Minimally Invasive Aesthetic Treatment of the Face and Neck Using Combinations of a PCL-Based Collagen Stimulator, PLLA/PLGA Suspension Sutures, and Cross-Linked Hyaluronic Acid.

BACKGROUND: Combinations of minimally invasive procedures (MIPs) are often used in aesthetic treatments and are increasingly considered as the new standard of care. Three agents with specific properties are available in this perspective: a polycaprolactone (PCL)-based collagen stimulator, a poly-L-lactic acid (PLLA)- and a poly-glycolic acid (PLGA)-based resorbable suspension suture with a 3D-cone technology, and a cross-linked hyaluronic acid (HA). OBJECTIVE: To develop the first practice guidelines on rejuvenation treatment of the face and the neck using combinations of these agents, whether associated or not with other widely used MIPs such as botulinum neurotoxins or energy-based devices. METHODS: A multi-disciplinary, multi-national board of plastic surgeons and dermatologists convened to develop guidelines using a predefined consensus method. The consensus was defined as ≥83% agreement rate between participants. RESULTS: Practice guidelines and algorithms, describing optimal procedure sequence and spacing, are proposed for the treatment of upper-, mid-, lower-face and neck, combining the PCL collagen stimulator, the PLLA/PLGA suspension sutures, and the cross-linked HA, whether associated or not with other MIPs. CONCLUSION: These new guidelines provide general support to optimal management strategies. Individual treatment plans should be adapted according to the physician's individual competence and the patient's preferences.

Recommendations for volume augmentation and rejuvenation of the face and hands with the new generation polycaprolactone-based collagen stimulator (Ellansé®).

BACKGROUND: The range of fillers currently available for soft-tissue augmentation is constantly expanding. The latest advances in filler technology include collagen biostimulators that exert their esthetic effect by promoting neocollagenesis. One such product is the next-generation collagen biostimulator (Ellansé®) that demonstrates properties as yet unseen in soft-tissue fillers. It is composed of polycaprolactone (PCL) microspheres in an aqueous carboxymethylcellulose gel carrier. Given its specific characteristics and the number of areas that can be treated with this innovative product, experts' recommendations were deemed necessary and are therefore presented in this paper with a specific focus on the indications, treatment areas and procedures as well as injection techniques. METHODS: A multinational, multidisciplinary group of plastic surgeons and dermatologists convened to develop recommendations with a worldwide perspective. This publication provides information on the specific characteristics of the product and focuses on the recommendations on the injection techniques. RESULTS: Recommendations on injection techniques are provided for the upper face, mid-face and lower face and zone by zone for each of these areas, as well as hands. Based on the particular anatomy of each area, the focus is on the techniques and devices of injection and the volume and depth of injection. The information is tabulated, and photos are presented for illustration. CONCLUSION: These recommendations provide a guideline for physicians who wish to perform safe and efficacious treatment with the PCL collagen stimulator for face and rejuvenation with volume augmentation.

Safety and Long-Term Efficacy of Forehead Contouring With a Polycaprolactone-Based Dermal Filler.

BACKGROUND: Recently, a biostimulatory dermal filler based on polycaprolactone (PCL) microspheres was introduced. To our knowledge, no report has examined the safety and efficacy of PCL-based dermal fillers in forehead augmentation. OBJECTIVE: To evaluate the safety and efficacy of forehead augmentation using a PCL-based dermal filler. MATERIALS AND METHODS: The study population consisted of 58 patients (57 women, 98%; 1 man, 2%), aged 20 to 65 years, undergoing forehead augmentation using a PCL-based dermal filler between October 2013 and October 2015 at our clinic. The physicians used the Global Aesthetic Improvement Scale (GAIS) to evaluate its efficacy 1, 3, 6, 12, and 24 months postoperatively. RESULTS: The mean GAIS score at 1, 3, 6, 12, and 24 months was 2.14 ± 0.95, 2.38 ± 0.77, 2.50 ± 0.76, 2.45 ± 0.52, and 2.33 ± 0.50, respectively. The scores increased markedly from 1 to 3 months and were maintained at 24 months. CONCLUSION: A PCL-based dermal filler is a good option for soft tissue augmentation of the forehead, as it is safe and has long-lasting favorable cosmetic efficacy.

A study on altered expression of serine palmitoyltransferase and ceramidase in psoriatic skin lesion.

Ceramides are the main lipid component maintaining the lamellae structure of stratum corneum, as well as lipid second messengers for the regulation of cellular proliferation and/or apoptosis. In our previous study, psoriatic skin lesions showed marked decreased levels of ceramides and signaling molecules, specially protein kinase C-alpha (PKC-alpha) and c-jun N-terminal kinase (JNK) in proportion to the psoriasis area and severity index (PASI) scores, which suggested that the depletion of ceramide is responsible for epidermal hyperproliferation of psoriasis via downregulation of proapoptotic signal cascade such as PKC-alpha and JNK. In this study, we investigated the protein expression of serine palmitoyltransferase (SPT) and ceramidase, two major ceramide metabolizing enzymes, in both psoriatic epidermis and non-lesional epidermis. The expression of SPT, the ceramide generating enzyme in the de novo synthesis in psoriatic epidermis, was significantly less than that of the non-lesional epidermis, which was inversely correlated with PASI score. However, the expression of ceramidase, the degradative enzyme of ceramides, showed no significant difference between the lesional epidermis and the non-lesional epidermis of psoriatic patients. This might suggest that decreased expression of SPT protein is one of the important causative factors for decreased ceramide levels in psoriasis.