Abdelmoez Hyaluronic Acid Dermal Filler Scoring System

Introduction: Dermal fillers industry is ever-expanding. Tens, if not hundreds, of brands are available to purchase legally or illegally. I have attempted in this paper to develop a scoring system for Hyaluronic acid dermal fillers that makes an injector’s verdict objective, fair and unbiased, and injection experience safer. Theoretically speaking, the worst filler will have, at least, &#4512 score and the best will have a score of 34 points. Some scoring points do not exist in any filler, suggesting hints to improve all brands. Objectives: To build a Hyaluronic acid dermal filler scoring system that deals with what the injector can easily read, see or experience on their own without using sophisticated technologies or the need to understand or estimate the physics or the chemistry behind the filler. Using a scoring system that depends more on objective than subjective findings will be easy and unbiased to apply, more practical. The scoring system structure should be holistic rather than being only results centered and more focused on safety.

The Abuse of Dermal Fillers: A Clinico-Epidemiological Study of 35 Cases

Background: Nowadays, the use of dermal fillers for correcting signs of aging, such as wrinkles, depressions, and folds, has become increasingly popular. However, the abuse of these products can lead to disfigurements and unpredictable consequences among users. Objective: To evaluate the clinical abnormalities related to dermal fillers abuse in Iraqi people, and identify the various factors contributing to them. Methods: A total of 35 patients with different facial abnormalities due to the abuse of dermal fillers, attending our clinic in Diwaniyah, Iraq, from September 2016 to December 2017, were enrolled. A questionnaire-based analysis was used to collect clinical and sociodemographic data from patients to determine the etiological profile behind this problem. Several disfigurements and facial defects were diagnosed on clinical base. We have treated most of the situations that require intervention and treatment. Results: A total of 35 patients aged between 25 and 54 years with a sex ratio of 0.093 were enrolled in this study. Their mean age was 42 years, and the age group between 35 and 45 years was forming 85.7% of the cases. The clinical abnormalities recorded in this study include: buffy face 8 (22.8%), facial asymmetry 3 (8.5%), Mdoka fish lips like 6 (17%), periorbital redness 1 (2.8%), filler fatigue 6 (17%), bags under eyes 4 (11.4%), sizeable bulbous nose 4 (11.4%), topographical changes 2 (5.7%), and stone-like cheeks 1 (2.8%). The leading causes for the abuse of fillers were as follows: 12 (34.28%) candidates were not compatible with the procedure, 9 (25.7%) were non-compliance with the indications of the Food and Drug Organization (FDA), 9 (25.7%) fillers were injected in the wrong place, 18 (51.4%) injections were of a larger quantity than required, and 5 (14.2%) had frequent and long-term injection. Conclusion: The use of dermal fillers for a wrong purpose can result in disfigurements rather than beautification. The commonest disfigurements are the puffy face, enlarged lips, and bags under eyes. The clinical uses of dermal fillers in Iraq need to be monitored by the health authorities, with the assurance that these products should be sold only by a doctor’s prescription to reduce their abuse.

Activating a Protocol for Prevention, Management and Follow up of Dermal Filler Injection Related Vascular Occlusion (A Clinical Audit)

With the increased demand for dermal filler injections, more complications and adverse events are reported. Vascular occlusion is one of the most serious complications. The need urges to adopt a powerful protocol to manage such cases. The private practice I am working for has six branches in the middle east. I tried to investigate if there were any vascular occlusion incidences through the last three years. Four cases without sufficient details were found. A protocol was adopted from a scientific reference to deal with similar cases properly. A re-audit was done after six months to test the efficiency of the suggested protocol.

Superiority of poly(L-lactic acid)microspheres as dermal fillers

The demand for injectable dermal filler has unde rgone significant growth with the rapid development of the beauty industry.Poly(lactic acid)(PLA) as a benefit of excellent biocompatibility and long-term promotion of collagen regeneration has been favored as a commonly used filler.However,the effects of chirality and particle size of PLA on the efficacy of dermal filler have not been studied.In this study,we prepared three kinds of microspheres(MSs) consisting of poly(D-lactic acid)(PDLA MS),poly(L-lactic acid)(PLLA MS),or meso-PLA(PDLLA MS)at 5,10 and 20 μmto reveal the different biological functions as dermal filler.Following intradermal injection into guinea pig,it was found that PLLA MS induced the slightest inflammation,and the level of pro-inflammatory cytokine IL-1β induced by PLLA MS is only 0.3 or 0.7-fold of that induced by PDLA or PDLLA MS,respectively.More importantly,PLLA MS significantly stimulated the regeneration of collagen,which was 1.4 or 1.1 times higher than those stimulated by PDLA MS or PDLLA MS,respectively.The size of PLA MSs did not affect the levels of inflammation and collagen regeneration.The results confirmed the superiority of PLLA as a dermal filler.

个体化综合治疗在眼周年轻化中的效果观察

目的观察个体化综合治疗眼周衰老的效果,探讨恢复眼周年轻态的优选方案。方法回顾性分析2018年5月至2023年5月就诊的女性患者。选取符合眼周年轻化治疗适应证的患者522例,根据诉求结合实际情况个体化制定综合治疗方案,包括但不限于手术、A型肉毒毒素注射除皱、自体脂肪移植、透明质酸填充等。观察治疗效果,术后6个月评估患者满意度。结果本组患者(n=522)整体满意度为97.9%,其中495例为非常满意,16例基本满意,11例不满意。术后无严重并发症,眼周整体形态呈现饱满年轻状态。结论个体化运用注射填充配合外科手术的综合诊疗方案,可有效恢复眼周年轻化外形。

国产交联透明质酸钠凝胶纠正中重度鼻唇沟皱纹的安全性及有效性

目的评价国产注射用交联透明质酸钠凝胶纠正中重度鼻唇沟皱纹(NLF)的安全性和有效性。方法本研究采用多中心、前瞻性、评价者-受试者双盲、随机对照的非劣效试验设计,自2021年4月至2023年4月在首都医科大学附属北京友谊医院、河南科技大学第一附属医院、沧州市人民医院和应急总医院4个研究中心前瞻性纳入296例中重度NLF患者作为研究对象。按照1∶1比例随机分为国产组和进口组,每组各148例。国产组注射用交联透明质酸钠凝胶,进口组注射用修饰透明质酸钠凝胶。注射后0.5、1、2 h,采用视觉模拟评分法(VAS)评估受试者两侧面部的疼痛情况;比较两组注射后1、3、6、12个月的鼻唇沟皱纹严重程度分级(WSRS)和面部整体美容效果改善分级(GAIS);比较两组受试者不良事件及实验室检查结果。结果注射后0.5、1、2 h,国产组与进口组两侧面部的VAS评分比较,差异均无统计学意义(P>0.05)。国产组注射1、3、6、12个月的WSRS改善率分别为96.62%、89.19%、91.22%、35.14%,进口组分别为97.30%、90.54%、90.54%、29.73%,两组WSRS改善率比较,差异均无统计学意义(P>0.05)。注射后1、3、6、12个月,国产组与进口组的GAIS改善情况比较,差异均无统计学意义(P>0.05)。本次试验无严重不良事件发生且实验室常规检查及生命体征组间均正常。结论国产注射用交联透明质酸钠凝胶在纠正中重度NLF的效果和安全性与进口产品相当。

Human dermal reticular fibroblasts at confluence display a signature micro pattern <i>in vitro</i>

This paper sets out to demonstrate that scraping of the flat dorsal surface of human dermis with a scalpel blade and cell plating without centrifugation can lead to the recognition and identification of the individual packing micro pattern of dermal reticular fibroblasts at confluence. The characteristic alignment of papillary and reticular fibroblasts at right angles to each other led to the positive identification of reticular fibroblasts. A non-enzymatic means of sub-culturing (passaging), which yields fully functional, healthy cells with normal, phenotypic morphology is also described. Implications for published subcutaneous wound healing studies are discussed as well as the confluent reticular fibroblast configuration, interpreted as ananatomic site identity code,which may be the address of a specific fibroblast gene pattern expression.

Viscoelastic Evaluation of Different Hyaluronic Acid Based Fillers Using Vibrational Optical Coherence Tomography

Hylauronic acid (HA) is used as a viscoelastic in Ophthalmology during cataract surgery based on its high viscosity at rest, its ability to shear thin and dissipate energy during phacoemulsification. However, these properties of HA solutions would make them susceptible to migration when used as dermal filler materials. In this study, we apply a new technique termed vibrational optical coherence tomography (VOCT) to compare the physical properties of different HA solutions and fillers used in facial aesthetics. Results presented in this study suggest that HA solutions and HA dermal fillers have markedly different physical properties. HA solutions are highly viscoelastic with high % viscous losses while fillers tend to have lower viscous energy dissipation properties. Clinical observations suggest that the high loss fillers are injected more superficially in the face where tension and internal and external forces are more likely minimized giving tissue of the hands and lips more volume and allowing more natural movement. In contrast, the lower loss gels that are used to lift tissue, generally have a higher G’, and are injected deeper into the face where injection and internal forces are likely to be higher. It is concluded that HA filler gel design can be optimized by use of VOCT to evaluate the % viscous energy loss both in vitro and in vivo.

医疗美容类面部注射填充材料评价

随着经济发展和技术进步,医疗美容的需求大幅增加,医用生物材料大量应用,其有效性和安全性的评价有必要进一步提高。目前,国内所采用的是理化性质及生物学评价,然而临床上的有效性是一个多方面的评价,无统一标准,大多主要采用客观指标量化分析,主观感受属于次要标准。本文对目前主要的面部填充物及其理化性能评价方法进行综述。

透明质酸在面部美容中的应用

目的评价应用透明质酸注射治疗面部的皱纹和凹陷的临床效果。方法使用自行研制的非动物源性透明质酸制剂,自2005年11月至2007年6月,对55例患者面部125处的皱纹和凹陷,于不同的皮下层次进行注射治疗,注射剂量为0.1～1.5ml,并观察注射后的临床效果、疗效时间、不良反应等。结果所有的注射部位均于注射后即刻得到改善。注射后随访患者,1、2、3个月分别有98.3%、91.2%、83.3%的注射部位维持了改善的效果;6～12个月有70.5%的注射部位维持了改善的效果;12～18个月有24.6%的注射部位维持了改善的效果,其中1例额部“抬头纹”的患者在18个月时仍未复发。注射治疗中,未出现急慢性过敏反应及感染、肉芽肿、血管栓塞等并发症。结论透明质酸是一种安全有效的、暂时性的面部美容填充剂。

聚甲基丙烯酸甲酯(爱贝芙)的临床应用

目的:评价注射聚甲基丙烯酸甲酯(商品名:爱贝芙,artecoll)治疗皱纹、轮廓塑形和软组织凹陷的安全性与有效性。方法:使用爱贝芙注射填充剂(主要有效成分为聚甲基丙烯酸甲酯微球)对463例患者1162处进行注射治疗,以改善皱纹、组织凹陷及面部轮廓塑形。所有患者均在注射前以及注射后即刻、1周、3个月、6个月、12个月和24个月进行随访和照像,由皮肤科医生和患者进行综合评估。结果:所有注射部位均在注射后即刻获得不同程度的改善,有效率为98.1%;注射后1周、3个月、12个月和24个月的综合评分分别为:3.78、2.91、2.82、2.79分,有效率为:97.1%、68.3%、64.3%、63.0%。未发生肉芽肿、过敏反应、感染等并发症。结论:爱贝芙是一种安全有效的永久性注射填充剂。

脂肪来源细胞和透明质酸钠复合物构建裸鼠皮下软组织

目的探讨脂肪来源细胞(ADCs)作为新型真皮充填物的可能性。方法ADCs取自3例行整复手术的男性患者的残余脂肪组织,支架材料为透明质酸钠。实验分为三组,实验组:ADCs(25×106/mL)与透明质酸钠混合,每一样本0.2mL注射于雌性BLAB/c裸鼠皮下;对照组1:单纯运用透明质酸钠,每一样本0.2mL注射于裸鼠皮下;对照组2:单纯运用ADCs(25×106/mL),每一样本0.2mL注射于裸鼠皮下。8周后取材,通过大体和组织学观察,以及性染色体RT-PCR检测,对再生组织进行评价。结果实验组形成软组织呈球形,平均体积(0.0352±0.0115)mL;组织学观察显示,生物材料完全降解,组织排列紊乱,间有大量排列紊乱的胶原纤维,无脂肪组织;两对照组均无任何组织形成。结论应用组织工程技术,以人脂肪来源细胞为种子细胞,透明质酸钠为支架材料,能构建出良好的组织工程化软组织;为探索一种安全、有效的除皱方法,提供了新的研究方向。

透明质酸类皮肤软组织填充剂及其研究进展

近几年透明质酸类皮肤软组织填充剂在世界各地美容医学的临床应用可谓如火如荼,已经证明它是对手术或非手术治疗面部年轻化的有力补充。本文将对各种透明质酸类填充剂的历史、理化性质和特性、临床应用及其研究进展做一介绍。

水晶纳交联透明质酸用于鼻唇沟皱纹治疗的安全性和有效性

目的评价水晶纳交联透明质酸应用于中国人群鼻唇沟皱纹治疗的安全性和有效性。方法本临床试验方案为前瞻性、随机、阳性对照的非劣效性试验。本中心共招募120例受试者,根据入选标准和排除标准确定受试对象并自愿签署知情同意书。受试者按入组时间顺序编号并随机分为试验组和对照组,分别采用水晶纳交联透明质酸和瑞蓝2对受试者双侧鼻唇沟纹进行填充治疗。每例患者注射次数为1~2次（第1次注射后4周,可进行第2次修正注射）,注射量根据皱纹深度每侧不超过2 ml。所有受试者在最后一次注射后第1、3、6、12个月进行随访,随访内容包括对受试者按统一标准拍照、受试者上交填写的注射后15 d局部不良反应日志、研究者和受试者分别进行皱纹严重程度评价（Wrinkle Severity Rating Scale,WSRS）。在试验结束后,独立第三方作WSRS,以6个月评价结果作为主要疗效指标,WSRS与基线比较改善1个或以上等级定义为有效。筛选时与6个月随访时进行血尿常规和肝肾功能等实验室检查。结果两组受试者各项基线指标差异均无统计学意义,两组间均衡可比。独立第三方对两组受试者术后6个月随访WSRS结果显示两组差异无统计学意义（P〉0.05）;术后6个月两组WSRS与基线比较鼻唇沟纹等级改善差异无统计学意义（P=0.105）;术后6个月试验组和对照组有效率差异无统计学意义（93.0%比96.7%,P=0.431）。试验过程中出现2例不良反应,但与产品和手术可能无关。无手术相关的实验室检查结果改变。结论水晶纳交联透明质酸用于鼻唇沟纹治疗试验期间未见与材料相关的不良反应,其组织相容性好,试验者能够接受。水晶纳交联透明质酸对鼻唇沟纹有明显改善作用,且疗效非劣效于对照材料瑞蓝2。

非透明质酸类皮肤软组织填充剂及其研究进展

随着透明质酸类软组织填充剂在世界各地广泛应用之际,其他非透明质酸类填充材料在临床应用及研究中显示出的独特优点亦受到新的关注。本文将对非透明质酸类填充材料的研发历史、理化特性以及临床应用研究进展做一介绍。

生物性注射美容材料的研究进展

生物性注射美容材料因其较好的组织相容性和安全性,在注射美容领域应用广泛。本文对其来源、性质、临床应用等进行综述,为临床选材和新材料开发提供参考。

Using injectable fillers for chin and jawline rejuvenation

Objective:As the population ages,facial plastic providers must remain aware of the treatments to prevent and reverse the external signs of aging.In the mandibular region,skin laxity and soft tissue sagging in the jawline may lead to jowling and chin ptosis along with reduced chin projection.While surgical procedures,including chin implantation,may be performed,nonsurgical procedures are becoming increasingly popular due to their temporary,noninvasive,yet effective methods.This review covers the use of hyaluronic acid,calcium hydroxylapatite,poly-L-lactic acid,and polymethyl methacrylate in the jawline.Methods:PubMed was searched for data on the mechanism of action,pertinent anatomy,indications,contraindications,technique,and evidence supporting the safety and efficacy of the fillers.Results:There are a wide variety of fillers available for use in the lower face with unique characteristics and application methods.While the advantages of injectable fillers include relatively affordable cost,minimal patient discomfort,and limited recovery times,taking measures to prevent short-and long-term complications is necessary for optimal results.Conclusions:Understanding the benefits and limitations of injectable fillers in the jawline can help providers appropriately counsel and treat patients.

六种注射用交联透明质酸钠的形态学观察及体外酶降解实验

目的:体外对比瑞蓝2、乔雅登、艾丽薇、润百颜、伊婉和海薇6种HA产品的形态及酶解反应时间。方法:取6种HA各0.050ml,经2%甲苯胺蓝染色12h,水溶液状态下分别于肉眼和显微镜下观察其形态;HA染色后室温条件下(24℃)置于300U(150U/ml)透明质酸酶中溶解,显微镜下观察溶解状态,并记录溶解时间。结果:6种HA均能观察到颗粒状形态,不同HA颗粒大小及分布均有所差异,其在透明质酸酶中完全溶解所需时间也不相同。结论:尽管不同HA产品相类似,但其因交联技术、制造工艺的不同,物理性质有一定差异,这种差异会在一定程度上影响其酶解反应速度。

注射用聚左旋乳酸微球体内可促胶原再生

背景:聚左旋乳酸皮下填充剂是美国FDA批准可作为修复皮下软组织胶原流失的医美产品,由于其形态为不规则颗粒,容易产生过度炎症反应。目的:观察辐照条件对聚左旋乳酸微球分子质量和粒径形貌的影响,以及聚左旋乳酸微球皮下填充剂植入兔皮下的异物反应程度和刺激胶原再生情况。方法:采用乳液-溶剂挥发法制备聚左旋乳酸微球,参考Sculptra的配方配制成可注射皮下填充剂,分别经25,50 kGy辐照灭菌,分析辐照灭菌对微球分子质量和粒径形貌的影响。采用MTT法检测不同质量浓度(50,100,250,500 mg/L,以微球的浓度计)可注射皮下填充剂对小鼠成纤维细胞增殖的影响。将25 kGy辐照灭菌的可注射皮下填充剂(实验组)、生理盐水(对照组)分别注射至兔背部皮下,于设定的时间点进行注射部位背部组织苏木精-伊红、马松三色染色及CD68、Ⅰ型胶原和Ⅲ型胶原免疫荧光染色。结果与结论:(1)随着辐照剂量的增加,微球的黏度、黏均分子质量和数均分子质量降低明显,但辐照灭菌并未导致微球的粒径和形貌发生明显改变。(2)MTT检测结果显示,当填充剂的质量浓度低于250 mg/L时细胞存活率均>90%,即使材料质量浓度高达500 mg/L时细胞存活率也仍高于80%,并且长时间的孵育(72 h)也并未产生显著的细胞毒性。(3)动物实验苏木精-伊红染色与CD68免疫荧光染色显示,填充剂植入后的第0.5-4个月只引起轻微炎性反应,植入后第6个月时炎性反应程度达到最高,且部分微球表面出现孔洞结构或不规则形状;植入后第9个月微球完全降解。(4)动物实验马松三色染色与Ⅰ型胶原、Ⅲ型胶原免疫荧光染色显示,植入后第4个月,微球周围主要为Ⅰ型胶原,外围主要以Ⅲ型胶原为主;植入后第6个月,微球附近的I型胶原增多,外围的Ⅲ型胶原增多;植入后第9个月,纤维包囊内部主要以Ⅰ型胶原为主,外围则Ⅰ型胶原与Ⅲ型胶原的比例接近均等。(5)结果表明,可注射聚左旋乳酸微球填充剂具有刺激胶原再生的效果,还可降低炎性反应程度。

皮肤填充剂在整形美容外科中的应用——不良事件及治疗方法概述

背景:越来越多的皮肤填充剂被应用于临床,这对患者和医生都是有益的。然而随着适应证的扩展及应用的增加,并发症的发生率也随之增长。目的:总结与皮下注射相关的不良事件,并为并发症的治疗与避免提供指导。方法:对皮肤填充剂相关的不良事件进行综述。以综述文献为基础,结合作者的日常工作经验,对预防和治疗不良事件提出相关建议。结果:不同的皮肤填充剂有各自的特点、风险和注射要求。皮肤填充剂都存在引起不良反应的可能,其中大部分与注射量和技术有关,也有一些与材料本身有关。短暂和轻微的不良反应,比如瘀伤和创伤相关水肿是最常见的。严重不良反应很少发生,依靠充分的计划和丰富的临床技术,大部分严重不良反应是可以避免的。结论:为了达到最好的注射结果,医生需要对面部解剖学、不同品种皮肤填充剂的特点、优势和不足有深入的了解,从而避免潜在的不良事件。