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Díaz-Aguayo I, Urdiales-Gálvez F, Benítez PA, Carvajal-Larrate A, Farollch-Prats L, Hospido A, Mira M, Uva L, Zuluaga L. Aesthetic management of lips and perioral region with Hylacross® and Vycross® hyaluronic-acid based fillers: A document of recommendations. J Cosmet Dermatol 2024; 23:2843-2856. [PMID: 38751134 DOI: 10.1111/jocd.16358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Lip volumization and perioral rejuvenation with hyaluronic-acid (HA) based dermal fillers are generating increasing interest and demand. However, this topic is still having many unmet needs nowadays. This document aimed to provide tips and recommendations that may help clinicians to achieve optimal and more predictable aesthetic outcomes. METHODS A multidisciplinary group of aesthetic medicine doctors from Spain and Portugal reviewed the tools used for assessing the patient and aesthetic outcomes, as well as the different techniques and products used in lips/perioral rejuvenation. RESULTS The consensus panel provided specific recommendations focusing on the basic information to collect before performing the aesthetic procedure; comprehensive approach to lips/perioral region rejuvenation; clinical and aesthetic assessment tools; product and technique selection; patient profile and needs; and safety issues (complications/adverse-events). CONCLUSIONS The rapid evolution of techniques and tools for assessing the patient and aesthetic outcomes, as well as the development of new HA-based fillers makes it necessary to update the clinical recommendations that guide the daily practice of clinicians, particularly those who have less experience with these procedures. This document addressed relevant subjects related to lip/perioral-region rejuvenation to perform the correct procedure, with the appropriate HA-based, on the right patient; to help specialists to obtain optimal and predictable aesthetic outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Mar Mira
- Clínica Mira + Cueto, Madrid, Spain
| | - Luís Uva
- Clinica Personal Derma, Lisbon, Portugal
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Czumbel LM, Farkasdi S, Gede N, Mikó A, Csupor D, Lukács A, Gaál V, Kiss S, Hegyi P, Varga G. Hyaluronic Acid Is an Effective Dermal Filler for Lip Augmentation: A Meta-Analysis. Front Surg 2021; 8:681028. [PMID: 34422892 PMCID: PMC8377277 DOI: 10.3389/fsurg.2021.681028] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: The lips and the mouth play an indispensable role in vocalization, mastication and face aesthetics. Various noxious factors may alter and destruct the original structure, and appearance of the lips and the anatomical area surrounding the mouth. The application of hyaluronic acid (HA) may serve as a safe method for lip regeneration. Although a number of studies exist for HA effectiveness and safety, its beneficial effect is not well-established. Aim: The present meta-analysis and systematic review was performed to investigate the effectiveness of HA on lip augmentation. We also investigated the types and nature of adverse effects (AEs) of HA application. Methods: We reported our meta-analysis in accordance with the PRISMA Statement. PROSPERO protocol registration: CRD42018102899. We performed the systematic literature search in CENTRAL, Embase, and MEDLINE. Randomized controlled trials, cohort studies, case series and case reports were included. The untransformed proportion (random-effects, DerSimonian-Laird method) of responder rate to HA injection was calculated. For treatment related AEs descriptive statistics were used. Results: The systematic literature search yielded 32 eligible records for descriptive statistics and 10 records for quantitative synthesis. The results indicated that the overall estimate of responders (percentage of subjects with increased lip fullness by one point or higher) was 91% (ES = 0.91, 95% CI:0.85-0.96) 2 months after injection. The rate of responders was 74% (ES = 0.74, 95% CI:0.66-0.82) and 46% (ES = 0.46, 95% CI:0.28-0.65) after 6 and 12 months, respectively. We included 1,496 participants for estimating the event rates of AEs. The most frequent treatment-related AEs were tenderness (88.8%), injection site swelling (74.3%) and bruising (39.5%). Rare AEs included foreign body granulomas (0.6%), herpes labialis (0.6%) and angioedema (0.3%). Conclusion: Our meta-analysis revealed that lip augmentation with injectable HA is an efficient method for increasing lip fullness for at least up to 6 months after augmentation. Moreover, we found that most AEs of HA treatment were mild or moderate, but a small number of serious adverse effects were also found. In conclusion, further well-designed RCTs are still needed to make the presently available evidence stronger.
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Affiliation(s)
- László Márk Czumbel
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Sándor Farkasdi
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dezső Csupor
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Anita Lukács
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Valéria Gaál
- Department of Ophthalmology, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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Schuetzenberger K, Pfister M, Messner A, Garhöfer G, Hohenadl C, Pfeiffenberger U, Schmetterer L, Werkmeister RM. Cutaneous optical coherence tomography for longitudinal volumetric assessment of intradermal volumes in a mouse model. Sci Rep 2020; 10:4245. [PMID: 32144359 PMCID: PMC7060266 DOI: 10.1038/s41598-020-61276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Clinical evaluation of skin lesions requires precise and reproducible technologies for their qualitative and quantitative assessment. In this study, we investigate the applicability of a custom-built dermatologic OCT system for longitudinal assessment of intradermal volumes in a mouse model. The OCT, based on an akinetic swept laser working at 1310 nm was employed for visualization and quantification of intradermal deposits of three different hyaluronic acid-based hydrogel formulations - one commercial and two test substances. Hydrogels were applied in 22 BALB/c mice, and measurements were performed over a six-month time period. All hydrogels increased in volume within the first weeks and degraded steadily thereafter. The half-lifes of the test hydrogels (27.2 ± 13.6 weeks for Hydrogel 1, 31.5 ± 17.2 weeks for Hydrogel 2) were higher in comparison to the commercially available HA hydrogel (21.4 ± 12.0 weeks), although differences were not significant. The sphericity parameter was used for evaluation of the deposit geometry. While on the injection day the sphericities were similar (~0.75 ± 0.04), at later time points significant differences between the different test substances were found (T24: PRV 0.59 ± 0.09, Hydrogel 1 0.70 ± 0.11, Hydrogel 2 0.78 ± 0.07; p ≤ 0.012 for all pairs). This study shows the applicability of OCT imaging for quantitative assessment of the volumetric behavior of intradermal deposits in vivo.
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Affiliation(s)
- Kornelia Schuetzenberger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
| | - Martin Pfister
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Institute of Applied Physics, Vienna University of Technology, Wiedner Hauptstr. 8-10, 1040, Vienna, Austria
| | - Alina Messner
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Garhöfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Hohenadl
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Croma Pharma GmbH, Cromazeile 2, 2100, Leobendorf, Austria
| | - Ulrike Pfeiffenberger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
| | - Leopold Schmetterer
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Singapore Eye Research Institute, 20 College Road Discovery Tower Level 6, The Academia, Singapore, 169856, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore, 636921, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Institute of Ophthalmology, 4031, Basel, Switzerland
| | - René M Werkmeister
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Vienna, Austria.
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Kandhari R, Goodman GJ, Signorini M, Rahman E. Use of a Hyaluronic Acid Soft-tissue Filler to Correct Congenital and Post-traumatic Lip Asymmetry. J Cutan Aesthet Surg 2017; 10:153-156. [PMID: 29403187 PMCID: PMC5782440 DOI: 10.4103/jcas.jcas_31_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The use of hyaluronic acid soft-tissue fillers for enhancement of lip features is a popular and minimally invasive office-based procedure used worldwide due to its relative simplicity and favorable safety profile. Materials and Methods: Hyaluronic acid was used in illustrative cases to attempt correction of congenital and acquired lip asymmetries. Results: In the cases presented, accurate and cosmetically acceptable results were attained and maintained for the duration of the product life. Conclusions: Hyaluronic acid may be used successfully when lip asymmetry is evident and is a relatively simple nonsurgical alternative.
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Affiliation(s)
| | - Gregory J Goodman
- Monash University, Clayton, Australia.,Skin and Cancer Foundation Carlton, Victoria, Australia
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