A split-face, blind, randomized placebo-controlled clinical trial investigating the efficacy and safety of hyaluronic acid filler for the correction of atrophic facial scars

Frontal Fibrosing Alopecia: A Comprehensive Guide for Cosmetic Dermatologists

Frontal fibrosing alopecia (FFA) is an inflammatory, scarring hair loss that commonly affects postmenopausal women and presents as frontal hairline recession, facial papules, loss of eyebrows, and facial hyperpigmentation. Because of the chronic, progressive nature of this disease and its important impact on aesthetic appearance, patients often consult dermatologists to improve unwanted FFA symptoms. Cosmetic practices including the use of non-ablative lasers, autologous fat injections, and oral isotretinoin can improve FFA-associated facial vein prominence, atrophic indentations, and facial papules, respectively. On the other hand, while exact etiology underlying FFA development remains unclear, some procedures including deep chemical peels and ablative laser therapies have been shown to induce facial scarring and are contraindicated in patients with FFA. In the same way, some cosmetic ingredients can possibly be a triggering or worsening factor for FFA as well. Therefore, it is essential for dermatologists to be aware of both the benefits and risks of cosmetic treatments in patients with diagnosed or suspected FFA. This comprehensive review aims to outline the key cosmetic products and procedures that may be useful in patients with FFA and those which should be considered contraindicated.

The Effect of Local Hyaluronic Acid Injection on Skin Aging: A Systematic Review and Meta-Analysis

BACKGROUND

Aging reduces the production of hyaluronic acid (HA) in the skin, leading to wrinkles and sagging. HA-based skincare products are being studied to improve skin quality. This systematic review and meta-analysis aimed to compare the effectiveness of HA-based injectable products for reducing wrinkles and enhancing skin elasticity, hydration, and radiation.

METHODS

Eligible trial reports were found by searching PubMed, Embase, Scopus, and Web of Science systematically until May 2024. A random-effects meta-analysis was performed to evaluate the effect of HA injection on skin aging. The protocol of the study has been registered in PROSPERO with a registration ID of CRD42024540703.

RESULTS

Overall, 12 studies met the inclusion criteria, of which 6 studies had enough data for meta-analysis. The random-effect meta-analysis showed improved hydration (SMD = 1.34, 95% CI = 0.14-2.54, and p < 0.05) and radiance (SMD = 0.51, 95% CI = 0.22-0.80, and p < 0.05) after HA filler injection. However, there was no significant difference in elasticity (SMD = 0.25, 95% CI = -0.20-0.70, and p = 0.27) and melanin index (SMD = -1.74, 95% CI = -4.89-1.41, p = 0.28) compared to controls.

CONCLUSIONS

According to the results of a meta-analysis, hyaluronic acid injections have been found to improve skin hydration and radiance, thus reversing the effects of skin aging. However, the study did not find any significant changes in the skin's elasticity or melanin index. Further research is required to confirm the effectiveness of hyaluronic acid in treating skin aging.

Synthetic Dermal Fillers in Treating Acne Scars: A Comparative Systematic Review

BACKGROUND

Acne is a common condition observed in adolescents and in most severe acne the scars develop. There are numerous treatment options for acne scars. However, no standardized guidelines have been established to guide physicians in the optimal treatment of acne scars.

AIMS

The objective of this systematic review is to evaluate the existing evidence on various fillers used for the treatment of acne scars and to compare their effectiveness with one another.

METHODS

The study was designed following PRISMA guidelines, and the information was retrieved in May 2024 using the PubMed database and ClinicalTrials.gov registry. The inclusion criteria were that studies involving patients of any age or gender with acne scars of any type treated with synthetic dermal fillers, and studies published in English. The exclusion criteria were studies with less than 10 participants and studies that did not use synthetic dermal fillers. To assess the risk of bias in the included studies, the Cochrane Collaboration's Risk of Bias tool was used for randomized controlled trials, and in observational studies, the Newcastle-Ottawa Scale was used.

RESULTS

Twenty-six studies were included with a total of 1121 participants. Fourteen studies evaluated HA on 372 subjects, five studies focused on PMMA on 305 subjects, four on CaHA on 392 subjects, two on PLLA on 42 subjects, and one on PCL on 10 subjects.

CONCLUSIONS

Most of the studies included in this review were of low quality, as indicated by their scores on quality assessments, lack of high-quality RCTs, and small sample sizes. Future research should focus on conducting randomized, controlled, split-face studies with an adequate number of participants and a detailed examination of different scar subtypes.

Prospective Clinical Trial Demonstrating the Efficacy of Hyaluronic Acid Filler for the Improvement of Atrophic Facial Scars up to 2 years

BACKGROUND

Hyaluronic acid (HA) filler longevity has been studied for wrinkles. However, its long-term use for treating atrophic facial scars has not yet been analyzed in long-term prospective studies.

OBJECTIVE

Analyze the safety and duration of a HA filler for the use in atrophic scars.

MATERIALS AND METHODS

Fifteen subjects received VYC-17.5L in atrophic scars on 1 randomized cheek and saline on the other, with 1 optional touch-up treatment and crossover after the short-term trial. Grading for this long-term extension was done on Day 720, using the Global Aesthetic Improvement Scale (GAIS) and the Quantitative Global Scarring Grading System.

RESULTS

On Day 720, a live blind evaluator rated the VYC-17.5L assigned side as having significant reduction in scar severity (-7.2 [t(22) = -6.01, p = .00009]) and number of scars (-8.8 [t(22) = -6.25, p = .00006]) as compared with baseline. There was no significant difference in the results from Day 120 to Day 720. Ninety-two percent (11/12) of subjects reported improvement (GAIS), were satisfied with the treatment, thought it looked natural, and had fewer side effects than expected. There were no persistent or late-onset side effects.

CONCLUSION

VYC-17.5L improved rolling atrophic facial scars, and the results were sustained throughout the 2-year trial without side effects.

Consensus Agreements on Regenerative Aesthetics: A Focus on Regenerative Biostimulation With Calcium Hydroxylapatite

BACKGROUND

A growing population of patients is seeking treatments that not only affect their overlying features but also restore a more biologically youthful structure and function to the underlying tissue. These strategies are part of what is known as regenerative aesthetics (RA). As an emergent field, clarity regarding the precise definitions and aims of RA and methods to measure the regenerative capacity of RA treatments are lacking.

METHODS

A panel of 6 multidisciplinary experts discussed the foundational aspects of RA. Consensus statements covered aspects of RA including terminology, goals of treatment, treatment strategies, and biological benchmarks indicating regeneration. Consensus on a statement was defined as ≥75% agreement.

RESULTS

Panelists emphasized the importance of natural, youthful tissue architecture and function including cellular and extracellular components. Replacement of a single biological component was not considered sufficient for an aesthetic treatment to be described as regenerative. Rather, the relative amounts, ratios, types, and organization are important to determine regenerative potential. Calcium hydroxylapatite is an example of an aesthetic injectable with evidence of regenerative capacity, as demonstrated by its ability to improve collagen type I/III ratios as well as induce the production of elastin and proteoglycans, which ultimately improve measures of skin quality.

Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies

BACKGROUND

Hyaluronic acid (HA) dermal fillers are widely used in aesthetic medicine. While generally safe, potential complications can arise.

OBJECTIVE

This systematic review aims to identify and classify potential complications linked to the use of HA dermal fillers, as informed by high-quality, low-risk-of-bias studies.

METHODS

This review follows the Cochrane review standards for clinical systematic reviews. This systematic review analyzed 48 high level of evidence studies on the use of hyaluronic acid (HA) dermal fillers in non-surgical facial aesthetics and the adverse events that occurred.The inclusion criteria were randomized control studies on HA dermal fillers and their complications. Excluded were case reports, case series, observational studies, and other non-randomized research due to their inability to provide generalized conclusions and their inherent publication bias.

RESULTS

Adverse events were classified into three categories: expected reactions, product or technique-related adverse events, and severe adverse events. Most adverse events were short-lived injection site reactions, which resolved spontaneously. Specific HA fillers and injection techniques influenced the occurrence of adverse events, which generally resolved within weeks without treatment. Severe adverse events were rare, persisting for months and requiring active medical intervention.

DISCUSSION

This classification system can enhance understanding, prevention, and treatment of HA filler complications, and support patient education. The common complications were injection site reactions, with persistent symptoms treated with topical steroids, NSAIDs, or hyaluronidase. Severe complications included severe edema, angioedema and others, often necessitating specific treatments.

CONCLUSION

HA dermal fillers are generally safe and effective, with most adverse events being transient and mild to moderate in severity. Severe adverse events, although rare, do occur and are generally non-treatment related. Informed consent, patient education, and professional training are crucial for safe and successful outcomes. Level of Evidence II 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 .

Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarring

Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.