Optimizing outcomes with polymethylmethacrylate fillers

High-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement

Soft tissue deficiencies profoundly impact the daily lives, and mental well-being of patients. Microspheres facilitate collagen synthesis by establishing a conducive environment for fibroblast growth. Existing synthetic polymer microspheres are typically prepared through emulsification and cross-linking at normal temperatures. However, residues of cross-linking agents can adversely affect biocompatibility, thereby limiting their biomedical applications. Agarose has garnered significant attention owing to its biodegradability and excellent biocompatibility. We have for the first time developed high-temperature emulsification coupled with low-temperature gelation for fabrication of agarose microsphere implants with well-controlled size for skin tissue enhancement. The agarose microspheres exhibited favorable sphericity and dispersion, possessing a uniform particle size with an average diameter of 37.24 μm. Furthermore, the microspheres demonstrated commendable injectability and biodegradability. Additionally, the implants displayed remarkable biocompatibility, effectively promoting the proliferation of human foreskin fibroblast-1 (HFF-1) cells. The microspheres exhibited no systemic toxicity and induced no hemolytic or thermogenic reactions. In photoaged mice skin models, the agarose microspheres augmented dermal density, and enhanced skin elasticity. The microspheres showed the capacity to stimulate the regeneration of collagen fibers. The agarose microspheres offer a novel avenue for soft tissue filling and hold significance in the field of tissue engineering and skin regeneration.

Oral/Perioral Reactions to Injectable Soft Tissue Fillers: A Clinicopathological Multicentric Study

OBJECTIVE

To analyze the characteristics of a series of oral reactions to injectable soft tissue fillers.

MATERIALS AND METHODS

Cases diagnosed as oral reactions to injectable soft tissue fillers were selected from eight Pathology laboratories. Information was retrieved from the laboratory charts and from the review of the hematoxylin and eosin-stained histological slides.

RESULTS

The 151 patients showed a mean age of 54.9 years, and 136 (90.1%) were females. Mean time of onset was 20.4 months, and the lips were the most frequent location (72.8%). Most cases presented as asymptomatic isolated nodules, with a mean size of 17.4 mm. Silicone (38.5%), polymethylmetacrylate (33%), and hyaluronic acid (11.9%) were the three most common fillers. Granulomas, foamy macrophages, and multinucleated giant cells were observed in 44%, 51.5%, and 65.3% of the cases, respectively. Time of onset was shorter for males (p = 0.033), and symptoms were common in the upper lip, buccal mucosa, and lower vestibule (p = 0.010). Foamy macrophages were more common in association with silicone and collagen (p < 0.001), whereas multinucleated giant cells were more common in association with polymethylmetacrylate, hydroxiapatite, and polylactic acid (p = 0.012).

CONCLUSION

Clinicians should consider reactions to injectable soft tissue fillers when evaluating asymptomatic submucosal nodules affecting the lips of adult/older females.

Modern techniques in addressing facial acne scars: A thorough analysis

BACKGROUND

Facial acne scars are a prevalent concern, leading to the development of various treatment modalities.

OBJECTIVES

This review aims to explore the latest advancements in the treatment of facial acne scars, focusing on both surgical and non-surgical methods.

METHODS

The non-surgical treatments reviewed include topical medications (such as retinoids and alpha hydroxy acids) and non-invasive procedures (like microdermabrasion and chemical peels). Surgical options discussed are punch excision, subcision, and fractional laser treatments.

RESULTS

Combination therapy, integrating both surgical and non-surgical approaches, is frequently utilized to achieve optimal results in scar improvement.

CONCLUSION

Recent advancements in the treatment of facial acne scars provide promising options for individuals seeking improvement. However, these treatments have associated risks and potential adverse effects, highlighting the importance of consulting a dermatologist before beginning any treatment regimen.

A practical guide to selecting facial fillers

BACKGROUND

Dermal fillers have created a multi-billion-dollar industry. They are the second most popular form of injectable, as they primarily address volume loss, augmentation, and provide immediate results. The most popular form includes hyaluronic acid-based fillers, however, alternatives exist.

OBJECTIVE

To create clinical charts to help with filler selection, injection, and addressing common complications.

METHODS

The current literature and expert opinions form our two senior authors were used to create a numerical and color-coded chart based on G-prime for filler selection, as well as an anatomical table with current recommendations and pearls. We have also included a safety table with current clinical recommendation to deal with common filler-related complications.

CONCLUSION

Fillers are a safe and reliable method to achieve augmentation. Filler selection in various anatomical planes plays a significant role in achieving favorable results.

Imaging Features and Complications of Facial Cosmetic Procedures

Facial aesthetic procedures have become increasingly popular and complex, making knowledge of facial anatomy crucial for achieving desired outcomes without complications. Some of the most common procedures include blepharoplasty, bichectomy, face-lifts, facial implants, thread lifting, and fillers. Blepharoplasty and bichectomy are surgical procedures that respectively aim to restore youthful contours to the periorbita and create a slimmer lower face by removing Bichat fat from the maxillofacial region. Facial implants are used for aesthetic augmentation of the skeletal structure and restoration of facial contour by using biomaterials or autogenous bone grafts. Face-lift surgeries involve incisions and removal of excess skin, and thread lifts involve less invasive procedures performed by inserting threads beneath the skin, with the aim to lift the skin and thus reduce wrinkles and sagging. Fillers improve wrinkles and loss of facial volume, with biologic types made from animal, human, or bacterial sources (such as hyaluronic acid), while synthetic fillers include substances such as paraffin, silicone, calcium hydroxyapatite, polymethylmethacrylate microspheres, polyacrylamide hydrogel, hydroxyethyl-ethyl methacrylate, and poly-l-lactic acid. Synthetic fillers can be classified as rapidly resorbable (<12 months), slowly resorbable (<24 months), or permanent. Imaging modalities such as US, CT, and MRI can help identify and analyze each type of facial aesthetic procedure or filler, as well as their possible complications such as foreign-body granuloma, noninflammatory nodule, late intermittent persistent edema, filler migration, infection, or complications after removal of the buccal fat pad. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center The online slide presentation from the RSNA Annual Meeting is available for this article.

Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives

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.

Using injectable fillers for chin and jawline rejuvenation

Objective

As the population ages, facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging. In the mandibular region, skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection. While surgical procedures, including chin implantation, may be performed, nonsurgical procedures are becoming increasingly popular due to their temporary, noninvasive, yet effective methods. This review covers the use of hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate in the jawline.

Methods

PubMed was searched for data on the mechanism of action, pertinent anatomy, indications, contraindications, technique, and evidence supporting the safety and efficacy of the fillers.

Results

There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods. While the advantages of injectable fillers include relatively affordable cost, minimal patient discomfort, and limited recovery times, taking measures to prevent short- and long-term complications is necessary for optimal results.

Conclusions

Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.

A pilot study comparing the efficacy of autologous cultured fibroblast injections with hyaluronic acid fillers for treating nasolabial folds

Autologous cultured fibroblast injections for soft tissue augmentation are a potential alternative to other filler materials. No studies have compared autologous fibroblast injections and hyaluronic acid (HA) fillers for treating nasolabial folds (NLFs). To compare the efficacies and safeties of autologous cultured fibroblast injections and HA fillers for treating NLFs. This prospective, evaluator-blinded, pilot study enrolled 60 Thai female adult patients diagnosed with moderate to severe NLFs. They were randomized to receive either 3 treatments of autologous fibroblasts at 2-week intervals or 1 treatment with HA fillers. The primary outcome was the clinical improvement of the NLFs graded by 2 blinded dermatologists immediately after injection and at 1-, 3-, 6-, and 12-month follow-ups. Objective measurement of the NLF volume was evaluated. Patient self-assessment scores, pain scores, and adverse reactions were recorded. Of the 60 patients, 55 (91.7%) completed the study protocol. The NLF volumes improved significantly in the autologous fibroblast group at all follow-ups relative to baseline (P = 0.000, 0.004, 0.000, 0.000, and 0.003). The patients in the autologous fibroblast group rated more noticeable NLF improvements than those in the HA filler group (3-month follow-up, 58.41% vs. 54.67%; 6-month follow-up, 52.50% vs. 46%; 12-month follow-up, 44.55% vs. 31.33%). No serious adverse reactions were recorded. Autologous fibroblast injections are safe and effective for treating NLFs. These injections also promise sustained growth of living cells, possibly leading to a greater persistence than shown by other fillers.

Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series

BACKGROUND

As nonsurgical rejuvenation with fillers continues to grow in popularity, patients are increasingly interested in more durable results. Polymethylmethacrylate (PMMA)-collagen gel is unique among fillers in that the PMMA microspheres are not completely absorbed and phagocytosed by the body. This durability coupled with the biophysical properties of PMMA makes it a poor choice for periorbital rejuvenation, an unforgiving and highly complex anatomic area.

METHODS

Between 2011 and 2018, 14 patients with PMMA granulomas in various facial areas self-referred to the senior author's practice. Of these patients, 11 were managed nonsurgically; however, all 3 patients who presented with granulomas in the infraorbital area required surgery to remove the filler and restore a natural aesthetic.

RESULTS

The 3 patients with significant swelling and PMMA filler nodules in the infraorbital area with unacceptable cosmetic appearance were females between the ages of 50 and 55 years. Nonsurgical protocols were unsuccessful, and surgical removal was required. All subjects have been followed for a minimum of 2 years with no immediate- or long-term postoperative complications secondary to PMMA removal. Patients remain satisfied with the outcome of the surgery.

CONCLUSIONS

Despite the evidence that the periorbital area is prone to adverse events when injected with particulate fillers, misguided enthusiasm for PMMA-collagen gel as a durable treatment continues to lead to unnecessary and severe complications in patients. The case studies presented here highlight that this product should not be introduced into the periorbital area. We also describe a surgical treatment approach for its removal if complications arise.

Evaluation of Paste-Type Micronized Acellular Dermal Matrix for Soft Tissue Augmentation: Volumetric and Histological Assessment in a Mouse Model

BACKGROUND

A biological injectable material, paste-type micronized acellular dermal matrix (ADM), has been proven effective in wound healing by filling defects through tissue replacement. This study aimed to compare the efficacy of paste-type micronized ADM on soft tissue augmentation with that of the conventional fillers in animal experiments.

METHODS

Two distinct paste-type micronized ADMs, which were mixed with distilled water (mADM) and gelatin (mADM+GEL), respectively, were compared with conventional fillers, hyaluronic acid (HA) and polymethyl methacrylate (COL+PMMA). Thus, four different types of fillers were each injected into the dorsum of nude mice to compare the volume retention and biocompatibility. During the 8-week experimental period, ultrasound and computed tomography (CT) images were obtained for volumetric analysis. Histological evaluation was performed using hematoxylin and eosin and CD 31 staining.

RESULTS

According to the CT images at week 8, the mADM and mADM+GEL showed a higher volume persistence rate of 113.54% and 51.12%, compared with 85.09% and 17.65% for HA and COL+PMMA, respectively. The 2-week interval ultrasound images revealed that the mADM showed a volume increase in width rather than in height, and an increase in height for HA did not vary much. Histological analysis showed marked fibrous invasion and neovascularization with the mADM and mADM+GEL compared to that of the conventional fillers.

CONCLUSIONS

Paste-type micronized ADM showed soft tissue augmentation with similar effectiveness to that of conventional fillers. Therefore, paste-type micronized ADM has potential as an alternative material for a soft tissue filler in tissue replacement.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety and Efficacy of Polymethylmethacrylate-Collagen Gel Filler for Correction of the Pre-Jowl Sulcus: A 24-month Prospective Study

Background

Polymethylmethacrylate (PMMA)-collagen gel is approved for the correction of nasolabial folds and severe atrophic, distensible facial acne scars on the cheek. However, fillers are often used off-label in clinical practice, necessitating additional study of safety and efficacy.

Objectives

To determine the safety and efficacy of PMMA-collagen gel for the correction of lower face aging, specifically the pre-jowl sulcus.

Methods

In this prospective, single-center, 1-year study (N = 20) and additional 1-year extension (N = 10), 20 patients with a pretreatment score of 2, 3, or 4 on the 5-point Merz Aesthetic Scale for jawline at rest were eligible for treatment with PMMA-collagen gel. Efficacy was measured by blinded review using the jawline scale, Subject and Physician Global Aesthetic Improvement Scale (GAIS) and Subject Satisfaction scores, collected at weeks 4, 12, 26, 52, and 104.

Results

Improvement in jawline score was significant at all posttreatment time points up to 104 weeks (P < 0.01). The percentage of patients with subject-reported GAIS ratings of “improved” or “much improved” was 79% at 12 weeks and ratings were maintained at 76% at 52 weeks and increased to 90% at week 104. At 52 and 104 weeks, 82% and 100% of patients, respectively, were at least “somewhat satisfied.” All adverse events were minor.

Conclusions

PMMA-collagen gel is well tolerated and effective for durable correction of the pre-jowl sulcus and jawline.

Level of Evidence: 4

A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring

Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.

Case Report of Idiopathic Masseteric Hypoplasia Treated With Polymethyl Methacrylate-Collagen Gel

Congenital hypoplasia of the masseter muscle is a rare condition most commonly associated with craniofacial or poly-malformation syndromes, with a small number of reported idiopathic cases. The condition is most commonly managed by orthodonture and later surgical intervention; however, surgery is not an option for all patients. Nonsurgical approaches to correcting asymmetry may be considered for patients for whom the functional impact of hypoplasia has been largely managed and the patient's concern is primarily aesthetic. In this case study, the patient presented for a consultation seeking a nonsurgical solution for marked facial asymmetry. The patient underwent physical examination and magnetic resonance imaging to confirm diagnosis of congenital masseter muscle hypoplasia. To treat the asymmetry, a total of 9.6 cc of polymethyl methacrylate (PMMA)-collagen gel (Bellafill; Suneva Medical, Inc., San Diego, CA) was injected along the border of the mandible from the gonial angle out to the area of the mental foramen and slightly above over the course of 6 months (2 visits spaced 3 months apart) to provide long-term, nonsurgical correction. The patient was very satisfied with the results, highlighting the potential for PMMA-collagen gel to be used in clinical situations in which durable, nonsurgical correction of lower-face asymmetry is needed.

LEVEL OF EVIDENCE 5

Preseptal cellulitis associated with cosmetic eyelash lifting procedure

BACKGROUND

The increased popularity of periocular cosmetic applications in recent years has resulted in the appearance of various complications. The cosmetic eyelash lifting is one of these new techniques and is gradually becoming more popular. There are no previous reports of any complications of this procedure in the literature.

AIMS

In this study, we present a clinical case of preseptal cellulitis following cosmetic eyelash lifting procedure.

PATIENT/METHODS

A 55-year-old woman presented with bilateral eyelid swelling and redness. The history revealed that she had undergone cosmetic eyelash lifting procedure 2 days ago. There was no ocular movement limitation or pain. The biomicroscopic examination revealed bilateral eyelid edema and hyperemia, conjunctival hyperemia, chemosis, and mucopurulent secretion. The diagnosis was preseptal cellulitis when the clinical examination was evaluated together with the results of the laboratory tests and radiological imaging.

RESULTS

Systemic and topical antibiotics were started, and the signs recovered in the first week.

CONCLUSIONS

Cosmetic eyelash lifting can rarely be one of the causes of preseptal cellulitis. It is important to detect and treat any blepharitis or meibomitis before the procedure. Eyelid hygiene and the proper sterilization conditions during the procedure must also be ensured.

A Potential Filling Material for Wound Healing and Shaping: Acellular Dermal Matrix Combined with Autologous Dermis

BACKGROUND

The currently used subcutaneous fillers are not effective enough. The use of autologous tissues or cells will reduce immune rejection and increase the stability of the fillers, while increasing the absorbability of filling materials. To establish a durable and safe filling material, we herein combined acellular dermal matrix (ADM) with autologous dermal cells and tested the performance of this matrix in wound healing and shaping.

METHODS

To prepare the ADM, stratified skin was obtained from the back of two New Zealand rabbits and decellularized to obtain ADM. The ADM was ultrasonically mixed with as-prepared autologous dermis in vitro. The mixture was injected as a subcutaneous filler into the back area of 20 New Zealand rabbits. In this procedure, different concentration ratios of the mixture were injected, and the volume change of the filler was measured and categorized into five groups. At 4 months and 8 months after filling, samples were obtained for quantitative evaluation of the thickness and vessel density, as well as qualitative evaluation of colonization.

RESULTS

Examination of the ADM conformed that the matrix had no cells. ADM and the prepared autologous dermis were evenly mixed, and the filler was gradually absorbed. The comprehensive evaluation of ADM and autologous dermis mixture showed that group C had the best filling effect with the least infiltration of inflammatory cells and the highest vascular density compared to A, B, D and E groups in the study.

CONCLUSION

When combined at the ratio of 50%:50%, the autologous dermis combined and acellular dermal matrix showed better performance compared to the other four different ratios in this study. This implies that this combination is potentially safer, effective and stable as a filling material compared to ADM or dermal matrix alone.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Applications of Natural, Semi-Synthetic, and Synthetic Polymers in Cosmetic Formulations

Cosmetics composed of synthetic and/or semi-synthetic polymers, associated or not with natural polymers, exhibit a dashing design, with thermal and chemo-sensitive properties. Cosmetic polymers are also used for the preparation of nanoparticles for the delivery of, e.g., fragrances, with the purpose to modify their release profile and also reducing the risk of evaporation. Besides, other cosmetically active nutrients, dermal permeation enhancers, have also been loaded into nanoparticles to improve their bioactivities on the skin. The use of natural polymers in cosmetic formulations is of particular relevance because of their biocompatible, safe, and eco-friendly character. These formulations are highly attractive and marketable to consumers, and are suitable for a plethora of applications, including make-up, skin, and hair care, and as modifiers and stabilizers. In this review, natural synthetic, semi-synthetic, and synthetic polymers are discussed considering their properties for cosmetic applications. Their uses in conventional and novel formulations are also presented.

Rheologic properties of soft tissue fillers and implications for clinical use

BACKGROUND

The use of injectable soft-tissue fillers has become an essential tool in esthetic rejuvenation. Rheology, the study of flow of matter, helps to understand the function of these products.

AIMS

The purpose of this article is to review the rheologic properties of soft-tissue fillers currently available in the United States and to evaluate how these properties relate to clinical performance.

METHODS

This article explains basic rheologic terms and describes how rheologic properties of specific soft-tissue fillers affect filler performance.

RESULTS

The currently available soft-tissue fillers have unique rheologic and physicochemical properties that influence performance and cosmetic outcome. These properties determine that filler product is most appropriate based on degree of soft-tissue defect and anatomic location.

CONCLUSION

It is imperative for physicians to have an in-depth understanding of the rheologic properties of soft-tissue fillers in order to appropriately select and utilize these products for the desired cosmetic outcome.

A multi-center, open-label, pilot study of allograft adipose matrix for the correction of atrophic temples

BACKGROUND

Autologous fat grafting (AFG) and synthetic fillers are currently used in esthetic and reconstructive surgery. Challenges in AFG include inconsistent graft retention, donor site morbidities, insufficient harvest, and excessive harvesting times. An allograft adipose matrix (AAM) has been developed as an off-the-shelf alternative to AFG and synthetic fillers.

AIMS

To evaluate the clinical safety and retention of an AAM over 24 weeks after treatment of bilateral atrophic temples.

PATIENTS/METHODS

Ten subjects (nine females, one male, aged 47-69 years) with temple atrophy were enrolled in the IRB-approved study. AAM (Renuva^® , MTF Biologics, Edison, NJ) was injected (<3 mL) bilaterally into the atrophic temples of each subject. Volume retention, global improvement, and safety were evaluated at 1, 4, 8, 12, 16, 20, and 24 weeks. Biopsy specimens were obtained for adipogenic and angiogenic histological evaluation.

RESULTS

The mean temple volume improved over the baseline and was retained throughout the study period. Fullness (measure of volume) increased immediately from 0 pretreatment to 2.8 post-treatment (scale 0-4 = none-maximum). Fullness varied from 0.8 to 2.2 from weeks 1 through 12 and was 2.7-3.0 from weeks 16-24, around 75% increase from baseline. Furthermore, skin tone, smoothness, texture, and overall appearance also improved with 71% of subjects being satisfied to very satisfied with the results. Adverse events were minimal and histology revealed native tissue incorporation and remodeling.

CONCLUSION

AAM is safe and well tolerated, provides at least 6-month volume retention, improves skin quality, and supports adipose tissue remodeling after treatment into temples.

New Frontiers in Skin Rejuvenation, Including Stem Cells and Autologous Therapies

One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.

Comparative Evaluation of the Biodegradability and Wrinkle Reduction Efficacy of Human-Derived Collagen Filler and Hyaluronic Acid Filler

BACKGROUND

The development of fillers for wrinkle prevention is growing to meet rising demands to reduce the aging of skin.

OBJECTIVE

In this experiment, we confirmed the effects of human collagen and hyaluronic acid filler biodegradation for wrinkle reduction using a photo-aging mouse model.

MATERIALS AND METHODS

A total of 10 hairless mice (SKH1-Hrhr) were randomly divided into two groups and injected with hyaluronic acid and human-derived collagen filler. At 0, 2, 4, 8, and 12 weeks, PRIMOSlite^®, folliscope, and MRI were used to evaluate the biodegradability of the fillers after the injections. We also studied the photo-aging mouse model for skin roughness and histological evaluation and confirmed that the filler injection had excellent anti-wrinkle effects.

RESULTS

Human-derived collagen fillers had excellent biodegradability compared to that of hyaluronic acid fillers. The skin surface roughness in the photo-aging mouse models was significantly reduced after injections of human-derived collagen filler.

CONCLUSION

Our results showed that the human-derived collagen filler had excellent biodegradability and effectively reduced wrinkle formation in a photo-aging mouse model.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of Autologous Platelet-Rich Plasma Combined With Ablative Fractional Carbon Dioxide Laser for Acne Scars: A Systematic Review and Meta-Analysis

BACKGROUND

Acne scars are common and challenging clinical complications of acne vulgaris. Ablative fractional carbon dioxide (CO2) laser is a well-established treatment for acne scars; however, some postlaser adverse effects have been noted. Autologous platelet-rich plasma (PRP) can improve tissue regeneration. Several studies have investigated the efficacy of combination therapy of CO2 laser and PRP for acne scars.

OBJECTIVES

The authors sought to conduct a meta-analysis of the efficacy of PRP combined with ablative fractional CO2 laser for treating acne scars by examining clinical trial results.

METHODS

A systematic review was performed by searching PubMed, Embase, Cochrane Library, and Web of Science, and a meta-analysis was conducted to assess the clinical outcomes after combination therapy of PRP and ablative fractional CO2 laser compared with laser alone.

RESULTS

We identified 4 eligible studies for the meta-analysis, including 3 randomized controlled trials. Our results demonstrated that clinical improvement after combination therapy was significantly higher than that after laser alone (odds ratio = 2.992, P = 0.001). Regarding major side effects, patients who underwent combination therapy experienced significantly shorter duration of crust compared with CO2 laser alone (standard mean difference = -1.140, P < 0.001); relatively shorter durations of erythema and edema were also noted after combination therapy. Furthermore, patient satisfaction rates were significantly higher after combination therapy than after laser alone (odds ratio = 3.169, P = 0.002).

CONCLUSIONS

The combination of autologous PRP and ablative fractional CO2 laser has synergistic positive effects on the clinical outcomes for acne scars and can accelerate the recovery of laser-damaged skin.

LEVEL OF EVIDENCE: 2

Risk Comparison of Filler Embolism Between Polymethyl Methacrylate (PMMA) and Hyaluronic Acid (HA)

Background

The incidence of vascular complications varies among different fillers. The main purpose of this study was to compare the risk of embolism between PMMA (Artecoll) and hyaluronic acid (HA, Restylane) after artery injection.

Methods

Rabbit ears were injected via the central artery with 0.1 ml PMMA (group A), 0.1 ml HA (group B), 0.2 ml PMMA (group C), or 0.2 mL HA (group D), respectively. The formation of transparent emboli was monitored right after injection. Tissue necrosis and histopathological changes were analyzed on day 7.

Results

With 0.1 ml injected volume, PMMA was dispersed within a few minutes and only 5% of the injected ears had mild necrosis on day 7, while HA tended to form obvious transparent emboli, an indication of blood vessel clotting, and 60% of injected ears showed necrosis on day 7. With 0.2 ml injected volume, PMMA had a risk of complete blood vessel clotting in between 0.1 ml PMMA group and 0.1 ml HA group, and 30% of injected ears had necrosis; in contrast, 100% of 0.2 ml HA-injected ears showed transparent emboli and necrosis. The necrosis areas were significantly increased in the HA groups compared with PMMA groups at the same injection volumes. HA injection also caused dilation of small blood vessels.

Conclusion

At the same injection volume, PMMA had less risk of embolism compared with HA. With increased injection volume, there were increased risks of embolism and necrosis for both PMMA and HA.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Electronic supplementary material

The online version of this article (10.1007/s00266-019-01320-w) contains supplementary material, which is available to authorized users.

Facial trauma reconstruction with polymethyl methacrylate-A case report

BACKGROUND

Polymethyl methacrylate (PMMA) is a dermatologic filler commonly used in esthetic procedures. However, it can also be used in more severe cases such as reconstruction of facial traumas.

AIMS

The aim of this report was to describe the use of PMMA in a nasal reconstruction of a patient victim of an automobilist accident which presented previous rejection of autograft.

PATIENT

A young female patient, 26 y, victim of automobilist accident, with no bone support due to trauma both in the mandibulum and maxilla, presented fracture of several facial bones. Presented rejection of a bone autograft from the skullcap implanted on the nose. In order to harmonize the facial aspect, a nasal fill with PMMA for the anatomic reconstruction of the nose was performed.

RESULTS AND CONCLUSIONS

PMMA promoted the recovery of facial and nasal esthetic characteristics of the patient ensuring a satisfactory result.