Gene Expression Changes in the Skin of Patients Undergoing Medial Thigh Liposuction With Pre-Surgical and Post-Surgical Application of Topical Products

A Multi-Center Evaluation of Restorative Eye Treatment and INhance With Trihex Technology to Improve Aesthetic Outcomes When Used Pre- and Post-Blepharoplasty

Background

Restorative Eye Treatment with TriHex Technology (RET) is a topical eye product with peptides and botanicals that reduce the appearance of crow's feet, under-eye bags, and dark circles. INhance with TriHex Technology (IH) is a topical product that has been clinically proven to accelerate the clearance of bruises and aid in the reduction of swelling. TriHex Technology has been shown to regenerate collagen and elastin.

Objectives

Evaluate the use of RET compared to a bland moisturizer prior to blepharoplasty and the bilateral use of INhance postoperatively.

Methods

Blepharoplasty patients were randomized to use either RET or a bland moisturizer, twice daily, on the designated periocular skin for 4 weeks prior to the procedure. Postoperatively, participants applied IH bilaterally, at least 4 times a day, and returned for follow-up on Days 1 or 3, 7, and 14. The removed upper-eyelid skin (13 patients) underwent independent dermatopathological evaluation.

Results

Investigators noted no differences in peri-operative complications but observed faster improvement in swelling, bruising, discomfort on the treated side. 85% of participants had less edema and bruising on the RET pretreated side. Biopsy results revealed improved extracellular matrix appearance on the RET pretreated side. Participants agreed that IH alleviated their swelling and noted that their skin felt and appeared more hydrated.

Conclusions

A regimen designed for eyelid surgery employing a pretreatment product component and a post treatment product appear to have a positive impact on measured outcomes in blepharoplasty patients including effects on bruising, swelling and patient comfort.

Level of Evidence 4

A Multicenter, Randomized, Double-Blind, Split-Body Clinical Trial Evaluating the Efficacy and Outcomes of a Topical Product Pre and Post Aesthetic Surgical Body Procedures

Background

Skin preconditioning prior to and following procedures, has previously been demonstrated to hasten and optimize healing, and decrease the symptoms and signs associated with invasive surgery. These trials involved the use of multiple topical products. In an effort to control costs and to increase patient compliance, a single surgical product was developed, with actives aimed at decreasing swelling, bruising, induration, and internal fibrous banding.

Objectives

This multi-center trial was designed to measure the efficacy of this single product in these mentioned parameters.

Methods

A double-blind, randomized, split body, clinical study was undertaken in 29 patients involving 38 surgical procedures. Assessments included photography, biopsies, ultrasound imaging, and blinded investigator and participant assessments.

Results

Differentiated results between test comparator sides became apparent at postop day 10-14 (as previously observed). Thus, blinded investigator and participant assessment scores demonstrated statistical significance exclusive to the test product side at postop day 10-14 for ecchymoses and then extending to skin discoloration, edema, induration and subcutaneous fibrous banding, at weeks 3, 4, 6, and 12. Ultrasound evaluation confirmed the earlier dissolution of fibrous banding on the test side in the subcutaneous tissue at the 3-6-week postop period. In addition, biopsies assessing the pre-conditioned period prior to surgery confirmed that the topical test product stimulated a remodeled extracellular matrix without comparative changes on the opposite side.

Conclusions

A single peri-surgical product designed for the use with invasive surgery produced significant differences in ecchymosis, skin discoloration, edema, induration and ongoing resolution of fibrous banding over many weeks. This study validation provides an additional adjunct to surgical procedures.

Level of Evidence 2

Topical Skin Treatment and Its Influence on Surgical Healing: Review of Literature and Underlying Physiology

TriHex Technology (Alastin Skincare, Carlsbad, CA) has been shown clinically to promote healing and outcomes post procedures and has been demonstrated clinically to improve lipid droplet dissolution and patient-reported outcomes post procedure. Histologically, the formulations have proven to regenerate collagen and elastin. The use of the technology to prepare the skin for surgical procedures combined with its use post procedure was assessed through clinical study outcomes, histological evidence, and gene expression analyses and demonstrated remodeling of the extracellular matrix (ECM), accelerating healing, and initiation of anti-inflammatory genes. While the improvement in clinical signs and outcomes has been validated, the changes taking place at a molecular level need to be explored. The interaction of cells (adipocytes, macrophages, fibroblasts) and the ECM proteins (collagen, elastin) secondary to the effects of the topical agent application are discussed. It appears that the manipulation of fat during body contouring surgery and the resultant adipocytolysis precipitates a molecular profile that can be positively directed toward hastened healing by using adjuvant topical applications as preconditioning prior to surgery and after the surgical procedure. Here, we review the literature and underlying physiology relating to these products and describe how interleukin 6 appears to be the primary facilitator of these effects.

Prospective, Randomized, Comparative Study of the Cutaneous Effects of a Topical Body Treatment Compared to a Bland Moisturizer

BACKGROUND

Over time human skin thins and loses elasticity; topical treatments attempt to reverse this process.

OBJECTIVES

The aim of this study was to assess the efficacy of TransFORM Body Treatment (TFB) in skin rejuvenation compared to a bland moisturizer on the extensor and volar forearms.

METHODS

Blinded participants were given 2 products to apply on the designated forearms with follow-up at 4, 8, and 12 weeks. Measurements included skin thickness, photography, dermatopathology, cutaneous elasticity determined by 2 different methods, and patient-reported outcomes. All were compared to baseline.

RESULTS

Changes between bland moisturizer and TFB were recorded for the following parameters. (1) Roughness: extensor -0.09 mm for bland moisturizer and -0.26 mm for TFB (P = 0.174); volar 0.01 mm for bland moisturizer and -0.23 mm for TFB (P = 0.004). (2) Recoil velocity: volar -56°/sec for bland moisturizer and -24°/sec for TFB (P = 0.61); extensor -95°/sec for bland moisturizer and -63°/sec for TFB (P = 0.57). Retraction speed: volar -3.25 ms for bland moisturizer and -20.08 ms for TFB (P = 0.33); extensor -2.17 ms for bland moisturizer and -10.83 ms for TFB (P = 0.66). Histologically, TFB resulted in an increase in mucopolysaccharide content, new collagen, and number of elastin fibers in the papillary dermis. Changes in the Rao-Goldman score were also observed: volar -0.17 for bland moisturizer and -0.33 for TFB (P = 0.25); extensor -0.08 for bland moisturizer and -0.17 for TFB (P = 0.36).

CONCLUSIONS

Histology showed production of new collagen and elastin. Quantification of changes in skin thickness, skin retraction speed, and skin recoil velocity showed trends that agree with the visual data.

LEVEL OF EVIDENCE: 4

Evaluating a Topical Adjunctive Post Submental ATX-101 (Deoxycholic Acid) Injections for Improved Recovery: A Single-Center, Double-Blind, Randomized Controlled Pilot Study

Background

Optimizing postprocedural recovery and outcomes for patients is the aim for all physicians. TransFORM Body Treatment with TriHex Technology (TFB) is a topical product that aids in the elimination of fat particles created during procedures and the reduction of associated inflammation, thus speeding up postprocedure recovery time.

Objectives

Evaluation of postprocedural symptoms, signs, and healing following submental deoxycholic acid (DCA) injections in combination with TFB.

Methods

Participants received 2 treatments of submental DCA injections. Posttreatment 1, every participant received TFB to apply twice daily to the submental area. Follow-up visits included weeks 1, 2, and 4. After week 4, participants discontinued TFB for 30 days before the second treatment. At the second treatment visit, participants were randomized to receive either TFB or a bland moisturizer to apply twice daily with the same follow-up visits as posttreatment 1. Induration measurements, submental fullness grading, and standardized photography were captured at every visit. At all follow-up visits and before treatment 2, investigator assessments and participant assessments were completed.

Results

Posttreatment 2, investigator assessments of edema and induration decreased in participants using TFB at weeks 1 and 2 compared with the bland moisturizer. Induration measurements objectively showed a statistically significant reduction at week 2 (posttreatment 2) in participants using TFB compared with the bland moisturizer. Furthermore, participants reported less tenderness and soreness in the TFB group over the bland moisturizer.

Conclusions

Investigator assessments, participant query, and objective induration analyses have demonstrated that the use of TFB post DCA injections may reduce induration, edema, and discomfort associated with this procedure.

Level of Evidence: 2

An Analysis of Patient-Reported Recovery Outcomes of Topical Tripeptide/Hexapeptide Formulations Utilized in a Prospective Randomized Double-Blind Split Neck and Body Study

BACKGROUND

Physicians strive to improve the postsurgical experience and optimize patient-reported recovery outcome measures (PROMs) following elective cosmetic surgical procedures. Our previous pilot feasibility study demonstrated that twice daily postoperative topical body treatment with tripeptide and hexapeptide (TransFORM Body Treatment with TriHex Technology [TFB, Alastin Skincare, Inc., Carlsbad, CA]) reduced PROMs of swelling, induration, soft tissue fibrosis, and pain as well as improved visible and palpable skin quality.

OBJECTIVES

Evaluate whether adding a tripeptide/hexapeptide anhydrous gel (Regenerating Skin Nectar with TriHex Technology [RSN, Alastin Skincare, Inc., Carlsbad, CA]) pre- and post-procedure to the existing postsurgical regimen of TFB significantly improves 6 PROMs in patients undergoing neck and body contouring cosmetic surgical procedures.

METHODS

Ten female patients underwent 15 neck and body contouring procedures and were blindly randomized to 1 of 2 topical treatment protocols (1 [TFB] and 2 [RSN/TFB]) pre- and post-procedure. Patient-reported scores of 5 skin parameters (skin discoloration, ecchymosis, edema, induration, and subcutaneous fibrous banding) and pain scores using the Visual Analog Scale were collected at 8 intervals for 12 weeks post-procedure.

RESULTS

The treatment side that used both topicals showed significantly reduced scores of edema, induration, and subcutaneous fibrous banding compared with the side that only used 1 topical, on days 5-7 and 10-14 (P < 0.05). All patients observed slower soft tissue recovery on the side that was treated with TFB alone and opted to break the code and use both topical treatments.

CONCLUSIONS

Patients had statistically significant improved patient-reported measures of skin edema, skin induration, and subcutaneous banding on the operated side that used both topicals.

LEVEL OF EVIDENCE 2

Evaluating the Efficacy, Tolerability, and Outcomes of Topical Tripeptide/Hexapeptide Formulations Before and After Liposuction of the Medial Thighs

Regenerating Skin Nectar with TriHex Technology (RSN) has been shown clinically to promote healing and outcomes post procedures. TransFORM Body Treatment with TriHex Technology (TFB) has demonstrated clinically to improve lipid droplet dissolution and patient-reported outcomes post procedure. Histologically, both have been proven to regenerate collagen and elastin. The objective is to evaluate postprocedural recovery, histological, and gene expression changes of medial thigh liposuction in participants using RSN and TFB on one thigh in comparison with a bland moisturizer on the other. Participants were randomized to apply RSN pre and post procedure and TFB post procedure to one thigh and a bland moisturizer to the other. After topical pretreatment, participants underwent bilateral medial thigh liposuction. Assessments included induration measurements, ultrasounds, blinded investigator assessments, participant assessments, photography, and biopsies for 10 weeks post procedure. Blinded investigator assessments of induration, edema, and subcutaneous fibrous banding had less severity at weeks 1, 2, and 4 on the RSN/TFB thigh, corresponding with induration measurements. Ultrasound images showed less fluid infiltration, edema, and induration on the RSN/TFB side over the bland moisturizer at 2 weeks. Gene expression confirmed a hastened inflammatory phase converting more rapidly to the anti-inflammatory regenerative healing environment with evidence of extracellular remodeling only present on the RSN/TFB side at week 4, and histological biopsies demonstrated improved collagenesis and elastogenesis. RSN used before surgical procedures combined with RSN and TFB post procedure has demonstrated remodeling of the extracellular matrix, accelerating healing, and initiation of anti-inflammatory genes.

LEVEL OF EVIDENCE 4