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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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2
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Ao YJ, Yi Y, Wu GH. Application of PLLA (Poly-L-Lactic acid) for rejuvenation and reproduction of facial cutaneous tissue in aesthetics: A review. Medicine (Baltimore) 2024; 103:e37506. [PMID: 38489708 PMCID: PMC10939544 DOI: 10.1097/md.0000000000037506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Poly-L-lactin acid (PLLA) has been widely used in the field of bio-medicine. In 2004, as an injectable material, PLLA was approved by the FDA to treat AIDS-related facial atrophy. Since then, several injectable stuffs containing PLLA have been approved for marketing in various countries and regions. Recently, PLLA has often been used to treat facial rejuvenation problems like cutaneous depressions and static wrinkles which always induce unsatisfactory facial expression. This review introduces the physicochemical properties, regeneration stimulating mechanism, applications in aesthetics and injectable comorbidity of PLLA.
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Affiliation(s)
- Yin-Jie Ao
- Zhengxing Stomatological Hospital, Yichun City, Jiangxi Province, P.R. China
| | - Yan Yi
- Zhengxing Stomatological Hospital, Yichun City, Jiangxi Province, P.R. China
| | - Guo-Hui Wu
- Ophthalmology Hospital Affiliated to Nanchang University, Nanchang City, Jiangxi Province, P.R. China
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Alcotzer I, Liassidou A, Hexsel D, Tsur Shenhav L, Artzi O. Optimal Changes Seen in Patients After Treatment With Poly- l -Lactic Acid: A Retrospective Descriptive Study. Dermatol Surg 2024; 50:69-74. [PMID: 37910604 DOI: 10.1097/dss.0000000000003993] [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: 11/03/2023]
Abstract
BACKGROUND Poly- l -lactic acid (PLLA) is a biostimulator that enhances collagen production and leads to volume restoration. It became popular because of its improvement of facial wrinkles and long-lasting effect, although the specific visible changes it causes in the facial area are not fully described. OBJECTIVE To identify and characterize the visible changes resulting from injecting PLLA into the facial area. METHODS A list of 678 patients who underwent 2 to 3 treatments with PLLA injections in this center between 2021 and 2022 were retrieved. After 2 rounds of evaluations, 31 independent international evaluators described the 3 main changes they observed in the before-and-after images (taken approximately 7 months after the last injection session) of the 12 patients with the most significant improvement. RESULTS A total of 1,015 descriptions were received. They were divided into categories based upon similarity. The main detected changes were better contouring and enhancement of the lateral face, a lifting effect and secondary impact on the nasolabial fold, and improvement of skin texture and skin firmness. CONCLUSION Poly- l -lactic acid injections were judged to be effective for contouring, lifting, and improving skin texture in the facial area. Further research is needed to validate these results and create an assessment scale for PLLA injections.
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Affiliation(s)
- Inbar Alcotzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aspasia Liassidou
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Doris Hexsel
- Hexsel Dermatologic Clinic and Research Center, Porto Alegre, RS, Brazil
| | - Leah Tsur Shenhav
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Israel
| | - Ofir Artzi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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4
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Kim HW, Jung YA, Yun JM, Kim Y, Kim SA, Suh SI, Ryoo YW. Effects of Poly-L-Lactic Acid on Adipogenesis and Collagen Gene Expression in Cultured Adipocytes Irradiated with Ultraviolet B Rays. Ann Dermatol 2023; 35:424-431. [PMID: 38086356 PMCID: PMC10733076 DOI: 10.5021/ad.22.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Poly-L-lactic acid (PLLA), a synthetic, biocompatible, and biodegradable polymer, has been safely used in several clinical applications. Recently, PLLA has been widely used in the field of dermatology to treat wrinkles in aging skin. Reportedly, PLLA directly acts on dermal fibroblasts causing a significant increase in the expression of type I collagen. However, little is known about the effect of PLLA on adipocytes. OBJECTIVE This study aimed to analyze the effect of PLLA on adipocytes and examine its potential in treating deep wrinkles engendered by the loss of subcutaneous fat because of aging and photoaging. METHODS To elucidate the effect of PLLA on skin photoaging, cultured 3T3-L1 adipocytes were irradiated with ultraviolet B (UVB) rays. Oil red O staining was used to detect lipid accumulation in the adipocytes. Real-time quantitative polymerase chain reaction and Western blotting were performed to detect types IV and VI collagen mRNA and protein levels, respectively, under different conditions. RESULTS The differentiation of 3T3-L1 cells enhanced adipogenesis and the expression of types IV and VI collagens, both of which were inhibited by UVB irradiation. Following this irradiation, PLLA stimulated adipogenesis and the expression of types IV and VI collagens. CONCLUSION PLLA may provide the beneficial effect on adipocytes from the aspect of adipogenesis and collagen expression in the subcutaneous adipose tissues.
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Affiliation(s)
- Hyun-Wook Kim
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Yun-A Jung
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Min Yun
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Yura Kim
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Sung-Ae Kim
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Seong-Il Suh
- Department of Microbiology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Wook Ryoo
- Department of Dermatology, Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea.
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Fabi S, Bråsäter D. Letter to the Editor on: "Safety and Efficacy of Poly-L-Lactic Acid Filler (Gana V vs. Sculptra) Injection for Correction of the Nasolabial Fold: A Double-Blind, Non-Inferiority, Randomized, Split-Face Controlled Trial". Aesthetic Plast Surg 2023:10.1007/s00266-023-03736-x. [PMID: 37993537 DOI: 10.1007/s00266-023-03736-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Sabrina Fabi
- Cosmetic Laser Dermatology, 9339 Genesee Ave #300,, San Diego, California, USA.
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Guo J, Fang W, Wang F. Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives. RSC Adv 2023; 13:23841-23858. [PMID: 37577103 PMCID: PMC10413051 DOI: 10.1039/d3ra04321e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
With the increasing understanding of the aging process and growing desire for minimally invasive treatments, injectable fillers have great potential for correcting and rejuvenating facial wrinkles/folds and contouring the face. However, considering the increasing availability of multiple soft tissue fillers, it is important to understand their inherent biophysical features and specific mechanism. Thus, in this review, we aim to provide an update on the current injectable filler products and analyze and compare their critical physicochemical properties and function mechanisms for volume-filling. Additionally, future trends and development processes for injectable fillers are also proposed.
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Affiliation(s)
- Jiahong Guo
- Yunnan Botanee Bio-technology Group Co., Ltd. Yunnan 650106 China
- Shanghai Jiyan Bio-pharmaceutical Co., Ltd. Shanghai 201702 China
| | - Wei Fang
- Yunnan Yunke Characteristic Plant Extraction Laboratory Co., Ltd. Yunnan 650106 China
- Medaesthee (Shanghai) Biotechnology Co., Ltd. Shanghai. 201700 China
| | - Feifei Wang
- Yunnan Botanee Bio-technology Group Co., Ltd. Yunnan 650106 China
- Shanghai Jiyan Bio-pharmaceutical Co., Ltd. Shanghai 201702 China
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Andrade MA, Barbosa CH, Mariño-Cortegoso S, Barbosa-Pereira L, Sendón R, Buonocore GG, Stanzione M, Coelho A, Correia CB, Saraiva M, Quirós ARBD, Vilarinho F, Khwaldia K, Silva AS, Ramos F. LDPE and PLA Active Food Packaging Incorporated with Lemon by-Products Extract: Preparation, Characterization and Effectiveness to Delay Lipid Oxidation in Almonds and Beef Meat. Foods 2023; 12:2450. [PMID: 37444188 DOI: 10.3390/foods12132450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
Low-density polyethylene-based packaging with 4% lemon extract (LDPE/4LE) and two polylactic-based (PLA) packaging materials with 4% and 6% lemon extract (PLA/PEG/4LE and PLA/6LE) were produced. O2 and water permeability tests were performed, the total and individual phenolic compounds content were measured, and the films' antioxidant activities were determined. The films' ability to delay lipid oxidation was tested in two model foods: almonds, packaged with LDPE/4LE, PLA/4LE and PLA/6LE for a maximum period of 60 days at 40 °C (accelerated assay); and beef meat, packaged with the PLA/6LE for a maximum period of 11 days at 4 °C. The LE improved the WVP in all of the active films by 33%, 20% and 60% for the LDPE/4LE, PLA/4LE and PLA/6LE films, respectively. At the end of 10 days, the migration of phenolic compounds through the PLA films was measured to be 142.27 and 114.9 μg/dm2 for the PLA/4LE and PLA/6LE films, respectively, and was significantly higher than phenolic compounds migration measured for the LDPE/4LE (15.97 μg/dm2). Naringenin, apigenin, ferulic acid, eriocitrin, hesperidin and 4-hydroxybenzoic acid were the main identified compounds in the PLA, but only 4-hydroxybenzoic acid, naringenin and p-coumaric acid were identified in the LDPE films. Regarding the films' ability to delay lipid oxidation, LDPE/4LE presented the best results, showing a capacity to delay lipid oxidation in almonds for 30 days. When applied to raw beef meat, the PLA/6LE packaging was able to significantly inhibit lipid oxidation for 6 days, and successfully inhibited total microorganisms' growth until the 8th day of storage.
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Affiliation(s)
- Mariana A Andrade
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (REQUIMTE/LAQV), R. D. Manuel II, Apartado, 55142 Porto, Portugal
| | - Cássia H Barbosa
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
- Mechanical Engineering and Resource Sustainability Center (METRICS), Department of Chemistry, NOVA School of Science and Technology, Campus de Caparica, NOVA University Lisbon, 2829-516 Caparica, Portugal
| | - Sandra Mariño-Cortegoso
- Analytical Chemistry, Nutrition and Food Science Department, Pharmacy Faculty, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Materiales (iMATUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Letricia Barbosa-Pereira
- Analytical Chemistry, Nutrition and Food Science Department, Pharmacy Faculty, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Materiales (iMATUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Raquel Sendón
- Analytical Chemistry, Nutrition and Food Science Department, Pharmacy Faculty, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Materiales (iMATUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Giovanna G Buonocore
- Institute of Polymers, Composites and Biomaterials (IPCB-CNR), Portici, 80125 Naples, Italy
| | - Mariamelia Stanzione
- Institute of Polymers, Composites and Biomaterials (IPCB-CNR), Portici, 80125 Naples, Italy
| | - Anabela Coelho
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - Cristina Belo Correia
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - Margarida Saraiva
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - Ana Rodríguez-Bernaldo de Quirós
- Analytical Chemistry, Nutrition and Food Science Department, Pharmacy Faculty, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Materiales (iMATUS), University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Fernanda Vilarinho
- Department of Food and Nutrition, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - Khaoula Khwaldia
- Laboratoire des Substances Naturelles, Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), Pôle Technologique de Sidi Thabet, Sidi Thabet 2020, Tunisia
| | - Ana Sanches Silva
- National Institute for Agricultural and Veterinary Research (INIAV), I.P., Rua dos Lagidos, Lugar da Madalena, Vairão, 4485-655 Vila do Conde, Portugal
- Center for Study in Animal Science (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA), University of Porto, 4200-319 Porto, Portugal
| | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (REQUIMTE/LAQV), R. D. Manuel II, Apartado, 55142 Porto, Portugal
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Moya-Lopez C, González-Fuentes J, Bravo I, Chapron D, Bourson P, Alonso-Moreno C, Hermida-Merino D. Polylactide Perspectives in Biomedicine: From Novel Synthesis to the Application Performance. Pharmaceutics 2022; 14:pharmaceutics14081673. [PMID: 36015299 PMCID: PMC9415503 DOI: 10.3390/pharmaceutics14081673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
The incessant developments in the pharmaceutical and biomedical fields, particularly, customised solutions for specific diseases with targeted therapeutic treatments, require the design of multicomponent materials with multifunctional capabilities. Biodegradable polymers offer a variety of tailored physicochemical properties minimising health adverse side effects at a low price and weight, which are ideal to design matrices for hybrid materials. PLAs emerge as an ideal candidate to develop novel materials as are endowed withcombined ambivalent performance parameters. The state-of-the-art of use of PLA-based materials aimed at pharmaceutical and biomedical applications is reviewed, with an emphasis on the correlation between the synthesis and the processing conditions that define the nanostructure generated, with the final performance studies typically conducted with either therapeutic agents by in vitro and/or in vivo experiments or biomedical devices.
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Affiliation(s)
- Carmen Moya-Lopez
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Joaquín González-Fuentes
- Centro Regional de Investigaciones Biomédicas (CRIB), 02008 Albacete, Spain
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
| | - Iván Bravo
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
- Unidad NanoCRIB, Centro Regional de Investigaciones Biomédicas, 02008 Albacete, Spain
| | - David Chapron
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Patrice Bourson
- Laboratoire Matériaux Optiques Photonique et Systèmes (LMOPS), CentraleSupélec, Université de Lorraine, 57000 Metz, France
| | - Carlos Alonso-Moreno
- Facultad de Farmacia de Albacete, Universidad de Castilla-La Mancha, 02008 Albacete, Spain
- Unidad NanoCRIB, Centro Regional de Investigaciones Biomédicas, 02008 Albacete, Spain
| | - Daniel Hermida-Merino
- DUBBLE@ESRF BP CS40220, 38043 Grenoble, France
- Departamento de Física Aplicada, CINBIO, Lagoas-Marcosende Campus, Universidade de Vigo, 36310 Vigo, Spain
- Correspondence: ; Tel.: +33-(0)476882375
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Altaie AM, Venkatachalam T, Samaranayake LP, Soliman SSM, Hamoudi R. Comparative Metabolomics Reveals the Microenvironment of Common T-Helper Cells and Differential Immune Cells Linked to Unique Periapical Lesions. Front Immunol 2021; 12:707267. [PMID: 34539639 PMCID: PMC8446658 DOI: 10.3389/fimmu.2021.707267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Periapical abscesses, radicular cysts, and periapical granulomas are the most frequently identified pathological lesions in the alveolar bone. While little is known about the initiation and progression of these conditions, the metabolic environment and the related immunological behaviors were examined for the first time to model the development of each pathological condition. Metabolites were extracted from each lesion and profiled using gas chromatography-mass spectrometry in comparison with healthy pulp tissue. The metabolites were clustered and linked to their related immune cell fractions. Clusters I and J in the periapical abscess upregulated the expression of MMP-9, IL-8, CYP4F3, and VEGF, while clusters L and M were related to lipophagy and apoptosis in radicular cyst, and cluster P in periapical granuloma, which contains L-(+)-lactic acid and ethylene glycol, was related to granuloma formation. Oleic acid, 17-octadecynoic acid, 1-nonadecene, and L-(+)-lactic acid were significantly the highest unique metabolites in healthy pulp tissue, periapical abscess, radicular cyst, and periapical granuloma, respectively. The correlated enriched metabolic pathways were identified, and the related active genes were predicted. Glutamatergic synapse (16–20),-hydroxyeicosatetraenoic acids, lipophagy, and retinoid X receptor coupled with vitamin D receptor were the most significantly enriched pathways in healthy control, abscess, cyst, and granuloma, respectively. Compared with the healthy control, significant upregulation in the gene expression of CYP4F3, VEGF, IL-8, TLR2 (P < 0.0001), and MMP-9 (P < 0.001) was found in the abscesses. While IL-12A was significantly upregulated in cysts (P < 0.01), IL-17A represents the highest significantly upregulated gene in granulomas (P < 0.0001). From the predicted active genes, CIBERSORT suggested the presence of natural killer cells, dendritic cells, pro-inflammatory M1 macrophages, and anti-inflammatory M2 macrophages in different proportions. In addition, the single nucleotide polymorphisms related to IL-10, IL-12A, and IL-17D genes were shown to be associated with periapical lesions and other oral lesions. Collectively, the unique metabolism and related immune response shape up an environment that initiates and maintains the existence and progression of these oral lesions, suggesting an important role in diagnosis and effective targeted therapy.
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Affiliation(s)
- Alaa Muayad Altaie
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Thenmozhi Venkatachalam
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Oral Biosciences, Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Sameh S M Soliman
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Division of Surgery and Interventional Science, University College London, London, United Kingdom
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10
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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: 15] [Impact Index Per Article: 5.0] [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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11
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Ebrahimi F, Ramezani Dana H. Poly lactic acid (PLA) polymers: from properties to biomedical applications. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1944140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Farnoosh Ebrahimi
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Hossein Ramezani Dana
- Laboratoire de Mécanique, Surface, Matériaux Procédés (MSMP) – EA 7350, Arts et Metiers Institute of Technology, HESAM Université, Aix-en-Provence, France
- Texas A&M Engineering Experiment Station (TEES), Texas A&M University, College Station, TX, USA
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12
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Derakhshan A, Reny DC, Rathi VK, McCarty JC, Lindsay RW, Lee LN, Gadkaree SK. Otolaryngologists Trail Other Specialties in Industry Payments From Dermal Filler Companies. Laryngoscope 2021; 132:301-306. [PMID: 34236083 DOI: 10.1002/lary.29746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dermal filler (DF) is a widely used nonsurgical option for facial rejuvenation with a rapidly expanding market. Physician payments by DF industry leaders have yet to be characterized. We sought to investigate trends in physician-industry payments by DF companies over 6 years. Differences in payments based on physician specialty and time were characterized. STUDY DESIGN Database review. METHODS The Open Payments Database was queried from 2013 to 2018. Payments made by the three largest DF companies by market share to otolaryngologists, plastic surgeons, and dermatologists were analyzed. Total dollars paid, number of payments made, type of payments made, and total number of specialists paid were recorded. One-way ANOVA was used for statistical analysis. RESULTS Otolaryngologists, plastic surgeons, and dermatologists received average annual payments of $0.36 million, $6.3 million, and $6.6 million respectively (P < .001). An average of 330 otolaryngologists, 2,128 plastic surgeons, and 5,980 dermatologists were paid annually (P < .001). Accredited speaking arrangements, consulting fees, and royalty/licensing fees comprised the majority of dollars paid to physicians. CONCLUSIONS Average physician payment by DF companies exceeds $12 million annually, with otolaryngologists receiving significantly less compared to plastic surgeons and dermatologists. LEVEL OF EVIDENCE Not applicable Laryngoscope, 2021.
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Affiliation(s)
- Adeeb Derakhshan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Danielle C Reny
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vinay K Rathi
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Justin C McCarty
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Robin W Lindsay
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linda N Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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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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Ray S, Ta HT. Investigating the Effect of Biomaterials Such as Poly-(l-Lactic Acid) Particles on Collagen Synthesis In Vitro: Method Is Matter. J Funct Biomater 2020; 11:E51. [PMID: 32722074 PMCID: PMC7564527 DOI: 10.3390/jfb11030051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
Poly-l-lactic acid (PLLA), a synthetic, biocompatible, biodegradable polymer, has been safely used in several clinical applications in recent decades. Typically, SculptraTM, the commercially injectable PLLA in the form of microparticles, has been used as facial volumizer in the treatment of lipoatrophy in HIV patients. It also has various applications in tissue engineering by improving cell proliferation and adhesion. Sculptra™ can be categorised as a stimulatory filler as it stimulates the synthesis and deposition of fibrous tissue and collagen. Collagen is one of the most significant components of the extracellular matrix and beneficial for the normal physiology. It is also the structural component of a human body. In most of the studies, the effect of Sculptra on collagen synthesis was investigated in vivo and the majority of the data were from clinical and histological reports. There is only one study reporting this effect in vitro using fibroblasts. Here, we investigated whether PLLA in the form of nanoparticles can provide the same effect on collagen synthesis in fibroblasts as Sculptra. We surprisingly found that there was no stimulation of collagen in fibroblasts alone, whereas the co-cultures of fibroblast and macrophage had shown collagen stimulation by PLLA nanoparticles. It is also confirmed that collagen synthesis was caused by fibroblasts but not macrophages. Although further study needs to be conducted to evaluate its mechanism, our findings showed that choosing an appropriate method is essential for investigating the effect of PLLA or other biomaterials on collagen synthesis by fibroblasts in vitro.
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Affiliation(s)
- Subarna Ray
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, QLD 4072, Australia;
- Queensland Micro- and Nanotechnology Centre, Griffith University, Brisbane, QLD 4111, Australia
| | - Hang T. Ta
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, QLD 4072, Australia;
- Queensland Micro- and Nanotechnology Centre, Griffith University, Brisbane, QLD 4111, Australia
- School of Environment and Science, Griffith University, Brisbane, QLD 4111, Australia
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Kim HY, An BS, Kim MJ, Jeoung YJ, Byun JH, Lee JH, Oh SH. Signaling Molecule-Immobilized Porous Particles with a Leaf-Stacked Structure as a Bioactive Filler System. ACS Biomater Sci Eng 2020; 6:2231-2239. [PMID: 33455335 DOI: 10.1021/acsbiomaterials.9b01731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ultimate purpose of this study was to develop a bioactive filler system that would allow volume restoration (passive property) and continuous release of signaling molecules to recruit soft tissues (bioactive property) and thus effectively correct facial aging. To achieve this, we prepared porous particles with a leaf-stacked structure throughout the entire particle volume (LSS particles) using a simple heating-cooling technique. LSS particles were loaded with insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) separately, by immersing the particles in signaling molecule-containing solutions for target tissue recruitment (adipose by IGF-1 and blood vessels by VEGF). IGF-1 and VEGF were continuously released from LSS particles for 28 and 21 days in vitro, respectively, even without additional chemical/physical modifications, because of the unique morphology of the particles. Signaling molecules preserved their bioactivity in vitro (induction of adipogenic and angiogenic differentiation) and in vivo (recruitment of fat and blood vessels) for a sufficient period. Moreover, it was observed that the LSS particles themselves have stable volume retention characteristics in the body. Thus, we suggest that the signaling molecule-loaded LSS particles can function as a bioactive filler system for volume retention and target tissue regeneration.
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Affiliation(s)
- Ho Yong Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea
| | - Bo Seul An
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea
| | - Min Ji Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea
| | - Yeoung Jo Jeoung
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea.,Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
| | - June-Ho Byun
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Institute of Health Sciences, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea.,Center for Bio-Medical Engineering Core Facility, Dankook University, Cheonan 31116, Republic of Korea
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Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial. Plast Reconstr Surg 2018; 141:613-623. [PMID: 29135895 DOI: 10.1097/prs.0000000000004173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate and compare the safety and effectiveness of four different dermal fillers in the treatment of facial lipoatrophy secondary to human immunodeficiency virus. METHODS The authors conducted a clinical trial including 147 patients suffering from human immunodeficiency virus-induced lipoatrophy treated with Sculptra (poly-L-lactic acid), Radiesse (calcium hydroxylapatite), Aquamid (polyacrylamide), or autologous fat. Objective and subjective changes were evaluated during a 24-month follow-up. Number of sessions, total volume injected, and overall costs of treatment were also analyzed. A comparative cost-effectiveness analysis of the treatment options was performed. RESULTS Objective improvement in facial lipoatrophy, assessed by the surgeon in terms of changes from baseline using the published classification of Fontdevila, was reported in 53 percent of the cases. Patient self-evaluation showed a general improvement after the use of facial fillers. Patients reported being satisfied with the treatment and with the reduced impact of lipodystrophy on their quality of life. Despite the nonsignificant differences observed in the number of sessions and volume, autologous fat showed significantly lower costs than all synthetic fillers (p < 0.05). CONCLUSIONS Surgical treatment of human immunodeficiency virus-associated facial lipoatrophy using dermal fillers is a safe and effective procedure that improves the aesthetic appearance and the quality of life of patients. Permanent fillers and autologous fat achieve the most consistent results over time, with lipofilling being the most cost-effective procedure.
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Qi F, Wu J, Li H, Ma G. Recent research and development of PLGA/PLA microspheres/nanoparticles: A review in scientific and industrial aspects. Front Chem Sci Eng 2018. [DOI: 10.1007/s11705-018-1729-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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19
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Goldberg DJ, Bass LM, Fitzgerald R, Graivier MH, Lorenc ZP. Expanding Treatment Options for Injectable Agents. Aesthet Surg J 2018; 38:S1-S7. [PMID: 29897519 DOI: 10.1093/asj/sjy016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loss of facial volume and soft-tissue support are common to types of facial aging. Restoration of a youthful appearance relies upon correction of this loss, and can be achieved in various capacities through use of biostimulatory or hyaluronic acids (HA) injectable fillers. Here, the authors discuss the versatility of calcium hydroxylapatite (CaHA) in volume replacement and the applications and facial regions for which CaHA, poly-L-lactic acid (PLLA), and HA fillers are best suited.
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Affiliation(s)
- David J Goldberg
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, NY
| | - Lawrence M Bass
- Department of Plastic Surgery, Manhattan Eye, Ear & Throat Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY
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Fitzgerald R, Bass LM, Goldberg DJ, Graivier MH, Lorenc ZP. Physiochemical Characteristics of Poly-L-Lactic Acid (PLLA). Aesthet Surg J 2018; 38:S13-S17. [PMID: 29897517 DOI: 10.1093/asj/sjy012] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Poly-L-lactic acid (PLLA) is a synthetic, biocompatible, biodegradable polymer. For soft-tissue augmentation, the size and chemical attributes of the PLLA microparticles are central to this agent's ability to promote a subclinical inflammatory response that stimulates deposition of collagen in the extracellular matrix. The resultant restoration of facial volume occurs in a controlled, predictable manner and is long lasting. The unique physiochemical and biostimulatory properties of PLLA differentiate it from other available treatments and are the foundation of the unique treatment methodology required for optimal results.
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Affiliation(s)
| | - Lawrence M Bass
- Department of Plastic Surgery, Manhattan Eye, Ear & Throat Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - David J Goldberg
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, NY
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Bayer IS. Thermomechanical Properties of Polylactic Acid-Graphene Composites: A State-of-the-Art Review for Biomedical Applications. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E748. [PMID: 28773109 PMCID: PMC5551791 DOI: 10.3390/ma10070748] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 01/18/2023]
Abstract
Due to its biodegradable and bioabsorbable characteristics polylactic acid (PLA) has attracted considerable attention for numerous biomedical applications. Moreover, a number of tissue engineering problems for function restoration of impaired tissues have been addressed by using PLA and its copolymers due to their biocompatibility and distinctive mechanical properties. Recent studies on various stereocomplex formation between enantiomeric PLA, poly(l-lactide) (PLLA) and poly(d-lactide) (PDLA) indicated that stereocomplexation enhances the mechanical properties as well as the thermal- and hydrolysis-resistance of PLA polymers. On the other hand, biomedical application of graphene is a relatively new front with significant potential. Many recent reports have indicated that understanding of graphene-cell (or tissue, organ) interactions; particularly the cellular uptake mechanisms are still challenging. Therefore, use of graphene or graphene oxide properly embedded in suitable PLA matrices can positively impact and accelerate the growth, differentiation, and proliferation of stem cells, conceivably minimizing concerns over cytotoxicity of graphene. As such, PLA-graphene composites hold great promise in tissue engineering, regenerative medicine, and in other biomedical fields. However, since PLA is classified as a hard bio-polyester prone to hydrolysis, understanding and engineering of thermo-mechanical properties of PLA-graphene composites are very crucial for such cutting-edge applications. Hence, this review aims to present an overview of current advances in the preparation and applications of PLA-graphene composites and their properties with focus on various biomedical uses such as scaffolds, drug delivery, cancer therapy, and biological imaging, together with a brief discussion on the challenges and perspectives for future research in this field.
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Affiliation(s)
- Ilker S Bayer
- Smart Materials, Istituto Italiano di Tecnologia, 16163 Genoa, Italy.
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Neuropathic Pain Following Poly-L-Lactic Acid (Sculptra) Injection. Ophthalmic Plast Reconstr Surg 2017; 33:S11-S12. [DOI: 10.1097/iop.0000000000000474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benedini S, Luzi L. Lipodystrophy HIV-related and FGF21: A new marker to follow the progression of lipodystrophy? J Transl Int Med 2016; 4:150-154. [PMID: 28191538 DOI: 10.1515/jtim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recently new evidence about fibroblast growth factor 21 (FGF21) highlights the opportunities to use this molecule in new pharmaceutical formulations to combat type 2 diabetes and metabolic syndrome. It is well known that HIV is per se a condition of insulin resistance and in particular the patient with HIV-related lipodystrophy has a condition strictly related to metabolic syndrome. Lipodystrophy is associated with severe metabolic side effects, including dyslipidemia, hepatic insulin resistance, and lipid oxidation impairment. Research carried out showed that FGF21 levels were significantly increased in untreated HIV-1-infected patients and the increase was much marked in HIV-1-infected antiretroviral-treated patients that have developed lipodystrophy and in the patients with greatest metabolic alterations. FGF21 is expressed mainly by the liver, but also by other tissues such as the thymus, adipose tissue, and skeletal muscle. Therefore, many researchers have considered the investigation of possible variations of FGF21 in patients with significant alterations in body composition both in regard to fat mass and lean mass. In the light of the possible interactions between FGF21 and metabolic syndrome, it seems interesting to evaluate the implication of this hormone in patients with HIV-related lipodystrophy who have a severe metabolic picture of insulin resistance with important alterations in body composition.
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Affiliation(s)
- Stefano Benedini
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy
| | - Livio Luzi
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy; Metabolism Research Center, IRCCS Policlinico San Donato, Milan, Italy
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Technical Considerations for Filler and Neuromodulator Refinements. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1178. [PMID: 28018778 PMCID: PMC5172486 DOI: 10.1097/gox.0000000000001178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The toolbox for cosmetic practitioners is growing at an unprecedented rate. There are novel products every year and expanding off-label indications for neurotoxin and soft-tissue filler applications. Consequently, aesthetic physicians are increasingly challenged by the task of selecting the most appropriate products and techniques to achieve optimal patient outcomes. Methods: We employed a PubMed literature search of facial injectables from the past 10 years (2005–2015), with emphasis on those articles embracing evidence-based medicine. We evaluated the scientific background of every product and the physicochemical properties that make each one ideal for specific indications. The 2 senior authors provide commentary regarding their clinical experience with specific technical refinements of neuromodulators and soft-tissue fillers. Results: Neurotoxins and fillers are characterized by unique physical characteristics that distinguish each product. This results in subtle but important differences in their clinical applications. Specific indications and recommendations for the use of the various neurotoxins and soft-tissue fillers are reviewed. The discussion highlights refinements in combination treatments and product physical modifications, according to specific treatment zones. Conclusions: The field of facial aesthetics has evolved dramatically, mostly secondary to our increased understanding of 3-dimensional structural volume restoration. Our work reviews Food and Drug Administration–approved injectables. In addition, we describe how to modify products to fulfill specific indications such as treatment of the mid face, décolletage, hands, and periorbital regions. Although we cannot directly evaluate the duration or exact physical properties of blended products, we argue that “product customization” is safe and provides natural results with excellent patient outcomes.
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Ramot Y, Haim-Zada M, Domb AJ, Nyska A. Biocompatibility and safety of PLA and its copolymers. Adv Drug Deliv Rev 2016; 107:153-162. [PMID: 27058154 DOI: 10.1016/j.addr.2016.03.012] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 03/24/2016] [Accepted: 03/26/2016] [Indexed: 12/20/2022]
Abstract
PLA and its copolymers are commonly used for a wide variety of applications. While they are considered to be biocompatible, side effects resulting from their implantation have been reported. The implantation of biomaterials always results in a foreign body reaction. Such a reaction has also been reported following PLA and its copolymers. This article reviews the process of inflammatory reaction that is to be expected following implantation of PLA, and it highlights specific cases in which the inflammatory reaction can result in safety concerns. The authors also review selected cases from different medical fields to demonstrate possible clinical side effects resulting from its use.
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Farah S, Anderson DG, Langer R. Physical and mechanical properties of PLA, and their functions in widespread applications - A comprehensive review. Adv Drug Deliv Rev 2016; 107:367-392. [PMID: 27356150 DOI: 10.1016/j.addr.2016.06.012] [Citation(s) in RCA: 1041] [Impact Index Per Article: 130.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 12/28/2022]
Abstract
Poly(lactic acid) (PLA), so far, is the most extensively researched and utilized biodegradable aliphatic polyester in human history. Due to its merits, PLA is a leading biomaterial for numerous applications in medicine as well as in industry replacing conventional petrochemical-based polymers. The main purpose of this review is to elaborate the mechanical and physical properties that affect its stability, processability, degradation, PLA-other polymers immiscibility, aging and recyclability, and therefore its potential suitability to fulfill specific application requirements. This review also summarizes variations in these properties during PLA processing (i.e. thermal degradation and recyclability), biodegradation, packaging and sterilization, and aging (i.e. weathering and hygrothermal). In addition, we discuss up-to-date strategies for PLA properties improvements including components and plasticizer blending, nucleation agent addition, and PLA modifications and nanoformulations. Incorporating better understanding of the role of these properties with available improvement strategies is the key for successful utilization of PLA and its copolymers/composites/blends to maximize their fit with worldwide application needs.
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El-Beyrouty C, Huang V, Darnold CJ, Clay PG. Poly-L-lactic Acid for Facial Lipoatrophy in HIV. Ann Pharmacother 2016; 40:1602-6. [PMID: 16912248 DOI: 10.1345/aph.1g740] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To review the clinical data for poly-L-lactic acid, a synthetic polymer used as an intradermal injection for the treatment of HIV associated facial fat loss (lipoatrophy). Data Sources: A literature search was performed using MEDLINE (1966–August 2006). The search was limited to articles published in English and used the key words polylactic acid, polylactides, degradation, lipodystrophy, lipoatrophy, and HIV/AIDS. Dermik Laboratories was contacted to obtain unpublished information. Additional articles were retrieved from citations of selected references. Study Selection and Data Extraction: Relevant information on the pharmacology, pharmacokinetics, safety, and efficacy of poly-L-lactic acid from clinical trials were selected. Data Synthesis: Poly-L-lactic acid (Sculptra) is a biocompatible, biodegradable, synthetic polymer able to be tailored into various desired morphologic features. It is approved by the Food and Drug Administration for the correction of facial lipoatrophy in people with HIV. Six clinical trials have evaluated the use of intradermal injections of poly-L-lactic acid. Results showed that cutaneous thickness is improved in patients receiving poly-L-lactic acid. Adverse effects included nodule and hematoma formation, as well as pain at the injection site. Conclusions: Poly-L-lactic acid offers a treatment alternative for patients with HIV-associated lipoatrophy. Further research is required in nonwhite populations.
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Affiliation(s)
- Claudine El-Beyrouty
- Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, PA 19107-4824, USA.
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The Efficacy of Massage in Reducing Nodule Formation After Poly-l-Lactic Acid Administration for Facial Volume Loss: A Randomized, Evaluator-Blinded Clinical Trial. Dermatol Surg 2016; 42:1266-1272. [DOI: 10.1097/dss.0000000000000882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Funk E, Bressler FJ, Brissett AE. Contemporary Surgical Management of HIV-Associated Facial Lipoatrophy. Otolaryngol Head Neck Surg 2016; 134:1015-22. [PMID: 16730549 DOI: 10.1016/j.otohns.2006.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 01/10/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: The purpose of this study is to describe our experience with facial volume restoration in 39 HIV-associated facial lipoatrophy patients, and formulate a treatment algorithm that can be utilized for these patients based on their disease severity.METHODS: Preoperative and postoperative photographs were evaluated by 2 experienced facial plastic surgeons using grading scales. The reviewers' scores were then compared and the distribution of scores was analyzed.RESULTS: Thirty-nine patients underwent malar silastic implantation. Seven patients required postoperative adjuvant filler injection. Most patients' results were rated good to excellent. There were 4 late complications.CONCLUSION: HIV-associated facial lipoatrophy is a socially disabling condition that causes noticeable disfigurement and stigmatizes the patient. We demonstrate the importance of combining a reliable grading scale with a strategic treatment algorithm that utilizes multiple modalities for volume restoration.
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Affiliation(s)
- E Funk
- Bobby R. Alford Department of Otolaryngology/Head and Neck Surgery and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030, USA.
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Denton AB, Tsaparas Y. Injectable hyaluronic acid for the correction of HIV-associated facial lipoatrophy. Otolaryngol Head Neck Surg 2016; 136:563-7. [PMID: 17418252 DOI: 10.1016/j.otohns.2006.11.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 11/30/2006] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the use of Perlane, an injectable form of hyaluronic acid, for the correction of HIV-associated facial lipoatrophy. Study Design And Setting A prospective, observational study in a consecutive series of 18 HIV-positive males with facial lipoatrophy injected with Perlane. Fourteen patients were available for final analysis. Results Mean follow-up time was 12 months. Based on photographic analysis, there was a significant early improvement ( P = 0.0035). This difference remained significant after 12 months ( P = 0.04666); no significant difference in grade was shown between 1 and 12 months ( P = 0.3693). Office assessments of improvement showed an early marked improvement in 85.8% of patients, and 78.6% of subjects demonstrated at least moderate improvement at 12 months. Conclusion/Significance Patient satisfaction was high, with only minor side effects and no late complications. Our findings support Perlane to be a feasible option for the provisional correction of mild to moderate facial lipoatrophy.
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Affiliation(s)
- Andrew B Denton
- Department of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
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Objective Analysis of Poly-L-Lactic Acid Injection Efficacy in Different Settings. Dermatol Surg 2015; 41 Suppl 1:S314-20. [DOI: 10.1097/dss.0000000000000552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rauso R. 5-year study of a polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatrophy. Aesthet Surg J 2015; 35:1021-9. [PMID: 25953480 DOI: 10.1093/asj/sjv036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lipoatrophy of the face negatively impacts the quality of life and body image of individuals on antiretroviral therapy. Facial fillers can minimize the stigma associated with the human immonodeficiency virus (HIV). OBJECTIVES In this 5-year follow-up study, the author assessed the safety and efficacy of a permanent, non-biodegradable, polyacrylamide hydrogel for facial volume restoration, and compared the results with those of a previous 18-month follow-up study. METHODS Thirty-one HIV-positive individuals, initially enrolled in the study between January 2008 and January 2009, received treatment of facial wasting by injection of the polyacrylamide gel until complete volume restoration was achieved. Asepsis rules were strictly observed before and during each injection session. Patients evaluated their aesthetic outcomes on a visual analog scale. RESULTS Patient satisfaction was high. There was no occurrence of local infection, foreign-body reaction, or product during the 5 years of follow-up. Small, palpable, nonvisible nodules were recorded in nine cases. It appears that these same nodules were present in the 18-month study. It is believed that the nodules were caused by overfilling in the same site. CONCLUSIONS As supported by the initial 18-month study, polyacrylamide hydrogel filler appears safe and effective for the treatment of HIV-related lipoatrophy. With strict observation of asepsis rules and patient adherence to posttreatment instructions, this filler can be ideal for treating facial wasting in patients with HIV. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Raffaele Rauso
- Dr Rauso is an Assistant Professor in the Department of Dentistry at the University of Foggia, Foggia, Italy
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Jagdeo J, Ho D, Lo A, Carruthers A. A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA). J Am Acad Dermatol 2015; 73:1040-54.e14. [PMID: 26481056 DOI: 10.1016/j.jaad.2015.08.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 01/07/2023]
Abstract
HIV facial lipoatrophy (FLA) is characterized by facial volume loss. HIV FLA affects the facial contours of the cheeks, temples, and orbits, and is associated with social stigma. Although new highly active antiretroviral therapy medications are associated with less severe FLA, the prevalence of HIV FLA among treated individuals exceeds 50%. The goal of our systematic review is to examine published clinical studies involving the use of filler agents for aesthetic treatment of HIV FLA and to provide evidence-based recommendations based on published efficacy and safety data. A systematic review of the published literature was performed on July 1, 2015, on filler agents for aesthetic treatment of HIV FLA. Based on published studies, poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D. Poly-L-lactic acid may be best for treatment over temples and cheeks, whereas calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement. Additional long-term randomized controlled trials are necessary to elucidate the advantages and disadvantages of fillers that have different biophysical properties, in conjunction with cost-effectiveness analysis, for treatment of HIV FLA.
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Affiliation(s)
- Jared Jagdeo
- Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California; Department of Dermatology, University of California Davis, Sacramento, California; Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York.
| | - Derek Ho
- Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California
| | - Alex Lo
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Negredo E, Puig J, Ornelas A, Echeverría P, Bonjoch A, Estany C, Higueras C, Gonzalez-Mestre V, Clotet B. Ten-Year Safety with Polyacrylamide Gel Used to Correct Facial Lipoatrophy in HIV-Infected Patients. AIDS Res Hum Retroviruses 2015; 31:817-21. [PMID: 25858612 DOI: 10.1089/aid.2015.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Long-term results (>5 years) for synthetic substances used to repair facial lipoatrophy have not been published. We performed a cross-sectional study to evaluate the 10-year safety of polyacrylamide hydrogel (Aquamid) among the 751 patients from our unit who received facial infiltrations at least 10 years ago. Epidemiological and clinical data such as complications and patient satisfaction were collected. We also identified those patients who presented a facial infection at any time after infiltration. A total of 104 patients had received Aquamid at least 10 years ago. Before infiltrations, 24.0%, 41.3%, and 34.7% presented very severe, severe, and moderate facial lipoatrophy, respectively. After a mean (SD) of 10.3 (0.5) years since the infiltrations, 19.2%, 47.7%, and 31.7% of patients reported moderate, mild, and no signs of facial lipoatrophy. The values reported by physicians for the same categories were 1.9%, 10.6%, and 87.5%. Indurations were detected in 6.7% of patients and nodules in 3.8%. Five patients (4.8%) had a local infection. A further 15 patients with a shorter follow-up (less than 10 years) presented local infections (overall incidence considering the 751 patients who received infiltrations of Aquamid, 2.7%); the product had to be withdrawn in three cases. The majority of patients were highly satisfied (74.8%) or satisfied (23.4%) with the cosmetic results; among patients with severe or very severe lipoatrophy at baseline, 31.4% were satisfied and 65.7% were highly satisfied. Infiltrations with polyacrylamide hydrogel (Aquamid) are a safe strategy for the treatment of facial lipoatrophy in the long term. The rate of severe complications was low, and patient satisfaction with the cosmetic results was high. However, facial infections may appear in the long term. Therefore, HIV-infected patients who received synthetic substances should be carefully monitored over time.
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Affiliation(s)
- Eugenia Negredo
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Jordi Puig
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arelly Ornelas
- Department of Econometrics, Statistics and Spanish Economy, University of Barcelona, Barcelona, Spain
| | - Patricia Echeverría
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Bonjoch
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Estany
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Higueras
- Plastic Surgery Department, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Gonzalez-Mestre
- Plastic Surgery Department, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
- Irsicaixa Foundation, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lolis M, Dunbar SW, Goldberg DJ, Hansen TJ, MacFarlane DF. Patient safety in procedural dermatology. J Am Acad Dermatol 2015; 73:15-24; quiz 25-6. [DOI: 10.1016/j.jaad.2014.11.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
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Ahn CS, Rao BK. The life cycles and biological end pathways of dermal fillers. J Cosmet Dermatol 2015; 13:212-23. [PMID: 25196689 DOI: 10.1111/jocd.12100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an increased demand for soft tissue augmentation procedures. A wide range of products can provide correction through different mechanisms and it is important for clinicians to understand the biological pathways of each material. This study presents a systematic review of the pathways of commonly used fillers, with consideration of the complications associated with each. METHODS The PubMed (National Library of Medicine) database was searched for MeSH headings for different types of fillers, including trade names, between January 1, 2000, and January 1, 2013. Article titles were screened, and only studies designed to determine the mechanism of action and histopathology of complications were included. RESULTS When restricted to studies on biological mechanisms, 109 manuscripts were identified and the mechanisms of action of short-term and long-term degradable as well as permanent fillers were reviewed. Hyaluronic acid fillers, which are the most commonly used, form a fibrous capsule and induce limited de novo collagen. Poly-l-lactic acid and calcium hydroxylapatite are semipermanent fillers that provide long-term restoration of tissue volume by stimulating fibroblasts to lay down a matrix of collagen and elastic fibers. Polymethyl methacrylate is the only FDA-approved permanent implant that is held in place by encapsulation, providing a scaffold upon which the dermis can recover to its original thickness. DISCUSSION Soft tissue augmentation products are variable, and no single product can be considered the most effective or ideal. An understanding of biological mechanisms may help guide physicians choose the best suited product among the various options available while minimizing the occurrence of complications.
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Affiliation(s)
- Christine S Ahn
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Yang Y, Yap M, Oo Tha N, Paton NI. Objective Assessment of Facial Lipoatrophy Changes in a Cohort of HIV-Infected Patients Taking Combination Antiretroviral Therapy. HIV CLINICAL TRIALS 2015; 9:399-406. [DOI: 10.1310/hct0906-399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Choi WY, Cho HW, Lee DW. Complications of Injectable Soft Tissue Filler. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2015. [DOI: 10.14730/aaps.2015.21.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Korea
| | | | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Seoul, Korea
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Janjua TA. Role of massage in preventing formation of papules and nodules after injecting poly-L-lactic acid. JAMA FACIAL PLAST SU 2014; 16:457. [PMID: 25375414 DOI: 10.1001/jamafacial.2014.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Duracinsky M, Leclercq P, Herrmann S, Christen MO, Dolivo M, Goujard C, Chassany O. Safety of poly-L-lactic acid (New-Fill®) in the treatment of facial lipoatrophy: a large observational study among HIV-positive patients. BMC Infect Dis 2014; 14:474. [PMID: 25178390 PMCID: PMC4160543 DOI: 10.1186/1471-2334-14-474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Facial lipoatrophy is a frequently reported condition associated with use of antiretroviral (ARV) drugs. Poly-L-lactic acid (PLLA) acid has been used to correct facial lipoatrophy in people with HIV since 2004 both in Europe and the United States. The objective of this study was to establish, in real life conditions and in a large sample, the safety of PLLA (New Fill®, Valeant US, Sinclair Pharma Paris, France) to correct facial lipoatrophy among HIV-positive patients. METHODS A longitudinal study was conducted between 2005 and 2008 in France. Data from 4,112 treatment courses (n = 4,112 patients) and 15,665 injections sessions (1 to 5 injection sessions per treatment course) were gathered by 200 physicians trained in the use of PLLA. RESULTS The average age of patients (88.3% males) treated for lipoatrophy was 47.1 ± 8.1 years (Mean ± SD); 91.2% of patients had been receiving ARV treatment for 10.9 (±4.2) years; CD4 T-cell count was 535 ± 266 cells/mm3. The duration of facial lipoatrophy was 5 ± 2.8 years and the severity was such that 47.3% of patients required five injection sessions of PLLA and 81.9% of the sessions required two vials of the preparation. The final visit, scheduled two months after the last injection session, was attended by 66.0% of patients (n = 2,713). 48 treatment courses (2.8%) were discontinued due to adverse events (AEs). The overall incidence of AEs per course was 18.8%. Immediate AEs, bleeding (3.4%), bruising (2.3%), pain (2.0%), redness at injection site (1.6%), and swelling of the face (0.7%), occurred in 15.4% of courses and 7.0% of sessions (usually during the first session). Non-immediate AEs, mainly nodules (5.7%), inflammation (0.7%), granuloma (0.3%), discolouration (0.2%), and skin hypertrophy (0.1%), occurred in 6.7% of courses. Non-immediate AEs occurred within a time ranging from 21 days (inflammation) to 101 days (granuloma) and all but three of the 13 cases of granuloma resolved. Product efficacy was rated satisfactory by 95% of the patients and physicians. CONCLUSIONS This study demonstrated, in real-life conditions and on a large sample, that PLLA injections were feasible, efficient, and safe when performed by trained physicians.
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Affiliation(s)
- Martin Duracinsky
- />Bicêtre Hospital, Internal Medicine and Clinical Immunology, University Paris Diderot, Sorbonne Paris Cité, EA REMES, Patient Reported Outcomes Unit, Paris, & AP-HP, Le Kremlin-Bicêtre Paris, France
| | - Pascale Leclercq
- />Grenoble University hospital, Michallon hospital, Information and Treatment Centres for Human Immunodeficiency, BP 217, 38043, CEDEX 09 Grenoble, France
| | - Susan Herrmann
- />Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia Australia
| | | | - Marc Dolivo
- />Association des Œuvres Sociales du Ministère des Affaires Etrangères, 57 Boulevard des Invalides, 75007 Paris, France
| | - Cécile Goujard
- />Bicêtre Hospital, Internal Medicine and Clinical Immunology, & University Paris Sud, Le Kremlin-Bicêtre Paris, France
| | - Olivier Chassany
- />Department of Clinical Research, University Paris Diderot, Sorbonne Paris Cité, EA REMES, Patient Reported Outcomes Unit & AP-HP, Saint-Louis Hospital, Paris, France
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Alves MD, Brites C, Sprinz E. HIV-associated lipodystrophy: a review from a Brazilian perspective. Ther Clin Risk Manag 2014; 10:559-66. [PMID: 25083134 PMCID: PMC4108257 DOI: 10.2147/tcrm.s35075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prognosis of human immunodeficiency virus (HIV)-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named "HIV-associated lipodystrophy syndrome", was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs) and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large number of patients on antiretroviral therapy.
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Affiliation(s)
- Marcelle D Alves
- Infectious Disease Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Brites
- School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Eduardo Sprinz
- Infectious Disease Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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44
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Multiple subcutaneous granulomas after poly-l-lactic acid (Sculptra) injections. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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45
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Bagatin E, de Vasconcelos Nasser Caetano L, Soares JLM. Ultrasound and dermatology: basic principles and main applications in dermatologic research. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2013.838513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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46
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van Rozelaar L, Kadouch JA, Duyndam DA, Nieuwkerk PT, Lutgendorff F, Karim RB. Semipermanent filler treatment of HIV-positive patients with facial lipoatrophy: long-term follow-up evaluating MR imaging and quality of life. Aesthet Surg J 2014; 34:118-32. [PMID: 24334306 DOI: 10.1177/1090820x13515270] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Injectable fillers such as poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) have shown promising results in the treatment of combination antiretroviral therapy (cART)-induced facial lipoatrophy (FLA). However, the effects of these substances on magnetic resonance imaging (MRI) have not yet been described. OBJECTIVE The authors analyze the association between the effects of treatment with semipermanent fillers on MRI and changes in quality of life (QOL). METHODS Eighty-two human immunodeficiency virus (HIV)-positive patients with cART-induced FLA (grades 2-4) were enrolled in this prospective study. A mean volume of 58.2 mL (range, 12-105 mL) of PLLA (n = 41 patients) and 9.1 mL (range, 3-23 mL) of CaHA (n = 41) was injected in multiple sessions. The MRI examinations were performed prior to treatment and again 12 months after. The self-reported severity of FLA as well as QOL was measured using questionnaires based on Short Form 36, Medical Outcomes Study HIV Health Survey, and Center for Epidemiologic Studies Depression Scale formats. RESULTS Significant increases in total subcutaneous thickness (TST) of the injected regions could be identified on MRI in nearly all patients 1 year posttreatment. Patients reported that mental health and social and role functioning improved; depressive symptoms decreased after treatment. In addition, the increase in TST was positively associated with improvement of QOL. CONCLUSIONS This study confirms that treatment with both PLLA and CaHA not only increases TST but also is associated with improved QOL for HIV-infected patients. Furthermore, the study also demonstrates that MRI can show filler-induced neocollagenesis and quantify FLA treatment effects.
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Affiliation(s)
- Leo van Rozelaar
- Dr van Rozelaar is a cosmetic medical practitioner in private practice in Amsterdam, the Netherlands
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de Vries CGJCA, Geertsma RE. Clinical data on injectable tissue fillers: a review. Expert Rev Med Devices 2013; 10:835-53. [PMID: 24164663 DOI: 10.1586/17434440.2013.839211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications.
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Affiliation(s)
- Claudette G J C A de Vries
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands
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Shahrabi-Farahani S, Lerman MA, Noonan V, Kabani S, Woo SB. Granulomatous foreign body reaction to dermal cosmetic fillers with intraoral migration. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:105-10. [PMID: 24332334 DOI: 10.1016/j.oooo.2013.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/26/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We report intraoral granulomatous foreign body reactions in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA). STUDY DESIGN Clinical and histopathologic data were obtained from 25 patients who developed orofacial nodules or swelling after dermal filler injections. RESULTS All 25 patients were women aged 35 to 78 years (median, 55 years). All had a history of injection of CHA (n = 13) or PLA (n = 12) to the lips, nasolabial area, or mental area. Two patients developed cutaneous nodules at the sites of injections; all others presented with intraoral nodules (labial/buccal or vestibular mucosa) distant from the site of injections, suggestive of filler migration. Five of 21 cases presented with pain. Histopathologically, CHA presented as a diffuse mass of mauve-gray or beige, nonrefractile spherules, and PLA as rice- or spindle-shaped, geometric, refractile bodies within circumscribed nodules. CONCLUSIONS Cutaneous injections of CHA and PLA fillers may induce granulomatous reactions presenting as intraoral nodules distant from the injection sites.
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Affiliation(s)
- Shokoufeh Shahrabi-Farahani
- Assistant Professor, Department of Diagnostic Sciences and Oral Medicine, Division of Oral and Maxillofacial Pathology, UTHSC College of Dentistry, Memphis, TN, USA.
| | - Mark A Lerman
- Assistant Clinical Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA
| | - Vikki Noonan
- Associate Professor, Boston University School of Dental Medicine, Boston, MA, USA; Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA
| | - Sadru Kabani
- Co-Director and Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA
| | - Sook-Bin Woo
- Associate Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Chief of Clinical Affairs, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Co-Director and Associate Pathologist, Center for Oral Pathology, StrataDx, Lexington, MA, USA
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Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14:401-11. [PMID: 24037757 DOI: 10.1007/s40257-013-0043-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.
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Affiliation(s)
- Jennifer A Ledon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, 2nd floor, Miami, FL, 33136, USA,
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Kadouch JA, van Rozelaar L, Karim RB, Hoekzema R. Current treatment methods for combination antiretroviral therapy-induced lipoatrophy of the face. Int J STD AIDS 2013; 24:685-94. [DOI: 10.1177/0956462412474539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary Combination antiretroviral therapy (CART) reduces the mortality and morbidity in HIV-infected patients. However, facial lipoatrophy (FLA) is one of the well-known side-effects of this treatment and subsequently imposes major problems for HIV-infected patients. In the last decade, ample experience has been obtained with both local therapeutic options as well as possible systemic treatment options. Soft tissue fillers are a relatively simple and efficient treatment option for FLA. Especially, the biodegradable semi-permanent fillers combine a good effect with durability and an acceptable safety profile. The best way to prevent or restrict the development of FLA remains the exclusion of thymidine analogue nucleoside reverse-transcriptase inhibitors from the CART schedule.
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Affiliation(s)
- J A Kadouch
- Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - R B Karim
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - R Hoekzema
- Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
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