Recommendations on the Use of Injectable Poly-L-Lactic Acid for Skin Laxity in Off-Face Areas

Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer that stimulates collagen production, leading to gradual volume restoration. The treatment of sagging skin in body areas is still a big challenge, as there are few aesthetic procedures aiming to improve it. This article provides recommendations on the use of PLLA in the treatment of skin laxity in off-face areas, as the neck, décolletage, arms, abdomen, buttocks, and thighs, including the patient selection, product preparation, and injection techniques. The use of PLLA is a promising method for the treatment of skin laxity in corporal areas, improving body contour and appearance. Further investigation is needed to better understand the efficacy and durability of PLLA in non-facial indications and to provide the best evidence for optimal patient outcomes. J Drugs Dermatol. 2019;18(9):929-935.

Managing the Aesthetic Patient

wide variety of therapeutic options, some challenges have arisen: designing an adequate treatment plan, electing the most suitable procedures for the patient, taking into consideration the rheological characteristics of the products, considering the amount needed to achieve a natural look, but also defining the safest way to deliver the treatment. Aging of the facial structural tissue layers occurs at a different pace and the requirements for the aesthetic approach of a 30-year-old patient are different from a 60-year-old patient. A group of twelve experts in minimally invasive injectable procedures sought to identify common changes observed in different age groups in order to help in establishing a plan of treatment for patients of different ages. The individualized aesthetic plan should consider the main pillars of the aesthetic treatment -- aging process, facial assessment, and facial anatomy, to identify and systematize common changes observed in different age groups, as well as the safest and most reproducible techniques, especially for new injectors. J Drugs Dermatol. 2019;18(1):92-102.

Dynamic Changes of Facial Supporting Cornerstones (Pillars): Considerations in Aesthetic Approach.

The bony structures of the face provide the framework upon which the soft-tissue envelope rests, such that facial symmetry and proportionality usually depend upon the morphological patterns and anthropometrical measurements of a symmetrical skull. Facial bony pillars are dynamic and variable according to the demands placed upon them, as well as gender and aging differences. Thus, a more profound knowledge of facial supporting pillars and their dynamic behavior by physicians who practice minimally cosmetic procedures would allow for a more natural approach to facial beautification. It would help them to rebalance age-related and asymmetric congenital imperfections, and minimize any harmful stigma associated with bad cosmetic practice.

J Drugs Dermatol. 2018;17(4):466-470.

A Retrospective Analysis of Safety in Participants Treated with a Hybrid Hyaluronic Acid and Calcium Hydroxyapatite Filler.

Background: Limited long-term safety data are published on HA/CaHA/L, a hybrid dermal filler combining hyaluronic acid (HA), calcium hydroxyapatite (CaHA), and lidocaine (L). Methods: This retrospective multicenter study assessed treatment-emergent adverse events (TEAEs) in adults treated with HA/CaHA/L. The full analysis set (FAS) included eligible consented adults (N = 403); the long-term safety analysis (LTSA) set included FAS participants with greater than or equal to 12-months HA/CaHA/L exposure (n = 243). Results: Participants were majority female (94.0%), with Fitzpatrick skin phototypes II/III (80.1%) and a mean age of 50.1 years. Most participants (86.4%) received one HA/CaHA/L treatment. The median time between participants' first HA/CaHA/L treatment and chart review was 15.4 months. Participants received a mean of 2.2 mL (0.5-8.9 mL) filler per treatment. Treated areas were predominantly malar (71.2%) and mandible (69.7%) regions. Most participants (95.0%) had one or more aesthetic treatments other than HA/CaHA/L [eg, other dermal fillers (84.1%), botulinum toxin (63.3%)]. Nineteen (4.7%) FAS participants had 20 documented TEAEs; most (3.5%, n = 14 participants) were mild in severity. Twelve TEAEs in 11 participants (2.7%) were related to HA/CaHA/L: induration (three, 0.7%), edema (3, 0.7%), and implant site nodules (five, 1.2%), which were noninflammatory and likely related to product placement. Among the LTSA, 15 (6.2%) participants had 16 documented TEAEs (six edema, five implant site nodules, one inflammation, three skin induration, one hypersensitivity); most were mild in severity. Nine TEAEs in eight participants (3.3%) were HA/CaHA/L-related. No treatment-emergent serious AEs were reported. Conclusion: The data from this noninterventional retrospective study support the favorable longer term (>12 month) safety profile of HA/CaHA/L.

Composto nutracêutico aumenta a síntese de colágeno, elastina e ácido hialurônico / Nutraceutical compound increases collagen, elastin and hyaluronic acid synthesis

Introdução: O uso de produtos nutracêuticos com a finalidade de atenuar os sinais do envelhecimento da pele tem sido proposto na literatura. O estímulo à síntese de elementos de sustentação da derme é um dos mecanismos relacionados a esse efeito. Objetivo: Avaliar a eficácia de um nutracêutico contendo luteína, licopeno, vitamina C e mangânes na síntese de colágeno, elastina e ácido hialurônico. Métodos: Estudo realizado in vitro, através de cultura de fibroblastos humanos tratadas com o produto investigado em diferentes concentrações não citotóxicas. A quantificação de elastina e colágeno foi determinada através de medidas espectrofotométricas enquanto que a de ácido hialurônico foi determinada por método imunoenzimático. Resultados: As culturas celulares tratadas com as diferentes concentrações do produto apresentaram quantidade sintetizada de colágeno, elastina e ácido hialurônico significativamente maior quando comparadas com a cultura não tratada (p<0,05). Conclusões: O uso de nutracêutico contendo licopeno, vitamina C, luteína e manganês demonstrou eficácia in vitro no estímulo à síntese de colágeno, elastina e ácido hialurônico, elementos essenciais na estrutura de sustentação da derme e responsáveis pelas características de firmeza e elasticidade da pele.

Introduction: The use of nutraceutical products in order to attenuate signs of skin aging has been proposed in the literature. The stimulus to the synthesis of substances that support the dermis is one of the mechanisms linked to this effect. Objective: To evaluate the effectiveness of a nutraceutical compound containing lutein, lycopene, vitamin C and manganese for the synthesis of collagen, elastin and hyaluronic acid. Methods: An in vitro study was carried out based on the culture of human fibroblasts treated with the investigated product in different non-cytotoxic concentrations. The quantification of the elastin and collagen was performed with the assistance of spectrophotometric measurements. Hyaluronic acid was measure using a immunoenzymatic method. Results: Cell cultures treated with the different concentrations of the product showed a significantly higher amount of synthesized collagen, elastin and hyaluronic acid as compared to the untreated culture (p <0.05). Conclusions: The use of the nutraceutical compound containing lycopene, vitamin C, lutein and manganese has shown in vitro efficacy for stimulating the synthesis of collagen, elastin and hyaluronic acid, components that are crucial for providing the dermis' supporting structure, being responsible for the skin's firmness and elasticity.

Manejo de complicações de preenchedores dérmicos / Overview and management of fillers complications

O preenchimento cutâneo figura entre os procedimentos cosméticos mais realizados. Apesar de os tratamentos estéticos possuírem perfil de segurança favorável, ocorreu um aumento nos processos jurídicos deles resultantes nos Estados Unidos. No Brasil, o número de procedimentos não cirúrgicos apresentou crescimento nos últimos anos devido não apenas ao maior número de opções de materiais para preenchimento disponíveis no mercado, mas também devido à maior quantidade de profissionais com permissão para executar esses procedimentos. O objetivo do presente estudo foi revisar a literatura, assim como delinear um guia prático para prevenção, diagnóstico e manejo das complicações secundárias ao uso de preenchedores semipermanentes e temporários.

Filler injections are among the most popular cosmetic procedures performed worldwide. Although fillers have a safety profile, there has been a rise in litigation as a result of treatments in the USA. In the Brazilian scenario, the number of non-surgical procedures has increased in the past years, mainly due to the increase of filler options available in the Brazilian market, as well as in the type of professionals allowed to perform injectable procedures. Therefore we sought to review the related literature regarding semi-permanent and temporary fillers adverse effects and outline a practical guide for complications avoidance, diagnosis and management.