blotting analysis revealed high content of type I collagen in HA compared to PLLA (p<0.05). Conclusion The present study addresses a potentially unfavorable effect of dermal PLLA filler on the fibroblast phenotype, with possible clinical complications, unlike HA.
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Affiliation(s)
| | - Lucas Novaes Teixeira
- Division of Cell Biology and Oral Pathology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Rodrigo Pinto Gimenez
- Division of Plastic Surgery, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - Ana Paula Dias Demasi
- Division of Cell Biology and Oral Pathology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | | | - Vera Cavalcanti de Araújo
- Division of Cell Biology and Oral Pathology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
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Abu Hajleh MN, Al-Samydai A, Al-Dujaili EAS. Nano, micro particulate and cosmetic delivery systems of polylactic acid: A mini review. J Cosmet Dermatol 2020; 19:2805-2811. [PMID: 32954588 DOI: 10.1111/jocd.13696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Poly lactic acid and its copolymers are considered to be the preferred substrates for drug delivery devices. Poly lactic acid is a biocompatible, biodegradable and nontoxic polymer. It was approved by Food and Drug Administration and thought to be among the most attractive polymeric candidates intended for controlling drug delivery. It was utilized for the development of devices for the delivery of small molecules, proteins, genes, vaccines, anticancer drugs, and macromolecules. OBJECTIVES AND METHODS This manuscript lists the different techniques for synthesizing poly lactic acid-based nano and microparticles such as emulsion-based methods, precipitation-based methods, direct compositing methods, in situ forming micro-particles, and microfluidic technique. CONCLUSIONS In addition, it describes the application and use of poly lactic acid in biomedical and cosmetic delivery systems.
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Affiliation(s)
- Maha N Abu Hajleh
- Department of Cosmetic Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Ali Al-Samydai
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Emad A S Al-Dujaili
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Iglesias J, Martínez-Salazar I, Maireles-Torres P, Martin Alonso D, Mariscal R, López Granados M. Advances in catalytic routes for the production of carboxylic acids from biomass: a step forward for sustainable polymers. Chem Soc Rev 2020; 49:5704-5771. [PMID: 32658221 DOI: 10.1039/d0cs00177e] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Polymers are ubiquitously present in our daily life because they can meet a wide range of needs and fields of applications. This success, based on an irresponsible linear consumption of plastics and the access to cheap oil, is creating serious environmental problems. Two lines of actions are needed to cope with them: to adopt a circular consumption of plastics and to produce renewable carbon-neutral monomers. This review analyses the recent advances in the chemocatalytic processes for producing biomass-derived carboxylic acids. These renewable carboxylic acids are involved in the synthesis of relevant general purpose and specialty polyesters and polyamides; some of them are currently derived from oil, while others can become surrogates of petrochemical polymers due to their excellent performance properties. Polyesters and polyamides are very suitable to be depolymerised to other valuable chemicals or to their constituent monomers, what facilitates the circular reutilisation of these monomers. Different types of carboxylic acids have been included in this review: monocarboxylic acids (like glycolic, lactic, hydroxypropanoic, methyl vinyl glycolic, methyl-4-methoxy-2-hydroxybutanoic, 2,5-dihydroxypent-3-enoic, 2,5,6-trihydroxyhex-3-enoic acids, diphenolic, acrylic and δ-amino levulinic acids), dicarboxylic acids (2,5-furandicarboxylic, maleic, succinic, adipic and terephthalic acids) and sugar acids (like gluconic and glucaric acids). The review evaluates the technology status and the advantages and drawbacks of each route in terms of feedstock, reaction pathways, catalysts and economic and environmental evaluation. The prospects and the new research that should be undertaken to overcome the main problems threatening their economic viability or the weaknesses that prevent their commercial implementation have also been underlined.
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Affiliation(s)
- J Iglesias
- Chemical & Environmental Engineering Group, Universidad Rey Juan Carlos, C/Tulipan, s/n, Mostoles, Madrid 28933, Spain
| | - I Martínez-Salazar
- EQS Group (Sustainable Energy and Chemistry Group), Institute of Catalysis and Petrochemistry (CSIC), C/Marie Curie, 2, 28049 Madrid, Spain.
| | - P Maireles-Torres
- Universidad de Málaga, Departamento de Química Inorgánica, Cristalografia y Mineralogía (Unidad Asociada al ICP-CSIC), Facultad de Ciencias, Campus de Teatinos, 29071 Málaga, Spain
| | - D Martin Alonso
- Glucan Biorenewables LLC, Madison, WI 53719, USA and Department of Chemical and Biological Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - R Mariscal
- EQS Group (Sustainable Energy and Chemistry Group), Institute of Catalysis and Petrochemistry (CSIC), C/Marie Curie, 2, 28049 Madrid, Spain.
| | - M López Granados
- EQS Group (Sustainable Energy and Chemistry Group), Institute of Catalysis and Petrochemistry (CSIC), C/Marie Curie, 2, 28049 Madrid, Spain.
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Lowe NJ, Ghanem AM. Volume restoration of hands with polycaprolactone by cannula delivery; a prospective single center consecutive case series evaluation. J COSMET LASER THER 2020; 22:55-59. [PMID: 32005078 DOI: 10.1080/14764172.2019.1711127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Dorsal hand volume loss results in the perception of aging appearance. Several volumizing fillers have been used for this correction.Objective: To report restoration of dorsal hand volume using cannula delivery of Polycaprolactone (PCL) microspheres and to assess efficacy, duration, and safety up to 3 years post treatment.Method: Fifteen patients with volume loss of their hands were evaluated by clinical examination, photography and a hand volume grading scale. PCL was injected by 25 G cannula after locating dorsal veins using a viewing laser to avoid intravascular injections. Patients' satisfaction and grade of severity were reevaluated at early (3-6 months) and late (12-18 months) timepoints following the procedure. A second treatment was offered if desired by the patient.Results: Eight participants required one treatment session to achieve satisfaction. Five had two treatments. Patients requiring a second treatment were reassessed after 12 months. All patients had improvements on the severity score by the end of the evaluation period. Side effects were minimal and transient. No patients developed bruising.Conclusion: PCL injections are reliable method for hand volumization. Results persisted for up to 3 years in some patients. Laser vein viewer and cannula delivery ensure uniform injections and avoid intravascular injuries.
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Affiliation(s)
| | - Ali M Ghanem
- Cranley Clinic for Dermatology, Cranley Clinic, London, UK.,Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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14
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An Update on Combination Treatments with Fractional Resurfacing Lasers. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Patients increasingly request rejuvenation of the aging and photodamaged décolletage. Rhytides in this area can be addressed with injectables such as poly-L-lactic acid and hyaluronic acid products and energy-based devices, such as fractionated ablative and nonablative lasers and microfocused ultrasound with visualization. METHODS This article will review the anatomy of the chest wall as it pertains to injectables that can be utilized in this area and injection technique. A review of the literature and the authors' experience will be discussed. CONCLUSION Cosmetic injectables can be utilized safely and effectively to improve the appearance of rhytides on the décolletage.
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Daines SM, Williams EF. Complications associated with injectable soft-tissue fillers: a 5-year retrospective review. JAMA FACIAL PLAST SU 2014; 15:226-31. [PMID: 23539246 DOI: 10.1001/jamafacial.2013.798] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Even when administered by experienced hands, injectable soft-tissue fillers can cause various unintended reactions, ranging from minor and self-limited responses to severe complications requiring prompt treatment and close follow-up. OBJECTIVES To review the complications associated with injectable soft-tissue filler treatments administered in the Williams Rejuva Center during a 5-year period and to discuss their management. DESIGN AND SETTING Retrospective medical record review in a private practice setting. PARTICIPANTS Patients receiving injectable soft-tissue fillers and having a treatment-related complication. INTERVENTIONS Injectable soft-tissue filler treatments. MAIN OUTCOME MEASURES A retrospective medical record review was conducted of patients undergoing treatment with injectable soft-tissue fillers between January 1, 2007, and December 31, 2011, and identified as having a treatment-related complication. RESULTS A total of 2089 injectable soft-tissue filler treatments were performed during the study period, including 1047 with hyaluronic acid, 811 with poly-L-lactic acid, and 231 with calcium hydroxylapatite. Fourteen complications were identified. The most common complication was nodule or granuloma formation. Treatment with calcium hydroxylapatite had the highest complication rate. CONCLUSIONS AND RELEVANCE Complications are rare following treatment with injectable soft-tissue fillers. Nevertheless, it is important to be aware of the spectrum of potential adverse sequelae and to be comfortable with their proper management. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Steven M Daines
- Daines Plastic Surgery, 180 NewportCenterDr, Ste 158, Newport Beach, CA 92660, USA.
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Winters R, Moulthrop T. Is autologous fat grafting superior to other fillers for facial rejuvenation? Laryngoscope 2013; 123:1068-9. [DOI: 10.1002/lary.23614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/13/2012] [Accepted: 07/02/2012] [Indexed: 11/06/2022]
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Mariwalla K, Narins RS, Wiest LG, França K, Alqubaisy Y, Vega J, Busso M, Brandt FS, Kaufman J, Green JB, Ballin AC, Cazzaniga A. Temporary Fillers. Dermatol Surg 2012. [DOI: 10.1002/9781118412633.ch35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Lorenc ZP. Techniques for the optimization of facial and nonfacial volumization with injectable poly-l-lactic acid. Aesthetic Plast Surg 2012; 36:1222-9. [PMID: 22926148 DOI: 10.1007/s00266-012-9920-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/08/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED With the recognition of the key role of volume loss in the facial aging process, injectable dermal fillers and volumizers have become increasingly important treatment options for recontouring and rejuvenating the aging face. While replacement fillers effectively correct individual lines and wrinkles, volumizing agents that replace collagen provide a longer-lasting, volume-based alternative. Poly-L-lactic acid (PLLA) has been shown to increase dermal thickness and volume for up to 2 years and beyond. Although early clinical use of this agent in patients with HIV-associated facial lipoatrophy was associated with a significant rate of nodule or papule formation, subsequent experience has helped define the proper reconstitution volumes and injection techniques for optimizing results and minimizing nodule/papule formation. While injectable PLLA has been used successfully for rejuvenation of most facial areas, increasing experience suggests that it is a versatile agent capable of providing aesthetic enhancement in multiple areas of the body, including the dorsum of the hands, the décolleté, the neck, the buttocks, the medial ankles, and acne scars. Although the current published experience in these areas is limited, further studies and clinical use of injectable PLLA will clarify the potential of this agent as a minimally invasive alternative and/or adjunct to surgery for restoring volume loss in multiple anatomic areas. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article.
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Affiliation(s)
- Z Paul Lorenc
- Lorenc Aesthetic Plastic Surgery Center, New York, NY, USA.
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22
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Abstract
All cosmetic injectable products are associated with the risk of both early and delayed complications. Early and expected side effects include swelling, bruising, and erythema at the injection. It is of utmost importance that patients are educated on the treatment they are consenting to receive and the potential risk of these therapies. Side effects of the various cosmetic injectable products, including both injectable neurotoxins and soft tissue fillers, are often technique associated, such as placing the filler too superficial or unintentional paralysis of facial muscles. Other complications, such as necrosis, intravascular injections, and infection may not be entirely technique-dependent, and must be managed swiftly and effectively. Finally, immunologic phenomena, such as delayed-type hypersensitivity reactions and foreign body granulomas, are complications that have no relationship to technique, and thus proper counseling and knowledge of management is required.
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Affiliation(s)
- Sue Ellen Cox
- Aesthetic Solutions Department of Dermatology, New York University Ronald O. Perelman, Chapel Hill, North Carolina 27517, USA.
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23
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Fabi SG, Goldman MP. The Safety and Efficacy of Combining Poly-L-Lactic Acid with Intense Pulsed Light in Facial Rejuvenation: A Retrospective Study of 90 Patients. Dermatol Surg 2012; 38:1208-16. [DOI: 10.1111/j.1524-4725.2012.02476.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bassichis B, Blick G, Conant M, Condoluci D, Echavez M, Eviatar J, Gold MH, Hamilton T, Hanke WC, Humble G, LaMarca A, Daro-Kaftan E, Mest D, Pierone G. Injectable Poly-l-Lactic Acid for Human Immunodeficiency Virus–Associated Facial Lipoatrophy: Cumulative Year 2 Interim Analysis of an Open-Label Study (FACES). Dermatol Surg 2012; 38:1193-205. [DOI: 10.1111/j.1524-4725.2012.02474.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND The aged hand is characterized by cutaneous and dermal atrophy, with deep intermetacarpal spaces, prominent bones and tendons, and bulging reticular veins. Epidermal changes include solar lentigines, seborrheic keratoses, actinic keratoses, skin laxity, rhytides, tactile roughness, and telangiectasia. STUDY DESIGN A Medline search was performed on hand rejuvenation from 1989 to 2011, and results are summarized. Practical applications of these procedures are also discussed. RESULTS Reports of injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, autologous fat transfer, vein treatment, and chemical peels, along with lasers and light sources such as Q-switched laser, intense pulsed light, photodynamic therapy, nonablative resurfacing lasers, and ablative resurfacing lasers, in the rejuvenation of hands were found. CONCLUSION Review of the literature revealed options for minimally invasive treatment for rejuvenation of the skin and volume restoration of the dorsal hand. These treatments include injectables and fat transfer for volume restoration; sclerotherapy or vein ablation for dorsal hand vein treatment; and chemical peels, lasers, light, and energies for the treatment of epidermal and dermal changes.
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Affiliation(s)
- Sabrina G Fabi
- Goldman, Butterwick, Fitzpatrick, and Groff Cosmetic Laser Dermatology, San Diego, CA 92121, USA.
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Mansor S, Breiting VB, Dahlstrøm K, Andersen AB, Andersen O, Christensen LH. Polyacrylamide gel treatment of antiretroviral therapy-induced facial lipoatrophy in HIV patients. Aesthetic Plast Surg 2011; 35:709-16. [PMID: 21359981 DOI: 10.1007/s00266-011-9671-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/23/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Today, highly active antiretroviral therapy is lifesaving for most HIV-infected patients, but the treatment can result in facial lipoatrophy, which changes the face so radically that patients may develop severe psychological and social problems. Since 2001 polyacrylamide gel (PAAG) has been used successfully in HIV patients abroad. This article describes the results of a Danish study. METHODS Forty HIV patients recruited from two major referral hospitals in the capitol area of Copenhagen, Denmark, each received a series of PAAG gel injections (small deposits in several sessions) with a 14-day interval. Patient satisfaction, injector's evaluation, evaluation by an external specialist in plastic surgery, and long-term aesthetic effect and complications were registered with follow-up until 2 years. RESULTS All patients were very satisfied or satisfied with the result. The injector found the result very satisfying in 33 cases and a slight irregularity in 7. The external specialist found improvement in all cases with a one-grade reduction of the lipoatrophy in 11 cases, a two-grade reduction in 20, and a three-grade reduction in 3 cases. No filler-associated complications were recorded. CONCLUSION This study has shown that PAAG can normalize contours in patients suffering from facial lipoatrophy within 3-6 sessions, with a mean amount of gel per session of 1.8 ml and a mean total amount of 8.8 ml. The results are in accordance with those of other large studies, confirming a high degree of biocompatibility and safety.
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Affiliation(s)
- Samreen Mansor
- Clinic of Infectious Disease and Center of Clinical Research, Hvidovre Hospital, Hvidovre, Denmark
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Bauer U, H Graivier M. Optimizing Injectable Poly-L-Lactic Acid Administration for Soft Tissue Augmentation: The Rationale for Three Treatment Sessions. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011. [DOI: 10.1177/229255031101900311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The availability and variety of different injectable modalities has led to a dramatic increase in soft tissue augmentation procedures in recent years. Injectable poly-L-lactic acid (PLLA) is a synthetic, biodegradable polymer device approved in the United States for use in immunocompetent patients as a single regimen of up to four treatment sessions for correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. Injectable PLLA is also approved for restoration and/or correction of signs of facial fat loss (lipoatrophy) in individuals with HIV. METHODS The present article provides an overview of previous studies with injectable PLLA, and specifically focuses on the number of recommended treatment sessions and intervals between treatment sessions. The authors also provide two case studies to support their recommendations for an average of three treatment sessions. RESULTS Although the specific mechanisms remain hypothetical, injections of PLLA are believed to cause a cascade of cellular events that lead to collagen repair and subsequent restoration of facial volume. Because the development of a response to injectable PLLA is gradual and its duration of effect is long lasting, sufficient time between treatment sessions should be allocated to avoid overcorrection. CONCLUSION Studies of injectable PLLA support the hypothesized mode of operation, and the experience and clinical recommendations of the authors that suggest that three treatment sessions are an optimal regimen for use of injectable PLLA in the majority of patients.
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Brandt FS, Cazzaniga A, Baumann L, Fagien S, Glazer S, Kenkel JM, Lowe NJ, Monheit GD, Narins RS, Rendon MI, Rohrich RJ, Werschler WP. Investigator global evaluations of efficacy of injectable poly-L-lactic acid versus human collagen in the correction of nasolabial fold wrinkles. Aesthet Surg J 2011; 31:521-8. [PMID: 21719865 DOI: 10.1177/1090820x11411161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Injectable poly-L-lactic acid (PLLA) is indicated in the United States for use in immune-competent patients for correction of shallow-to-deep nasolabial fold contour deficiencies and other facial wrinkles in which a deep dermal grid pattern injection technique is appropriate. It is also indicated for restoration and/or correction of signs of lipoatrophy in patients with human immunodeficiency virus. OBJECTIVE The authors examine the efficacy of injectable PLLA for correction of nasolabial fold wrinkles, based on Investigator Global Evaluations (IGE). METHODS A randomized, multicenter, subject-blinded, parallel-group study compared injectable PLLA versus human collagen for correction of nasolabial fold wrinkles for 13 months after up to four treatments (intent-to-treat population, 233). Injectable PLLA-treated subjects were followed up for an additional 12 months (total, 25 months) after the final treatment session. Efficacy was also assessed through secondary IGE for improvement, which is the subject of this report. RESULTS IGE reports of improvement were significantly greater in subjects who received injectable PLLA versus those who received human collagen (p < .001). Overall improvement with injectable PLLA was 100% three weeks after the final treatment, remaining above 85% through month 25. Overall IGE of improvement with human collagen declined from 94.0% at week three to 6.0% at month 13. Both treatment groups had similar safety profiles. CONCLUSIONS IGE of improvement were significantly greater with injectable PLLA treatment than with human collagen treatment at all time points following the last treatment. Injectable PLLA treatment continued to show a beneficial effect for up to 25 months.
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Abstract
The purpose of this article is to discuss current techniques used with poly-l-lactic acid to safely and effectively address changes observed in the aging face. Several important points deserve mention. First, this unique agent is not a filler but a stimulator of the host's own collagen, which then acts to volumize tissue in a gradual, progressive, and predictable manner. The technical differences between the use of biostimulatory agents and replacement fillers are simple and straightforward, but are critically important to the safe and successful use of these products and will be reviewed in detail. Second, in addition to gains in technical insights that have improved our understanding of how to use the product to best advantage, where to use the product to best advantage in facial filling has also improved with ever-evolving insights into the changes observed in the aging face. Finally, it is important to recognize that a patient's final outcome, and the amount of product and work it will take to get there, is a reflection of the quality of tissues with which they start. This is, of course, an issue of patient selection and not product selection.
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Affiliation(s)
- Rebecca Fitzgerald
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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Lowe P, Lowe NJ, Patnaik R. Three-dimensional digital surface imaging measurement of the volumizing effect of injectable poly-l-lactic acid for nasolabial folds. J COSMET LASER THER 2011; 13:87-94. [DOI: 10.3109/14764172.2011.564627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention, and treatment of dermal filler complications. Aesthet Surg J 2011; 31:110-21. [PMID: 21239678 DOI: 10.1177/1090820x10391083] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The availability of dermal fillers for multiple cosmetic indications has led to a dramatic increase in their application. Although fillers are generally regarded as safe tools for soft tissue augmentation, complications can occur. Therefore, to describe and review the complications associated with the currently-available dermal filling agents, the authors conducted a literature review in peer-reviewed journals and present the reported complication rates. They also describe current strategies to avoid, diagnose, and manage complications if they do occur.
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Affiliation(s)
- Steven H Bailey
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75038, USA
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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Abstract
There are many types of dermal fillers currently used for cosmetic and medical indications in routine clinical practice. Fillers can be classified as temporary, semipermanent, or permanent depending on the length of time the substance remains in tissue. They can also be classified by the composition of the product. Materials can be based on collagen (bovine, porcine, and human), hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, polymethal methacrylates, and polyacrylamide gels, among others. Temporary fillers are the products most often used for cosmetic purposes, in particular hyaluronic acid. This is due to the ease of application of fillers based on this substance, the good results obtained, and their safety profile. This review presents an overview of the techniques used for the correct placement of dermal fillers and the most common clinical indications for these procedures. It also covers the nature, properties, and mechanisms of action of the principal temporary, semipermanent, and permanent dermal fillers as well as the indications for each type of material. Finally, we describe the most common complications encountered and their treatment.
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Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, Vleggaar D, Werschler WP, Kenkel JM. Nonsurgical modalities to treat the aging face. Aesthet Surg J 2010; 30 Suppl:31S-5S. [PMID: 20844299 DOI: 10.1177/1090820x10373361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Injectable shaping agents include neurotoxins (botulinum toxin type A products), replacement fillers (hyaluronic acid [HA] agents), and biostimulatory fillers (calcium hydroxylapatite [CaHA], polymethylmethacrylate [PMMA], and poly-L-lactic acid [PLLA]). This article presents an overview of the agents currently available for use in facial rejuvenation in the United States.
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Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, Vleggaar D, Werschler WP, Kenkel JM. Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations. Aesthet Surg J 2010; 30 Suppl:36S-45S. [PMID: 20844300 DOI: 10.1177/1090820x10378697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As injectable products have been introduced and as clinicians have gained experience with them, applications and techniques for injection have evolved, with better cosmetic results, enhanced patient safety, and greatly improved patient satisfaction. Within the past four years, several consensus recommendation panels have been convened to summarize the accumulated clinical experience and knowledge about the application of these products. The guidelines that already exist in the literature are referred to, and suggested guidelines for the administration of poly-L-lactic acid-for which no consensus guidelines have previously been published-are included in this article.
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Sánchez-Carpintero I, Candelas D, Ruiz-Rodríguez R. Materiales de relleno: tipos, indicaciones y complicaciones. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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