Search

Background: Injectable fillers like PDLLA offer a novel approach to addressing lower eyelid rejuvenation. Despite their growing popularity, comprehensive studies on newer products like PDLLA are limited., Aims: This study evaluates the efficacy and safety of PDLLA (Juvelook, VAIM Inc., Seoul, Korea) for treating tear trough deformities in Korean women, aiming to provide a long-term, minimally invasive solution for periorbital rejuvenation., Materials & Methods: A selected group of Korean women exhibiting tear trough deformities underwent treatment with PDLLA. Patients were assessed pre-treatment and followed up at 1 week, 1 month, and 6 months post-treatment, with outcomes measured by independent clinicians using the Hirmand classification and patient satisfaction scores., Results: PDLLA demonstrated significant improvements in tear trough deformities with high patient satisfaction and minimal adverse effects. Follow-up results showed sustained improvements and no severe complications, indicating a safe profile for PDLLA., Discussion: The study highlights PDLLA's potential advantages over traditional fillers, including longer-lasting effects and enhanced collagen production, suggesting it as a superior option for those seeking durable aesthetic improvements., Conclusion: PDLLA is an effective and safe treatment for periorbital rejuvenation in Korean women, providing lasting benefits and high patient satisfaction, warranting further comparative studies for broader applications., (© 2025 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: The function of injectable hyaluronic acid-based fillers is to smooth dermal wrinkles formed during aging. The aim of this study is to evaluate the performance and safety of a dermal filler after its commercialization., Methods: In this context, an 18-month prospective randomized single-blind study for the efficacy and safety of ART FILLER Fine Lines (AFFL) was performed on the forehead, the upper lip, the cheek folds, and the crow's feet. The efficacy, the longevity, and the safety were evaluated after a single filler injection without any re-touch injection. The persistence of the correction was evaluated at 3, 6, 9, 12, 15, and 18 months., Results: The observations performed on 196 subjects enrolled showed that AFFL injections induced a significant improvement in wrinkle correction for all the assessed areas. These effects were significant as soon as 3 weeks after injection and remained significant until 18 months. Furthermore, injections of AFFL were well tolerated and no severe event was recorded. The minor reported reactions were resolved within 3 weeks., Conclusion: AFFL with Tri-Hyal technology is suitable and well tolerated for the treatment of superficial wrinkles without any irregularity or Tyndall effect and showed a prolonged efficacy for at least 18 months., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: The growing popularity of aesthetic procedures involving fillers, biostimulators, and neurotoxins has prompted concerns about patient safety. To address these concerns, a global Safety Task Force (STF) was formed., Aims: The inaugural STF meeting prioritized vascular compromise prevention and management, guiding clinical trial design and materials for future meetings, and collecting data from experts on current safety methods., Methods: The STF was formed and consisted of 16 experts from nine different countries, with each possessing distinct expertise in various fields related to aesthetic injectables. Current safety data, protocols, knowledge gaps and future research priorities were discussed and voted upon., Results: The establishment of a global database for tracking filler-related AEs was favored by 93% of participants. Discussions revolved around the database's scope, data standardization, and whether non-medical contributors should be included. Aspiration as a safety technique garnered support from 73% of participants. Approximately 43% of participants incorporate ultrasound in their injections, with divergent opinions on its impact and potential when used as a standard of practice versus in AE management. Most physicians on the task force incorporated cannula use for some of their injections (93%). There were varying perspectives on treatments for vascular adverse events (VAE), the primary causes, and the adoption of new protocols in the field., Conclusions: The STF meeting underscored the need for a coordinated effort to address complications related to HA fillers, including VAE management and hyaluronidase protocols. Reliable treatment endpoints were evaluated, but improved measurement methods are needed. Future meetings will focus on addressing delayed complications, furthering safety in this field., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Hyaluronic acid-based dermal fillers are the cornerstones of wrinkle correction and facial contour redefinition., Objective: To assess the efficacy and safety of EST LF compared with RES L for the treatment of nasolabial folds (NLFs)., Materials and Methods: In this prospective, split-face, randomized, investigator and subject-blinded trial, 45 subjects with moderate-to-severe symmetrical NLFs were randomized to EST LF on one side of the face and RES L on the other side and were followed up for 9 months. The primary end point was change in WSRS score from the baseline to Month 1 (M1). Secondary end points included changes in WSRS score at other time points, aesthetic improvement, wrinkle volume quantification, adverse events, and local tolerance., Results: The efficacy difference between EST LF and RES L at M1 was in favor of EST LF (-0.16, CI, -0.28 to -0.03]), demonstrating its noninferiority. Considering other time points, significant differences were observed at 3 and 6 months for EST LF , assessed with WSRS, GAIS, or NLF volume quantification. Both treatments were well tolerated., Conclusion: EST LF is effective and well tolerated for the treatment of NLFs., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Dermatologic Surgery, Inc.)

Background: Facial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods., Objective: To showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections., Methods: Twenty-eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters., Results: The material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra-periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6 I.U. [range: 75-150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with p = 0.578. The position of the oral commissure increased by 0.60 cm in vertical and by 0.30 cm in horizontal directions (both p < 0.001)., Conclusion: Facial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re-establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: The aim of our study was to identify and evaluate the complications related to hyaluronic acid during the COVID-19 pandemic., Method: Twelve dermatologists participated in this study. A cohort and a non-cohort follow-up were ensured., Results: (1) Cohort follow-up: 1041 patients. 8% had a COVID-19 infection, 27% had received COVID-19 vaccination. 2% had immediate side effects (edema, erythema, bruising). 0.5% had delayed side effects (two inflammatory nodules, one nodule without inflammation, one edema). None of these side effects occurred in the context of infection or COVID-19 vaccinations. (2) Non-cohort follow-up: 7900 syringes used. Two early side effects (inflammatory edema) were reported, of which one occurred 15 days after vaccination. Two cases of delayed side effects such as inflammation on the injected area and inflammatory nodules occurred of which one was in the context of vaccination and one during COVID-19 infection. We estimate the frequency of complications possibly attributable to the disease or to the COVID vaccination to be 0.06% in our population., Discussion: Complications of HA injections in the context of COVID-19 disease or vaccination appear to be very rare but the frequency could be underestimated because of the low rate of vaccination/infection in our population. Our study shows a very good tolerance of hyaluronic acid injections during the COVID-19 pandemic., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Age-related changes of facial soft tissue cause clinical signs of facial aging such as lip atrophy, marionette lines, and an accentuated nasolabial fold. These changes can be modified using dermal fillers., Aims: To evaluate efficacy, longevity, and safety of a cross-linked hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips, nasolabial folds, and marionette lines., Materials and Methods: This prospective, multi-center trial evaluated injections of three different areas (lips, nasolabial fold alone, or with marionette wrinkles) with a soft tissue filler containing 25 mg/ml cross-linked hyaluronic acid and 0.3% lidocaine. Primary endpoint was the aesthetic correction 3 weeks after one injection session without touch-up. Follow-up was 18 months. Assessments were performed using the Global Aesthetic Score (GAS), clinical scoring based on photographic scales, high-frequency ultrasound imaging, and the Global Aesthetic Improvement Scale (GAIS)., Results: In total, 100 subjects were injected. GAS improved significantly for all treatment indications at 3 weeks (p < 0.0001). Success rates were highest for nasolabial folds (98.4%), followed by marionette lines (94.4%) and lips (73.5%). After 18 months post-injection, success was observed in 91%, 88%, and 33% of subjects injected into nasolabial folds, marionette lines, and lips, respectively. GAIS scored highest for nasolabial folds (SGAIS: 71%; IGAIS: 40%), followed by marionette lines (SGAIS: 56%; IGAIS: 33%) and lips (SGAIS: 30%; IGAIS: 22%) at 18 months follow-up., Conclusions: The filler demonstrated high efficacy and safety in all indications. Regional differences in longevity were evident. Thus, the necessity of regional retreatments should be discussed with patients before injection., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Ultrasound (US) has been used for many years in the field of medicine. Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality., Methods: US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues., Conclusion: This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The beneficial role of subcutaneous adipose tissue in skin rejuvenation derived from its capacity to fill the under-layer volumes but also from its ability to regulate the extracellular matrix production by dermis fibroblasts. Hyaluronic acid (HA), a major component of the extracellular matrix, is a commonly used injectable dermal filler showing excellent efficiencies to maintain tissue augmentation even after its biodegradation. To improve their stability, the HA molecules can also be "cross-linked" to each other. The effects of cross-linked HA-based fillers on the dermal structure are well known. For safety reasons, most of the physicians prefer to use the blunt cannula for injections. However, evidences showed that the cannula could not be located in the dermis, but it passes through immediate hypodermis and the long-lasting effect of cross-linked HA-based fillers may be related to its effects on adipose tissue. To test whether cross-linked HA has a direct effect on human adipocytes, we treated isolated adipocytes and precursors cells from human skin donors with cross-linked HA. Biochemical and cellular analysis demonstrated that treatment by cross-linked HA showed beneficial effects on differentiated cell adherence and survival as well as reduced basal and induced lipolysis in fully mature adipocytes. Taken together, these data showed that cross-linked HA promoted cell adherence and preserved the adipogenic capacity of preadipocytes during prolonged cell culture, bringing additional evidences of the beneficial role of cross-linked HA-based fillers in maintenance of the subcutaneous fat mass. This first study could defend a preventive approach to facial volume loss during natural aging., (© 2020 Laboratoires FILLMED. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Aims: In vitro evaluation of aspiration of viscous hyaluronic acid (HA) fillers through dermatologic needles, with and without a new solution for safe aspiration with a saline flashing procedure. The final objective is to be able to offer an easy-to-use device for a practitioner who injects fillers under and into the skin blindly. This device aims to protect him from an immediate and reproducible intravascular venous or arterial injection whatever the type of product used and independently of its rheological properties or the diameter of the needle used., Materials and Methods: We performed in vitro aspiration experiment using syringes and commonly used needle sizes (27G, 29G). We measured the time to observe a blood being aspirated through the needle with HA filler. Intervals longer than 10 seconds were considered as false results. We added a new approach of flashing a saline solution through the needle with a filler prior to aspiration. Saline solution pressurized by a syringe plunger opens a fluid path in the needle and enables the successful and efficient aspiration in 1-2 seconds through smallest needle size for 6 commercial HA fillers., Conclusion: The saline flashing of the dermatological needles with HA fillers appeared to be a feasible and efficient solution for the 100% safe aspiration safety test., Results: Aspiration was possible only in few trials with HA fillers for the 27G and all false for 29G needle, respectively. The aspiration with the novel saline flashing procedure is successful for 100% of cases with the two commonly used HA fillers and all needle sizes. The time to aspiration is also significantly shorter with the saline flashing., (© 2020 Wiley Periodicals LLC.)

Background: Full-face aesthetic treatment involving several treatment modalities may improve facial aesthetic outcome., Objective: To evaluate clinical outcomes and patient perceptions of monotherapy with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by full-face combination treatments of ABO, HA filler, and skin-boosting HA (RSB)., Materials and Methods: Subjects aged 35 to 50 years were randomized to monotherapy with 50 s.U ABO in the glabella or ≤1 mL HA filler in the nasolabial folds (NLFs)/cheeks. At Month 6 and Month 12, all subjects received combination treatment with ≤50 s.U ABO in the glabella, ≤2 mL HA filler in the NLFs/cheeks (and other facial areas as applicable), and ≤1 mL RSB (additional RSB treatment at Month 7). Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events., Results: Repeated full-face combination treatment with ABO, HA filler, and RSB was associated with considerably higher levels of aesthetic improvement and subject satisfaction than monotherapy with ABO or HA filler. Improvement rate of glabellar lines was increasing with each treatment., Conclusion: Repeated combination treatment achieved greater change in global facial aesthetic appearance than monotherapy. Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated.

Background: It is important to study full-face aesthetic combination treatments to establish well-founded individual treatment plans. Objective: To evaluate clinical outcome and perception of treatment with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by repeated combined treatment with ABO, HA filler, and Restylane® Skinboosters (RSB). Methods & Materials: This study was conducted at four sites in Sweden, France, and Brazil and included subjects aged 35-50 years with mild/moderate nasolabial folds and moderate/severe upper facial lines. Monotherapy was ≤125 s.U ABO in at least two upper facial indications with optional touch-up or ≤1 mL HA filler in nasolabial folds/cheeks. At months 6 and 12, both cohorts received ≤125 s.U. ABO in upper facial lines with optional touch-up, ≤2 mL HA filler in nasolabial folds/cheeks (and other facial areas as applicable), and ≤1 mL RSB. Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events. Results: Repeated full-face treatment with ABO, HA filler, and RSB was associated with better aesthetic outcome and higher levels of satisfaction than treatment with ABO or HA filler alone. However, even modest volumes of HA filler achieved good aesthetic outcomes and high satisfaction. Treatment of several indications was well tolerated. Conclusion: Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated. These data may be used as support when establishing individual treatment plans. J Drugs Dermatol. 2019;18(7):682-689.

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. [ABSTRACT FROM AUTHOR]

Purpose: Injectable hyaluronic acid-based fillers are commonly used for the correction of skin contour irregularities and to smooth skin depressions formed by volume loss during the aging process. These fillers are particularly efficient to restore perioral skin depressions/wrinkles or to correct topographical anomalies. The European directives require a continuous evaluation of the performance of these medical devices, particularly for CE marked products.Methods: An 18-month prospective randomized single-blind study for the efficacy and safety of ART FILLER Universal (AFU) was performed on the lips, the nasolabial folds, and the marionettes lines. The evaluations were performed on 153 subjects enrolled in this study. The efficacy, the longevity, and the safety were evaluated for the injected areas via area specific clinical scoring after a single injection with the filler and with no re-touch.Results: We showed here that filler injection induced potent improvements of volume restoration after a single injection on all the treated areas. These beneficial properties of the filler were significant 3 weeks after injection and during the whole study period. Moreover, injections of the filler were well tolerated by the subjects. The recorded adverse events are routinely seen with HA fillers for face volume corrections, and most of these local reactions resolved within 14 days.Conclusion: AFU was well tolerated and showed a continuous efficacy for at least 18 months, in exploratory analyses. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Conclusion Glucagon‐like peptide‐1 (GLP‐1) receptor agonists, such as semaglutide, have revolutionized the treatment of diabetes and obesity by promoting significant weight loss through incretin effects. However, rapid weight reduction induced by these medications often leads to esthetic challenges, including facial volume loss, skin laxity, and body contour irregularities. This commentary reviews the esthetic consequences of GLP‐1‐induced weight loss and explores solutions for managing these concerns in clinical practice.This review synthesizes available literature and clinical observations to identify key esthetic concerns associated with GLP‐1‐induced weight loss. It examines various treatment modalities, including dermal fillers, biostimulatory agents, energy‐based devices, and surgical procedures. The discussion highlights gaps in empirical data, optimal timing for interventions, and the need for personalized, multimodal treatment strategies. Imaging tools and psychological support are also considered as complementary approaches.As GLP‐1 agonists become a cornerstone in obesity management, their esthetic implications necessitate a proactive response from esthetic practitioners. Effective management of facial volume loss, skin laxity, and body contour challenges requires a combination of injectable treatments, energy‐based devices, and, in some cases, surgical interventions. Future research should focus on understanding the molecular mechanisms of skin and fat changes and developing standardized guidelines for treating this unique patient population. Additionally, a holistic approach that addresses both physical and psychological outcomes is critical to ensuring patient satisfaction and long‐term well‐being. [ABSTRACT FROM AUTHOR]

INTRODUCTION Noninflammatory nodules may be persistent to dissolve. To evaluate the possible reasons, a case series of ultrasound images and medical data of patients who were prospectively referred with noninflammatory nodules were evaluated. MATERIALS AND METHODS A total of 27 patients with nodules but without signs of inflammation were included. All cases were assessed with an 18-MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi-square tests. RESULTS Early onset of complaints (>2 weeks) was found in 16 patients and late onset (<2 weeks) in 11. All patients had multiple nodules. In all cases, the filler nodule was found to be located inside the fascia. Extension to the subcutaneous tissue was seen in 8 cases and to the deeper planes in 5. In 14 cases, the filler material was completely located inside layers of the fascia, and migration was observed in 5 cases. DISCUSSION Accumulation of filler material in the superficial musculoaponeurotic system or fascia may be an important cause for the occurrence of persistent noninflammatory nodules, either by initial faulty injection technique or by later accumulation through the pathway generated with a needle or cannula. Ultrasound-guided injections are helpful to dissolve the nodule. [ABSTRACT FROM AUTHOR]