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provides its high solubility and high water binding affinity, at 28 mg/mL. [22,29,30]
[23]
which also contributes to volume augmentation. HA may
also stimulate neocollagenesis which is another reason for (4) The HA dermal fillers on the horizon are Puragen, Puragen
volume augmentation. [8,24,25] The injected HA is eventually Plus, Prevelle, Prevelle Plus, Belotero, and Teosyal family of
degraded and cleared by hepatic metabolism as thus the products. Puragen and Puragen plus are based on double
effect diminished. crosslinked (DXL™) technology with non-animal HA chains.
DXL™ technology increases the resistance to degradation
HA has no organ or species specificity, and therefore in once the product is implanted Hyaluronic acid dermal fillers
theory there is no risk of an allergic reaction. Very few to come and not yet available in the USA.
adverse hypersensitivity reactions secondary to injections
of HA used as filler have been reported; in histology, Despite its great popularity and satisfying aesthetic
they consisted of a granulomatous foreign body reaction, outcome, there are some advertise reactions of HA injection.
with abundant multinucleated giant cells surrounding an Nonallergic local side effects at the sites of injections are
extracellular basophilic amorphous material, which was the frequent, including pain, bruising, and transient edema,
injected hyaluronic acid gel. One favorable character of HA but they disappear in a few days and usually do not need
is that it can be easily dissolved with hyaluronidase if there any treatment. Too superficial placement of HA fillers
[31]
is an undesired or adverse effect. The duration of action or an uneven distribution of the injected product can lead
averages 6 months with a residual effect lasting up to 2 to 3 to visible, pale nodules in the skin. Uncommon additional
years. The short longevity is the primary limitation of HA. nonallergic reactions include bacterial infections, herpes
[26]
reactivation, generalized scleromyxedema, [32] aseptic
Currently available HA dermal fillers, depending on HA abscess, scar sarcoidosis, and interferon-induced
[34]
[33]
concentration, cross-link density, and manufacturing systemic sarcoidosis in patients with chronic hepatitis
process, has different hydration capacity at equilibrium. C, who also developed sarcoidal granulomas around the
Below are some of the favorable HA products by the plastic injected HA filler and necrosis and livedoid pattern after
[35]
surgeons and dermatologist. accidental arterial embolization. Blood vessels-embolism
[36]
by HA injection is the most severe complications, which
(1) Restylane® was FDA-approved in December of 2003, which is may lead to organ necrosis, such as blindness, stroke, which
now the most popular dermal filler. Restylane® has been proven sometimes could be irreversible.
to be safe and effective in the treatment of nasolabial folds in a
pivotal multicenter, double-blind clinical study. Perlane® is a Platelet-rich plasma
[27]
more viscous version of Restylane®, which was FDA-approved Platelet-rich fibrin matrices (Selphyl System; Aesthetic
in 2007. Both Restylane® and Perlane® are producted by Factors, LLC, Princeton, N.J.), derived through the collection
Q-Med AB in Sweden and distributed in the USA by Medicis and centrifugation of blood, is approved by the FDA as a
Pharmaceutical Corporation. They are based on “nonanimal medical device designed for the safe and rapid preparation of
stabilized hyaluronic acid” and produced from cultures of autologous platelet-rich plasma (PRP) for use in orthopedic
Streptococcus equi via a proprietary process crosslinked with surgery. For cosmetic applications, PRP is injected into the
1,4-butanediol diglycidyl ether giving a final concentration of
20 mg/mL. This manufacturing process produces a chemically face to stimulate cell proliferation via the release of growth-
[37]
identical, transparent, viscous beaded gel. [28] promoting proteins. Histological examination shows
activated fibroblasts and new collagen deposition at the site
[38]
(2) Juvéderm™ Ultra and Juvéderm™ Ultra Plus, FDA-approved of injection. Injection is an office-based procedure used to
in September, 2006, are new injectable HA dermal fillers, fill scars and rhytides with only minor transient ecchymosis
[31,37]
which are distributed by Allergan, Inc. The FDA has granted and edema. Additional studies are required to evaluate
a label extension for Juvéderm™ Ultra and Juvéderm™ Ultra the efficacy and safety of platelet-rich fibrin matrices for
Plus in June, 2007 (Allergan, Inc. 2007). Both products soft-tissue augmentation. [3]
feature a novel crosslinking process called Hylacross, which
provides a concentration of 24 mg/mL of HA. Juvéderm™ Ultra PLLA
Plus is a more robust formulation with a higher crosslinked Injectable PLLA is biocompatible, biodegradable,
composition of 8% versus 6% in the Juvéderm™ Ultra. This biostimulatory, synthetic filler that must be injected
revolutionary formulation produces a softer, more viscous, into the reticular dermis or subcutaneous fat. Polylactic
non-beaded gel which is intended to enhance durability. acid as Sculptra® was licensed by FDA in July, 2009. [39,40]
The clinical data demonstrates that the effects with a single Sculptra® effects by stimulating neocollagenesis through
[41]
treatment of Juvéderm™ Ultra or Juvéderm ™ Ultra Plus may fibroblast activation, thus becomes popular as soft-tissue
last for up to 12 months. [22,29,30] augmentation filler. Animal studies have revealed that PLLA
are able to stimulate the proliferation of dermal fibroblasts
(3) Elevess™ is the latest HA approved by the FDA, in July with subsequent endogenous production of collagen. [41,42]
2007, which was manufactured by Anika Therapeutics, MA, Histological studies in humans have shown gradual
USA, and was based on chemically modified non-animal HA dissolution of the injected PLLA and dermal in-growth of
proprietary technology which incorporates 0.3% lidocaine type I collagen over 8 to 30 months after injection. [43,44]
hydrochloride as a component of the treatment syringe. The PLLA is gradually degraded by nonenzymatic hydrolysis
concentration of HA in this product is the highest available into water and carbon dioxide over approximately 9 to 24
94 Plast Aesthet Res || Vol 3 || Mar 23, 2016