An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique

BACKGROUND

The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach.

METHODS

This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment.

RESULTS

Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume.

CONCLUSIONS

The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion.

LEVEL OF EVIDENCE IV

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Efficacy and Tolerability of Hyperdiluted Calcium Hydroxylapatite (Radiesse) for Neck Rejuvenation: Clinical and Ultrasonographic Assessment

Background

The subdermal injection of calcium hydroxylapatite (CaHA) can improve the mechanical properties of the skin, providing immediate correction and stimulating the endogenous production of collagen, elastin, angiogenesis, and dermal cell proliferation; however, few studies have examined the neck region.

Purpose

This study assessed the clinical and ultrasonographic improvement induced by two sessions of subdermal injection of hyperdiluted (1:4) CaHA for neck rejuvenation in 22 women.

Patients and Methods

A quasi-experimental longitudinal trial (before and after) was performed by enrolling 22 adult women with mild and moderate neck aging (grades 1 and 2) on Merz Neck Volume Scale at rest (laxity) and Neck Horizontal Lines. They were submitted to two sessions of subdermal hyperdiluted CaHA (D0 and D45) treatments and assessed clinically and ultrasonographically at D0, D45, and D120. The main outcomes were the blinded photographic assessment (Merz scales of neck laxity and horizontal lines), dermal thickness (at three points), and the GAIS (Global Aesthetic Improvement Scale) score.

Results

The mean (SD) age was 43.5 (5.6) years. At the inclusion, the Merz scores for neck laxity were mild for 27% and moderate for 73% of participants, and the Merz scores for necklines were mild for 32% and moderate for 68%. At D120, scores decreased in 86% (95% CI 68-99%) of the participants by at least one degree on the necklines scale and in 82% (95% CI 73-90%) for neck laxity. According to the GAIS, 91% (95% CI 77-99%) of the participants evidenced improvement at D120. The mean dermal thickness increased by 15% (95% CI 8-21%) at D120. No severe adverse effects were recorded, and high satisfaction was reported by 82% of the participants.

Conclusion

Two sessions of subdermal hyperdiluted CaHA were well-tolerated and improved necklines, neck laxity, and dermal thickness in adult women with mild and moderate cervical aging.

Contouring Plus: A Comprehensive Approach of the Lower Third of the Face with Calcium Hydroxylapatite and Hyaluronic Acid

A well-defined jawline is aesthetically pleasing, so that rejuvenation of the jawline is becoming part of routine aesthetic practice. Restoring balance to the lower face without surgical intervention requires a multiple treatment approach, among which the minimally invasive injectables play a central role. Nevertheless, amidst the plethora of different injectable products available, choosing the option that best suits the patient's need can be a challenge. A panel of experts sought to describe herein 4 clinical cases, illustrating the Contouring Plus technique, which provides a practical guidance for lower third assessment, choice of products, and treatment execution, especially among hyaluronic acid and calcium hydroxylapatite, aiming for immediate, as well as mid-to-long-term results.

After the Temporal Lifting Technique-What comes next?

BACKGROUND

The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA)-based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique.

OBJECTIVES

To identify the safety and esthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, and increase jawline contouring when included into a full-face injection algorithm.

METHODS

The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m² were retrospectively analyzed after a full-face injection algorithm was performed using HA-based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region, and the pyriform fossa using both needles and cannula.

RESULTS

No adverse events were observed during the 6-month retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001.

CONCLUSION

Despite each individual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and esthetically effective. Future studies will need to confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective esthetic outcomes.

Abstract 503: Modeling Premature Cardiac Aging by Induced Pluripotent Stem Cell From a Patient With Hutchinson-Gilford Progeria Syndrome

Background: Hutchinson-Gilford Progeria Syndrome (HGPS) is an extremely rare genetic disorder characterized by accelerated aging and high incidence of cardiovascular complications and metabolic alterations. However, the underlying mechanisms of this syndrome are not fully understood.

Methods and Results: This study modelled HGPS using cardiomyocytes generated from induced pluripotent stem cells (iPSc) derived from a patient affected by the syndrome, characterizing the molecular and biophysical alterations found in cardiomyocytes obtained from three distinct differentiation protocols run in parallel with a control iPSc. Electrophysiology recordings were performed with intracellular microelectrodes and the Progeria cardiomyocytes fired action potentials similar to those from control iPSc-derived cardiomyocytes. High resolution respirometry performed on Oroboros system in isolated cardiomyocytes showed that Progeria cardiomyocytes have a tendency to decrease the oxygen consumption under basal condition and after FCCP, when compared to control cardiomyocytes (P=0.06). Furthermore, HGPS cardiomyocytes produced less ROS under basal and after 100uM Hydrogen peroxide treatment. However, mitotracker analysis shows no difference on mitochondrial content. Electron tomography and 3D reconstruction analysis suggest structural abnormalities in the mitochondria of Progeria cardiomyocytes. Proteomics analysis, performed with Liquid Chromatography tandem mass spectrometry (LC-MS/MS) in a high-resolution system (Q-Exactive Plus, Thermo Fischer), shows differential protein expression between Progeria (183 unique proteins) and Control (225 unique proteins) IPSc - derived cardiomyocytes.

Conclusions: Our work demonstrate that iPSc- derived cardiomyocytes from Progeria patients have significant alterations in cellular respiration and protein expression.

Fluoxetine increases plasticity and modulates the proteomic profile in the adult mouse visual cortex

The scarce functional recovery of the adult CNS following injuries or diseases is largely due to its reduced potential for plasticity, the ability to reorganize neural connections as a function of experience. Recently, some new strategies restoring high levels of plasticity in the adult brain have been identified, especially in the paradigmatic model of the visual system. A chronic treatment with the anti-depressant fluoxetine reinstates plasticity in the adult rat primary visual cortex, inducing recovery of vision in amblyopic animals. The molecular mechanisms underlying this effect remain largely unknown. Here, we explored fluoxetine effects on mouse visual cortical plasticity, and exploited a proteomic approach to identify possible candidates mediating the outcome of the antidepressant treatment on adult cortical plasticity. We showed that fluoxetine restores ocular dominance plasticity in the adult mouse visual cortex, and identified 31 differentially expressed protein spots in fluoxetine-treated animals vs. controls. MALDITOF/TOF mass spectrometry identification followed by bioinformatics analysis revealed that these proteins are involved in the control of cytoskeleton organization, endocytosis, molecular transport, intracellular signaling, redox cellular state, metabolism and protein degradation. Altogether, these results indicate a complex effect of fluoxetine on neuronal signaling mechanisms potentially involved in restoring plasticity in the adult brain.

Na, K, Ca, Mg, and U-series in fossil bone and the proposal of a radial diffusion-adsorption model of uranium uptake

Fossil bones are often the only materials available for chronological reconstruction of important archeological sites. However, since bone is an open system for uranium, it cannot be dated directly and therefore it is necessary to develop models for the U uptake. Hence, a radial diffusion-adsorption (RDA) model is described. Unlike the classic diffusion-adsorption (D-A) model, RDA uses a cylindrical geometry to describe the U uptake in fossil bones. The model was applied across a transverse section of a tibia of an extinct megamammal Macrauchenia patachonica from the La Paz Local Fauna, Montevideo State, Uruguay. Measurements of spatial distribution of Na, K, Ca, and Mg were also performed by neutron activation analysis (NAA). Gamma-ray spectrometric U-series dating was applied to determine the age of the bone sample. From U concentration profile, it was possible to observe the occurrence of a relatively slow and continuous uranium uptake under constant conditions that had not yet reached equilibrium, since the uranium distribution is a ∪-shaped closed-system. Predictions of the RDA model were obtained for a specific geochemical scenario, indicating that the effective diffusion coefficient D/R in this fossil bone is (2.4 ± 0.6)10(-12) cm(2)s(-1). Mean values of Na, K, Ca, and Mg contents along the radial line of the fossil tibia are consistent with the expected behavior for spatial distributions of these mineral elements across a modern bone section. This result indicates that the fossil tibia may have its mineral structure preserved.

Patient-specific transfusion-related acute lung injury

Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-associated mortality. The inadvertent transfusion of neutrophil antibodies can cause pulmonary transfusion reactions and TRALI. However, not all patients transfused with neutrophil antibodies experience transfusion reactions. A 22-year-old man with severe aplastic anaemia (SAA) experienced TRALI after a platelet transfusion. The donor was found to be alloimmunized to human neutrophil antigen (HNA)-3a, an antigen expressed by neutrophils from approximately 90% of Caucasians. Eleven other platelet components from this donor were transfused prior to this event and two caused reactions: one chills and one TRALI. Both episodes of TRALI occurred in the same male patient with SAA. The fact that one patient experienced TRALI following both exposures to anti-HNA-3a from the same donor whereas nine other recipients did not adds evidence to the observation that patient factors make a significant contribution to neutrophil antibody-mediated transfusion reactions.

Comparative trial of the canine parvovirus, canine distemper virus and canine adenovirus type 2 fractions of two commercially available modified live vaccines

The results of vaccinating two groups of puppies with commercial vaccines, both of which claimed to provide adequate protection with a final vaccination at 10 weeks of age, were compared. Groups of 19 and 20 puppies with similar titres of maternally derived antibodies against canine parvovirus (cpv), canine distemper virus (cdv) and canine adenovirus type 2 (cav-2) at four weeks of age were vaccinated at six and 10 weeks of age and their responses to each vaccination were measured by comparing the titres against cpv, cdv and cav-2 in the serum samples taken immediately before the vaccination and four weeks later. After the vaccination at six weeks of age, all 19 of the puppies in group 1 had responded to cpv and cdv, and 14 had responded to cav-2; in group 2, 17 of the 20 had responded to cpv, 19 to cdv and 15 to cav-2. In both groups the puppies that did not respond to the first vaccination had responded serologically to cpv, cdv and cav-2 at 10 weeks of age.

Brazilian spotted fever in Espirito Santo, Brazil: description of a focus of infection in a new endemic region

Although Brazilian spotted fever is known to occur in several adjacent states, infection with spotted fever group (SFG) rickettsiae has not previously been documented in the Brazilian state of Espirito Santo. We report a cluster of two proven and four suspected cases of Brazilian spotted fever in a small valley near Colatina, Espirito Santo. Four patients died without confirmatory serologic or pathologic studies. The two surviving patients had serologic and/or pathologic evidence of infection with SFG rickettsiae. Results of a survey done in 1991 confirmed the presence of antibodies reactive with SFG rickettsiae in the serum of dogs living in this region. Two of 25 dogs had elevated microimmunofluorescent antibody titers (1:64 and 1:256). Both seropositive dogs were pets of the index cases and lived in the valley where all six human cases were presumed to have acquired their infections. These cases and the results of the canine serosurvey suggest that a focus of virulent disease exists in an area not previously known to be endemic for SFG rickettsiae.