Search Results (80)

Background: Acne scarring presents a significant esthetic and psychological concern, commonly classified into atrophic and hypertrophic types. Effectively managing these lesions often involves the use of therapeutic strategies such as laser treatments, dermabrasion, and fillers. This study investigates the efficacy of 1550 nm erbium glass laser therapy in the treatment of atrophic acne scars through a quantitative assessment. Material and Methods: Participants with mild to moderate atrophic acne scars received two sessions of fractional erbium glass laser therapy at one-month intervals. Skin density and epidermal thickness were measured using a high-frequency ultrasound device (DUB SkinScanner), while the Antera 3D imaging system facilitated a comprehensive analysis of skin parameters, including texture, volumetric depressions, and pigmentation. Results: The use of this therapy led to significant improvements across multiple parameters. Skin density and epidermal thickness increased. Significant reductions were observed in fold depth, pore volume, and depression volume, indicating enhanced smoothness and minimized scar appearance. Improvements in texture roughness and pigmentation contributed to a visually coherent skin surface. Conclusions: Fractional erbium glass laser therapy effectively ameliorates the appearance of atrophic acne scars by increasing skin density, reducing dermal depressions, and improving texture and pigmentation uniformity. The Antera 3D system and high-frequency ultrasound device demonstrated high efficacy in capturing subtle changes, supporting its value in clinical applications for optimizing treatment parameters. Full article

The skin comprises three main layers: epidermis, dermis, and hypodermis. The dermis is formed by connective tissue with an extracellular matrix composed of glycosaminoglycans and collagen fibers, providing skin resistance. During aging, the loss of the skin’s biomechanical properties results in sagging. Exogenous hyaluronic acid is highly used as a filler. However, few studies using biopsies have demonstrated its action as a dermal remodeler and collagen stimulator in superficial applications and using polidensified cohesive gel. Methods: Skin tissues obtained from biopsies in the patient’s arms were evaluated for histological, immunohistochemical, and biochemical analyses, in addition to clinical assessments by skin ultrasound. Biopsies were performed at time zero, three, and six months after intradermal injection of hyaluronic acid with a polydensified cohesive matrix in four women of different age groups. Results: The individual results showed hyaluronic acid synthesis, an increase in type I and III collagen, and a thickening of the dermal layer after the treatment. Conclusion: In four thirty-five to sixty-year-old patients, we observed the effectiveness of using polydensified cohesive matrix hyaluronic acid as a collagen stimulator, thickening the dermis and stimulating endogenous hyaluronic acid synthesis. This study highlights the importance of individual analysis of the variables studied. Full article

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment. Full article

Introduction: Enlarged facial pores are a common cosmetic concern caused by excessive sebum production, visible hair shafts, and a reduction in skin elasticity, leading to a decrease in skin quality and overall appearance. Various treatment modalities have been explored to address this issue. This study focuses on the efficacy and safety of combining Onabotulinumtoxin A (OnaBoNT-A) and hyaluronic acid filler (HA filler) to target enlarged facial pores in Asians. Materials and Methods: This study aimed to compare the efficacy and safety of OnaBoNT-A monotherapy in combination with HA filler for the treatment of enlarged facial pores. This study was a prospective, randomized, single-blinded, split-face, controlled trial that enrolled 32 subjects with visibly enlarged pores on both cheeks. One side of the face received intradermal injections of OnaBoNT-A, while the other side received OnaBoNT-A in combination with intradermal hyaluronic acid filler injection. The outcomes were measured by pore volume, visual assessment, pain score, improvement score, and side effects at various time intervals up to 24 weeks. Results: This study investigated the effects of onaBoNT-A monotherapy or in combination with HA filler on facial pore size and skin roughness. The results showed that both sides exhibited a reduction in pore volume and skin roughness over time, but the side treated with onaBoNT-A monotherapy had a slightly better improvement than the combination side at the 6-month follow-up. Subjects with histories of facial oiliness were more likely to respond to onaBoNT-A monotherapy, while those without histories of facial oiliness were more likely to respond to the side treated with combined treatment. The most common adverse events were erythema, bruising, and edema, which were more frequent on the combination side. Additionally, 18 subjects (56.25%) experienced a palpable lump on the combination side, which resolved in most cases within a few months. Conclusion: BoNT-A and HA dermal filler had a role in reducing pore size. Nonetheless, individuals with enlarged pores who exhibited beneficial effects to botulinum toxin injection typically had a background of facial oiliness. Adverse incidents like dermal edema and palpable nodules were observed, underscoring the significance of meticulous patient selection and accurate injection technique. Full article

The demand for minimally invasive body contouring procedures, particularly for gluteal augmentation, has grown significantly. This study evaluates the morphologic and rheological properties of four commercially available hyaluronic acid (HA) fillers used for body contouring and explores their clinical implications. Critical parameters such as storage modulus (G′), loss modulus (G″), complex modulus (G*), and damping factor (tan δ) were measured using oscillatory rheological tests to assess each filler’s elasticity, viscosity, and viscoelastic profile. Scanning Electron Microscopy (SEM) was performed to analyze the microstructure of the fillers, providing insights into their microscopic architecture. The results showed differences in mechanical properties and viscoelastic behavior among the fillers. These variations suggest that the choice of filler may need to be tailored to specific body contouring requirements. Understanding these differences is crucial for achieving the best clinical results and patient satisfaction, helping professionals select the most suitable filler for each case. Full article

Background and Objectives: The history of facial fillers is very broad, ranging from the use of various materials to modern technologies. Although procedures are considered safe, complications such as skin inflammation, infection, necrosis, or swelling may occur. It is crucial for specialists to be adequately prepared, inform patients how to prepare for corrective procedures, adhere to high safety standards, and continually educate. The goal of this systematic review is to identify complications arising during facial wrinkle correction procedures, as well as to explore safety and potential prevention strategies. Materials and methods: The review of the scientific literature followed the PRISMA guidelines. The search was performed in a single scientific database: PubMed. Considering predefined inclusion and exclusion criteria, articles evaluating the safety of dermal fillers used for facial wrinkle correction, complications, and treatment outcomes were selected. The chosen articles were published from 15 February 2019 to 15 February 2024 (last search date: 25 February 2024). The selected articles compared the complications, product safety, and result longevity of various dermal fillers used for facial wrinkle correction. Results: In thirty-eight articles, which involved 3967 participants, a total of 8795 complications were reported. The majority of complications occurred after injections into the chin and surrounding area (n = 2852). Others were reported in lips and the surrounding area (n = 1911) and cheeks and the surrounding area (n = 1077). Out of the 8795 complications, 1076 were adverse events (AE), including two severe AE cases: mild skin necrosis (n = 1) and abscess (n = 1). There were no cases of vascular occlusion, visual impairment, or deaths related to the performed procedures. A total of 7719 injection site reactions were classified as mild or temporary, such as swelling (n = 1184), sensitivity (n = 1145), pain (n = 1064), bleeding (n = 969), hardening/stiffness (n = 888), nodules/irregularities (n = 849), and erythema (redness) (n = 785). Conclusions: Facial wrinkle correction procedures are generally safe and effective and the results can last from 6 to 24 months, depending on the dermal filler material and its components used. The most common complications after dermal filler injection usually resolve spontaneously, but if they persist, various pharmacological treatment methods can be used according to the condition, and surgical intervention is generally not required. Full article

Poly(L-lactic acid) (PLLA) and poly(D,L-lactic acid) (PDLLA) particles have been applied as dermal fillers for soft-tissue augmentation because they can induce foreign-body reactions, resulting in fibroblast proliferation and collagen formation. Although PLLA and PDLLA fillers are safe and biocompatible, clinical complications such as nodules and granulomas have been reported, possibly due to incomplete reconstitution. PDLLA particles were prepared via emulsification in this study, and three stirring speeds were investigated when adding PDLLA into carboxymethyl cellulose solution. The particle size, molecular weight of PDLLA, optical rotation, pH value, osmotic pressure, and reconstitution time were analyzed. A rabbit dorsal ear model was established to evaluate the soft-tissue augmentation of a commercial PDLLA filler. The results demonstrated that the stirring speed affected the particle size, but not other physical–chemical properties of the PDLLA particles. All the PDLLA particles were reconstituted in less than 7 min, which is faster than the process for the other commercial PDLLA dermal filler products. In addition, the PDLLA particles could induce inflammation and fibroblast proliferation. Although the PDLLA particles generated in this study have not yet been investigated in vivo, the results demonstrated here suggest their potential for application as dermal fillers. Full article

This study presents the development of thiol–maleimide/thiol–thiol double self-crosslinking hyaluronic acid-based (dscHA) hydrogels for use as dermal fillers. Hyaluronic acid with varying degrees of maleimide substitution (10%, 20%, and 30%) was synthesized and characterized, and dscHA hydrogels were fabricated using two molecular weights of four-arm polyethylene glycol (PEG10K/20K)–thiol as crosslinkers. The six resulting dscHA hydrogels demonstrated solid-like behavior with distinct physical and rheological properties. SEM analysis revealed a decrease in porosity with higher crosslinker MW and maleimide substitution. The swelling ratios of the six hydrogels reached equilibrium at approximately 1 h and ranged from 20% to 35%, indicating relatively low swelling. Degradation rates decreased with increasing maleimide substitution, while crosslinker MW had little effect. Higher maleimide substitution also required greater injection force. Elastic modulus (G′) in the linear viscoelastic region increased with maleimide substitution and crosslinker MW, indicating enhanced firmness. All hydrogels displayed similar creep-recovery behavior, showing instantaneous deformation under constant stress. Alternate-step strain tests indicated that all six dscHA hydrogels could maintain elasticity, allowing them to integrate with the surrounding tissue via viscous deformation caused by the stress exerted by changes in facial expression. Ultimately, the connection between the clinical performance of the obtained dscHA hydrogels used as dermal filler and their physicochemical and rheological properties was discussed to aid clinicians in the selection of the most appropriate hydrogel for facial rejuvenation. While these findings are promising, further studies are required to assess irritation, toxicity, and in vivo degradation before clinical use. Overall, it was concluded that all six dscHA hydrogels show promise as dermal fillers for various facial regions. Full article

This study proposes a new and simple process that improves the quality of a hyaluronic acid (HA) filler crosslinked with 1,4-butanediol diglycidyl ether (BDDE) using solution dispersion at a low temperature. This process involves the solvent being dispersed among the solute naturally after the mixing process. The process used in this study involved two reactions. First, the solution was dispersed among HA molecules (Mw = ~0.7 MDa) creating a well-homogenized mixture. Second, the decomposition and synthesis of HA occurred naturally in an aqueous alkaline solution (>pH 11), the weight average molar mass (Mw) was adjusted (Mw = ~143,000), and the crosslinking surface area was expanded, allowing for a high degree of crosslinking. Therefore, the viscoelasticity and cohesion of the filler increased with the new method compared to the previous process both at the lab scale (previous process:new process, viscosity (cP) = 24M:43M, storage modulus (Pa) = 306:538, loss modulus (Pa) = 33:61, and tack (N) = 0.24:0.43) and at the factory scale (previous process:new process, complex viscosity (cP) = 19M:26M, storage modulus (Pa) = 229:314, loss modulus (Pa) = 71:107, and tack (N) = 0.35:0.43). Full article

This article describes a technique for gluteal augmentation using cross-linked hyaluronic acid (HA) filler, with a focus on long-term patient follow-up. The rising demand for buttock enhancement driven by esthetic preferences has led to the exploration of minimally invasive alternatives to traditional surgical methods. Ultrasound imaging was utilised to evaluate the presence and distribution of HA filler over time. The patients reported satisfactory aesthetic improvements, with mild transient side effects. The findings highlight the technique’s effectiveness in achieving enhanced gluteal contour with a minimal volume of filler, demonstrating both safety and durability in the long term. This innovative approach may serve as a valuable option in aesthetic practises focused on body contouring. Full article

Poly-D,L-lactic acid (PDLLA) filler, which increases volume and collagen synthesis, is used for skin rejuvenation. PDLLA filler also increases M2 macrophages and IL-10. Ultraviolet (UV) radiation induces dermal hyperpigmentation by disrupting the basement membrane (BM), allowing melanin to move into the dermis. Therefore, using UV-irradiated macrophages and animal skin, we determined whether PDLLA filler decreased M1 macrophages and skin inflammation, thereby reducing BM destruction and dermal hyperpigmentation. UV radiation increased the M1 macrophage marker CD86 and TNF-α expression, which was inhibited by the treatment of macrophages with PDLLA. In fibroblasts treated with conditioned medium from UV-irradiated macrophages, NF-κB activity, NLRP3 inflammasome components (NLRP3, ASC, and pro-caspase-1), IL-18, MMP2, and MMP9 increased, but all decreased after PDLLA treatment. Similar to the in vitro study, UV-irradiated mouse skin showed increased CD86, NLRP3, ASC, pro-caspase-1, MMP2, and MMP9, which decreased after PDLLA injection. Disruption of the lamina densa of the BM and dermal pigmentation increased after UV irradiation and decreased after PDLLA injection. In conclusion, PDLLA reduced dermal pigmentation by decreasing BM destruction in UV-irradiated skin. PDLLA has the potential to reduce dermal pigmentation by regenerating the BM. Full article

Hyaluronic acid (HA) fillers are extensively utilized in aesthetic medicine due to their biocompatibility, reversibility, and effectiveness in enhancing skin hydration, volume, and overall appearance. These fillers are predominantly produced through microbial fermentation, followed by a critical cross-linking process that enhances their longevity by resisting enzymatic degradation. This review provides a thorough examination of the manufacturing processes that differentiate HA fillers, with particular attention to the distinctions between biphasic and monophasic variants. Unlike previous studies, this review emphasizes the specific cross-linking techniques and their substantial impact on the fillers’ rheological properties, such as elasticity and cohesiveness, which are crucial to their clinical performance and patient outcomes. Additionally, the review offers a comprehensive comparison of HA fillers with non-HA alternatives, including calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate, highlighting the unique advantages and potential complications associated with each type. By presenting novel insights into the latest advancements and challenges in filler technology, this review aims to provide clinicians with a deeper understanding of filler properties, thereby guiding them in making informed decisions to optimize patient safety and aesthetic results. Full article

Objective: The aim of this study was to systematically review the safety and effectiveness of the injectable biostimulators dermal fillers calcium hydroxyapatite (CaHA) and polycaprolactone (PCL) in facial esthetic procedures. Materials and Methods: Comprehensive electronic searches were executed across six academic databases. The primary outcome focused on safety by examining studies that reported the incidence of adverse events (AEs). The secondary outcome gauged the satisfaction of the patients and injectors by validated esthetic scales. To evaluate biases, the Joanna Briggs Institute Checklist tools were employed. Results: We included a total of 79 studies. In the quantitative assessment of the CaHA, out of 5032 injected patients, 21.8% manifested early AEs, 0.85% experienced delayed reactions, and 0.27% had severe complications. Within the PCL group, consisting of 1119 patients, 83.3% exhibited early AEs, 5.6% had delayed reactions, and none had serious complications. Regarding esthetic satisfaction outcome, both products presented favorable results, but a limited number of studies assessed these data. In the studies evaluated qualitatively, a broad array of AEs were cataloged. Conclusions: The occurrence of serious AEs associated with CaHA and PCL fillers is relatively low. Both CaHA and PCL fillers exhibit favorable safety profiles, with most AEs being transient in nature. Full article

Poly-d,l-lactic acid (PDLLA) is a biodegradable and biocompatible polymer that has garnered significant attention in dermatology due to its unique properties and versatile applications. This literature review offers a comprehensive analysis of PDLLA’s roles in various dermatological conditions and wound-healing applications. PDLLA demonstrates significant benefits in enhancing skin elasticity and firmness, reducing wrinkles, and promoting tissue regeneration and scar remodeling. Its biodegradable properties render it highly suitable for soft tissue augmentation, including facial and breast reconstruction. We discuss the critical importance of understanding PDLLA’s physical and chemical characteristics to optimize its performance and safety, with a focus on how nano- and micro-particulate systems can improve delivery and stability. While potential complications, such as granuloma formation and non-inflammatory nodules, are highlighted, effective monitoring and early intervention strategies are essential. PDLLA’s applications extend beyond dermatology into orthopedics and drug delivery, owing to its superior mechanical stability and biocompatibility. This review underscores the need for ongoing research to fully elucidate the mechanisms of PDLLA and to maximize its therapeutic potential across diverse medical fields. Full article

Background: Hypersensitivity to the new dermal injectable porcine-based collagen with lidocaine featuring a novel cross-linking technology (test filler) for nasolabial fold correction was compared to the commercially available traditional cross-linked dermal injectable porcine-based collagen with lidocaine (control filler). Methods: Recruited participants (n = 279) received a single 0.1 mL intradermal injection of either test filler or control filler in the left forearm as a screening skin allergy test. Injection sites were assessed clinically at 24 h post-implant. Treatment was given to 252 successfully screened participants, and injection sites were monitored for 21 days. Immunological examinations were performed at screening and then at 4 and 24 weeks post-treatment. Observations for adverse events continued until the 52nd week. Results: Intradermal allergy testing results were negative for all the test recipients (0/124) and positive for two control recipients (2/132, 1.5%). Most of the participants exhibited no changes in serum immunoglobulin (IgG, IgM) and complement (C3, C4) levels. No serious adverse events related to the device were recorded. Most adverse events were common complications of dermal filler treatment and were related to the injection site. Most adverse effects were resolved or under control by 52 weeks. Conclusions: Hypersensitivity reactions with the test filler were lower than those with the control filler, validating the safe use of test filler for nasolabial fold correction without the need for pretreatment skin testing. Full article