A prospective open‐label, multicentre study evaluating a non‐cross‐linked hyaluronic acid based soft‐tissue filler in the correction of lateral canthal and perioral lines

Abstract

Objective The aim of this investigation was to assess the effectiveness of a non‐cross‐linked hyaluronic acid based soft‐tissue filler in the correction of lateral canthal lines and periorbital lines. Material and methods A total of 59 female Caucasian patients with a mean age of 52.6 ± 9.0 years were enrolled in this prospective open‐label, multicentre study and received intradermal injections of a soft‐tissue filler at baseline, after 3 and 6 weeks. Aesthetic improvement and patient satisfaction, skin hydration, skin firmness and skin elasticity, as well as adverse events were assessed at 3, 6, 8, 12 and 16 weeks. Results At baseline, the lateral canthal skin firmness was 0.206 ± 0.07 mm and increased after 8 weeks to 0.087 ± 0.08 mm with p < 0.001, while the perioral skin firmness was 0.205 ± 0.09 mm and increased after 8 weeks to 0.116 ± 0.08 mm with p < 0.001. Increases in skin hydration were observed after 8 weeks in both areas, however, did not reach statistical significance at any point. At week 8, 12 and 16 a majority (93.1%, 91.1% and 73.7% respectively) of the patients stated that they were ‘satisfied’ or ‘very satisfied’ with the treatment. Conclusion Overall, the skin firmness and skin visco‐elasticity showed significant increases in the lateral canthal and perioral region. Moreover, albeit not statistically significant, skin hydration increased in both areas after 8 weeks. The procedure has been shown to be safe and satisfactory for the treated patients; however, emergence of oral herpes should be added to the safety profile of intradermally applied hyaluronic acid treatments.

Histopathologic analysis of hyaluronic acid composite solution following intravascular injection: Variability and safety

“…Non-crosslinked hyaluronic acid composite solution, which is commonly injected into superficial soft tissue for cosmetic enhancement, has been widely used in mesotherapy and to treat horizontal neck wrinkles. [1][2][3][4] It differs from crosslinked hyaluronic acid in terms of biological properties and is considered relatively safe as it is not believed to obstruct the vessel or form emboli, 5 with no serious complications reported. However, mechanical embolism is not the only potential risk associated with fillers 6 ; an embolus may comprise blood cell components including red thrombi that can enter the gaps in the hyaluronic acid gel structure, evolving into white and mixed thrombi over time.…”

Validated 5 – Point photonumeric scales for the assessment of hand atrophy

“…1 While a rejuvenated look of the face can lower the perceived age of its beholder and increase self-confidence, happiness, and satisfaction with the own look, signs, of aging of the hands might create a disbalance to the younger-looking face of the patient. [2][3][4][5][6][7][8] A plethora of signs of aging characterize the aged hand which include, but are not limited to, discoloration of the skin and atrophy of the subcutaneous fat, which causes increased visibility and prominence of the extensor tendons, veins, and metacarpophalangeal joints. 9,10 To enhance the texture and decrease hyperpigmentation and discoloration of the dorsum of the hand, resurfacing by energy-and light-based devices as lasers or injections of platelet rich plasma can be used.…”

Validated 5‐point photonumeric scales for the assessment of the periorbital region

“…1 Visible signs of aging in the periorbital region include the appearance of aggravated lateral canthal lines at rest (ie, static crow's feet) and upon smiling (ie, dynamic crow's feet) and infraorbital hollowing. [2][3][4][5][6][7] The pathophysiology of crow's feet has not been explained in full detail; however, the repeated activation of the orbicularis oculi muscle and its dense connection to the dermis by so called retinaculae cutis together with increasing skin laxity is considered as the main reasons for their appearance.…”

“…5,8,9 A plethora of minimally invasive and surgical treatments can be chosen to ameliorate static and dynamic crow's feet as well as infraorbital hollows. 2,3,10,11 The use of neurotoxins to relax the orbicularis oculi muscle and intradermal injection of hyaluronic acid bases soft tissue fillers have been shown to reduce the severity of crow's feet efficiently and with high satisfaction for the patient, while possessing an acceptable safety profile and relatively little side effects. For infraorbital hollows, injections with low-viscosity hyaluronic acid-based soft tissue fillers have been shown to create a rejuvenated look by replenishing lost volume.…”

“…The appearance of infraorbital hollows has been subject of several investigations and recent publications attribute their formation to changes in the bony orbit and to descend and atrophy of the superficial and deep fat compartments 5,8,9 . A plethora of minimally invasive and surgical treatments can be chosen to ameliorate static and dynamic crow's feet as well as infraorbital hollows 2,3,10,11 …”