Evaluating the role of small particle hyaluronic acid fillers using micro-droplet technique in the face, neck and hands: a retrospective chart review

Investigating the Mechanisms of Intradermal Injection for Easier "Skin Booster" Treatment: A Fluid Mechanics Approach to Determine Optimal Delivery Method

Background

The use of "skin boosters" for rejuvenating aged skin is widely used. However, the accurate injection of the skin booster into the dermal layer remains a challenge due to the density of the dermis. The purpose of this study was to investigate the optimal mechanical variables of delivery that enabled correct targeting of the product to the dermis for optimal results.

Methods

We investigated the impact of mechanical variables (syringe diameter, needle diameter and length, and viscosity of the skin booster) on the force required for intradermal injection in porcine skin. The correlation between these variables and the injection force was examined as well.

Results

The results show that smaller syringe diameters, larger needle diameters, shorter needle lengths, and lower viscosity of the skin boosters reduce the injection force needed for intradermal injections.

Conclusions

During the administration of skin booster injections, clinicians should take into account optimal conditions that facilitate intradermal injections, thus maximizing rejuvenating outcomes. Furthermore, manufacturers of skin boosters should formulate the products with decreased viscosity and provide the product in conjunction with appropriate needles and syringes, designed to optimize ease of injection.

Low Molecular Weight Hyaluronic Acid Added to Six Specific Amino Acids in the Treatment of Striae Alba (SA): An Observational Study

Striae distensae or stretch marks are a common complaint among women and can be distressing. The present study aimed to assess the efficacy of a mixture of low molecular weight hyaluronic acid and six amino acids when applied with a specific intradermal injection technique known as intra-mural fluid technique. A clinical study was carried out in 32 patients (with a dropout rate by 9.4%) with striae distensae alba (SA) in one or more of the following anatomical areas: breast, abdomen, inner thigh, trochanteric area, gluteal area, posterior supra-iliac area, and lumbar area. Product efficacy was assessed by the investigator using the Global Aesthetic Improvement Scale, while a Likert scale was used to evaluate to score the treatment tolerability and a QoL stretch marks questionnaire was used to investigate the patients' self-body image. The treatment was effective in improving the appearance of SA fifteen days after the second treatment and 6 months after the first treatment (and after a total of 4 treatments). The product efficacy and tolerability were also perceived by the patients during each treatment session. Our results suggest that the test treatment is a valid treatment option to decrease the appearance of SA. LEVEL OF EVIDENCE IV: 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 https://www.springer.com/00266.

A Randomized, Multicenter, Evaluator-blind Study to Evaluate the Safety and Effectiveness of VYC-12L Treatment for Skin Quality Improvements

BACKGROUND

Skin quality may be assessed by degrees of skin smoothness, fine lines, and hydration. VYC-12L is a recently developed hyaluronic acid filler to improve skin quality.

OBJECTIVE

This was a randomized, evaluator-blind study assessing safety and effectiveness of intradermal VYC-12L treatment for improving cheek skin smoothness, fine lines, and hydration.

METHODS

Participants (≥22 years) with moderate-to-severe investigator-assessed Allergan Cheek Smoothness Scale (ACSS) scores were randomized in 2:1 ratio to receive VYC-12L or control (no treatment with optional treatment). Effectiveness was assessed 1 month after last injection (initial or touch-up) by a responder rate (≥1-grade improvement from baseline on both cheeks) using investigator-rated ACSS and Allergan Fine Lines Scale (AFLS), and tissue dielectric constant probe-measured skin hydration. Safety was evaluated throughout.

RESULTS

Participants (VYC-12L, n = 131; control, n = 71) were 86.1% female with a median age of 58.0 years. At month 1, ACSS and AFLS responder rates were statistically significantly higher in the VYC-12L group (57.9%, 58.3%, respectively) than in the untreated controls (4.5%, 5.4%, respectively; p < .001). VYC-12L ACSS and AFLS responder rates remained consistent throughout the 6-month follow-up. Six participants reported treatment-related adverse events; none led to study discontinuation.

CONCLUSION

VYC-12L is an effective, well-tolerated treatment for lasting improvement of cheek skin smoothness, fine lines, and hydration.

The Effectiveness of Injectable Hyaluronic Acid in the Improvement of the Facial Skin Quality: A Systematic Review

Background

Several studies have evaluated the role of various injectable formulations of hyaluronic acid (HA) in the improvement of the quality of facial skin. It is important to systematically summarize the available evidence in this regard.

Methods

Relevant databases were searched for clinical studies that evaluated the therapeutic role of any injectable formulation of HA in improving the quality of facial skin in adult humans until 31 December 2022. The available studies were critically analyzed and the data were extracted.

Results

A total of 2996 articles were screened and 13 studies were finally included. Eight studies evaluated the effect of various formulations of HA alone, while five evaluated the effect of various formulations of HA along with other active ingredients (cocktails) on the quality of facial skin. All types of HA formulations cause a significant improvement in facial skin quality, in terms of hydration, firmness, skin-tiring effect/fatigue, brightness, texture, radiance, and elasticity. The effect of HA monotherapy was more pronounced than that of the cocktail ingredients. HA treatment was quite safe and the patient satisfaction level was high.

Conclusion

The clinical evidence on the use of injectable HA alone in the improvement of the quality of facial skin, in terms of hydration, firmness, skin-tiring effect/fatigue, brightness, texture, radiance, and elasticity, is quite promising. Large randomized controlled trials are required in this regard.

Facial Skin Revitalization with Cohesive Polydensified Matrix-HA20G: Results from a Randomized Multicenter Clinical Study

Background:

There is a growing interest in the application of hyaluronic acid (HA) derivatives in skin quality improvement. The aim of this study was to confirm safety and effectiveness of cohesive polydensified matrix-hyaluronic acid + glycerol (CPM-HA20G; Belotero Revive) in revitalization of early-onset photodamaged facial skin.

Methods:

A total of 159 subjects with early signs of facial photodamaged skin were randomized in a 2:1 ratio to multiple- or single-dose treatment with CPMHA20G. Effectiveness assessments included biophysical measurements of skin hydration; elasticity, firmness, and roughness; investigator- and subject-assessed Global Aesthetic Improvement Scales; and FACE-Q Skin Changes and Treatment Satisfaction questionnaires.

Results:

In both treatment groups, skin hydration improved from baseline to all follow-up visits in subjects with dry or very dry skin. This improvement was significant at week 16 after initial treatment in the multiple-dose group (P = 0.0013). Investigator- and subject-reported outcomes showed that the majority of subjects across all skin hydration types benefited from treatment, with higher satisfaction rates observed in the multiple-dose group. According to investigator-assessed Global Aesthetic Improvement Scale, 90.7% of subjects at week 12 in the multiple-dose and 74.6% of subjects at week 4 in the single-dose group were rated as at least “improved.” All related treatment-emergent adverse events were transient, expected injection-site reactions of mild to moderate intensity.

Conclusions:

Effectiveness of CPM-HA20G for skin hydration in subjects with dry or very dry skin was demonstrated up to 9 months after last injection. Overall, CPM-HA20G demonstrated effective and safe use in facial skin revitalization among subjects with early-onset photodamaged skin.

Features to consider for mimicring tissues in orofacial aesthetics with optimal balance technology and non-animal stabilized hyaluronic acid (Restylane®): The MIMT concept

Nonsurgical cosmetic treatments have significantly increased over the last decade. Therefore, this study aims to review the features that should be considered in orofacial esthetic procedures, thorough of a proposal of a new concept called the tissue mimicry concept (MIMT concept) and filling techniques. The MIMT concept described in this article comprises knowledge about anatomy of the face and associated structures, understanding of aging and how this process affects the facial tissues interactions (skin, subcutaneous tissues, muscles, and bones), interpretation of facial analysis, comprehension of dermal fillers characteristics and discernment of the correct filling technique for each region. Based on these variables the MIMT concept proposes the implantation of the minimum-effective quantity of acid hyaluronic fillers (HA) with different physical, chemical and rheological properties (complex viscosity and elastic modulus) in the correct layers; in order to optimize their performance resulting in a natural appearance with fewer risks of adverse events. the versatility, acceptable safety profile, biocompatibility and greater patient compliance presented in the Restylane® line (by Galderma) should be taken in consideration, since the use of a proper HA is noteworthiness. The Non-Animal Stabilized Hyaluronic Acid Tecnology (NASHA®) and the Optimal Balance Technology (OBT®), which make up this line of fillers, allow us to have very firm to very flexible gels, with different particle sizes, with an optimal concentration of HA and with viscoelastic and biocompatible characteristics according to the region of the treated face.

Comparing Water Absorption of Food and Drug Administration-Approved Hyaluronic Acid Fillers

BACKGROUND

To compare the water absorption of 12 FDA-approved hyaluronic acid (HA) facial fillers in vitro in conditions relevant to in vivo injection.

OBJECTIVE

The goal of this study was to provide long-term insight into an improved, tailored facial rejuvenation approach and to understand sequelae that could affect preoperative surgical planning.

METHODS

In 2 experiments, 12 FDA-approved HA fillers were loaded into test tubes with nonpreserved normal saline and then placed in a 94.5°F-96°F environment for 1 month to allow water absorption by passive diffusion. The test tubes were centrifuged so that the hydrated filler could pass to the bottom of the tube. The tubes were centrifuged for 12 minutes at 1,200 revolutions per minute in the first experiment and for 7 minutes in the second experiment. A blue dye was then instilled to demarcate the filler/saline interface.

RESULTS

There was variation in the water absorption of different HAs. Low absorption occurred in non-animal-stabilized hyaluronic acid.

CONCLUSION

The pattern of water absorption was similar in the 2 experiments. The results inform us about in vivo conditions and provide guidance for filler selection.

High-velocity pneumatic injection of non-crosslinked hyaluronic acid for skin regeneration and scar remodeling: A retrospective analysis of 115 patients

BACKGROUND

Pneumatic-assisted high velocity jet injections are an alternative method for intradermal delivery of hyaluronic acid (HA) and demonstrated efficacy in dermal thickening and scar remodeling with minimal side effects.

AIMS

We aimed to investigate the clinical efficacy comparing non-crosslinked HA (NCL-HA) and crosslinked HA (CL-HA) for aesthetic skin concerns.

METHODS

We retrospectively analyzed charts of 115 patients treated with jet injected NCL-HA and CL-HA for skin rejuvenation, age-related laxity and rhytidosis, hypertrophic and acne scars and striae. Global Aesthetic Improvement Scale (GAIS) and the 5-grade patient satisfaction scale were used for assessment of the treatment efficacy at the 3-month follow-up. Efficacy was separately analyzed between patients receiving NCL-HA vs. CL-HA. Longevity of treatment effect was measured by the time to voluntary return for repeat treatment.

RESULTS

An average of 2.8 treatments was completed per patient with a low incidence of side effects including bruises (7%) and temporary local edema (1%). Patients were highly-satisfied with the treatment results in all categories with the average satisfaction scores of 3.68 (NCL-HA) and 3.76 (CL-HA). An average GAIS score of 1.7 ("much improved") was calculated for neck, décolleté and perioral areas. An overall GAIS score averaged as 1.78 (NCL-HA) and 1.6 (CL-HA). Longevity of the effect averaged 13.1 months for NCL-HA and 13.2 months for CL-HA groups.

CONCLUSION

Our retrospective data showed similar significant improvement of all aesthetic skin concerns in 115 subjects treated with either NCL-HA or CL-HA delivered intradermally by a high velocity jet-injector device with minimal downtime, pain or side-effects.

Biorevitalization of the skin with skin boosters: Concepts, variables, and limitations

Aging leads to diminished capacity in the functionality of all the skin layers, which in turn leads to a structurally weak and esthetically unappealing skin which is dull, dehydrated, and inelastic. Skin boosters can be defined as biological materials or bio-actives that help or encourage the skin to increase or improve its function. Boosters have been used in treating skin structural changes associated with aging as well as other factors such as corticosteroid-induced skin atrophy. Restoring the loss in skin nourishment and vital components is the concept involved in biorevitalization of the skin. The authors aim to present an update and a short review of skin boosters in this commentary.

Case Report: The role of intradermal micro-droplet hyaluronic acid injection in the correction of filler nodules complication

Filler injection has been widely used as a non-surgical intervention for skin rejuvenation and augmentation for the past decade. Hyaluronic acid (HA) is considered the most common treated material with high safety profile. Various mechanisms, including promoting collagen synthesis are postulated the efficacy of this powerful skin rejuvenation. The greater number of its used, the more complications were seen. Among the non-vascular complications from filler injection, the most frequent one is nodule formation. It could occur as early or late onset even with HA injection. One of the causes of these nodule formation is from poor injection technique leading to visible skin beads and lumps. The current treatments of these filler side effects mainly aim to remove or reduce excessive or displaced filler product. To the best of our knowledge, there has been no report of using the intradermal injection of the micro-droplet HA to correct filler nodule and simultaneously revitalize the skin quality. This novel treatment technique could be a safe alternative for nodule formation correction.