Search Results (105)

A 56-year-old patient presented to our dermatology clinic with asymmetric hyperpigmentation on her lower lip, which had developed over the previous six to twelve months. Her medical history included kidney and pancreas transplants, requiring chronic immunosuppression, and two lip filler injections with hyaluronic acid (HA). Clinical examination revealed irregular pigmented macules limited strictly to the lower lip. Histological analysis showed epidermal melanosis, pigmentary incontinence, solar elastosis, and amorphous dermal HA deposits, without evidence of melanocytic hyperplasia or granulomatous inflammation. Full article

Background: Hyaluronic acid (HA) fillers are commonly used for midface augmentation because of their biocompatibility and reversibility. Nonetheless, discussions continue about their effectiveness and safety relative to other options. This systematic review and meta-analysis assess the effectiveness, duration, and side effects of HA fillers in midface volume restoration. Methods: Following PRISMA guidelines, a thorough search was performed on PubMed, CENTRAL, Web of Science, Scopus, and EMBASE up to March 2025. The review included randomized controlled trials (RCTs) that compared HA fillers with controls, such as placebo or alternative treatments, for midface augmentation. Results: A total of fourteen studies were included in the review, and five studies in the statistical analysis. Analysis of five RCTs involving 748 participants showed a higher and significant difference in GAIS responder rates between HA and control groups (RR = 3.27, 95% CI: 2.26–4.75, p = 0.79; I² = 95%). GAIS scores at 4, 8, and 24 weeks demonstrated no notable improvements (all p > 0.05). Adverse events were rarely reported, and there was no significant rise in moderate-to-severe adverse events associated with HA fillers (RR = 1.70, 95% CI: 0.08–34.55, p = 0.73). Conclusions: HA fillers used for midface augmentation are generally safe, they have very high midface augmentation and patient satisfaction value, but they might not provide a notable subjective aesthetic benefit over the other fillers. Clinicians need to take into account patient expectations and refine their techniques, all while recognizing the limitations of existing evidence. Future research should include objective volumetric measurements and extend follow-up durations. Full article

Hyaluronic acid (HA) fillers and botulinum toxin remain among the most frequently requested non-surgical esthetic procedures, due to their favorable safety profile and ability to restore volume and improve skin quality. However, variability in product performance and the lack of objective measurement tools remain challenges in clinical practice. This prospective, single-arm, non-randomized pilot study aimed to assess the esthetic efficacy, tolerability, and duration of effect of Sofiderm^® HA fillers in Caucasian patients with signs of facial aging, and to explore the correlation between subjective visual grading and instrumental imaging outcomes. Five patients with Griffiths photoaging scores ranging from 4 to 8 were treated with different Sofiderm^® formulations. Standardized evaluations were performed at baseline, 2 months, and 9 months using VISIA-CR and PRIMOS 3D optical profilometry. All subjects experienced measurable improvements, with an average 2-point reduction in Griffiths scores at 2 months, maintained at 9 months in most cases. Objective imaging data confirmed enhancements in volume, texture, and surface regularity. No serious adverse events occurred. These findings suggest that Sofiderm^® fillers may offer sustained esthetic benefits with a favorable safety profile and demonstrate how integrated digital imaging can enhance treatment evaluation in esthetic dermatology. Full article

Background and Clinical Significance: Granulomatous reactions are rare but clinically significant complications of aesthetic procedures involving dermal fillers, particularly in individuals with underlying immune dysregulation. These reactions present diagnostic and therapeutic challenges, especially when associated with undiagnosed or latent autoimmune diseases. This case illustrates the interaction between filler composition, immune status, and the risk of delayed inflammatory responses, underscoring the need for thorough patient evaluation and individualized management strategies. Case Presentation: A 49-year-old woman developed delayed-onset subcutaneous nodules following midface augmentation with two filler types: a monophasic, cross-linked hyaluronic acid gel (concentration 20 mg/mL, 1.0 mL per side) injected into the deep malar fat pads, and a calcium hydroxyapatite suspension (30% CaHA microspheres in a carboxymethylcellulose carrier, 0.5 mL per side) placed in the subdermal plane along the zygomatic arch. The procedure was performed in a single session using a 22 G blunt cannula, with no immediate adverse events. High-resolution ultrasound demonstrated hypoechoic inflammatory nodules without systemic symptoms. A retrospective review of her medical history revealed a latent, previously undisclosed diagnosis of granulomatosis with polyangiitis (GPA). The immune-adjuvant properties of calcium hydroxyapatite likely triggered a localized pro-inflammatory response in this predisposed patient. A conservative, staged, non-invasive therapeutic protocol—saline infiltration, intradermal polynucleotide injections, and manual lymphatic drainage—achieved complete clinical and radiological resolution without systemic immunosuppression or surgical intervention. Conclusions: This case highlights the critical importance of pre-procedural immunological assessment in aesthetic medicine. Subclinical autoimmune conditions may predispose patients to delayed granulomatous reactions after filler injections. An individualized, conservative management strategy can effectively resolve such complications while minimizing the risks associated with aggressive treatment. Greater awareness of immune-mediated responses to dermal fillers is essential to ensure patient safety and optimize clinical outcomes. Full article

Background: Hyaluronic acid (HA) dermal fillers are among the most widely used injectable materials in esthetic medicine. They are generally safe, but delayed inflammatory reactions (DIRs) have been observed, particularly after viral infections or vaccinations. Such events have raised questions about the role of immune activation in filler-related complications. Objective: This review examined the available literature on DIRs to HA fillers that occurred in the context of viral illness or immunization, with attention to how these reactions present and how they are managed. Methods: A systematic search was carried out in PubMed, ScienceDirect, ClinicalKey, and Google Scholar between October and November 2024. Only human case reports and case series were included. The protocol was registered in PROSPERO (CRD420251030918), and study quality was assessed using the Newcastle–Ottawa Scale. Results: Six publications met inclusion criteria: four case series and two case reports, describing 25 women between 22 and 65 years of age. Patients developed swelling, erythema, angioedema, or, in severe cases, marked facial edema after HA filler injections, with symptom onset ranging from several hours to several weeks following viral exposure. Corticosteroids and hyaluronidase were the most common treatments, though milder cases sometimes resolved without intervention. Study quality varied, with some reports providing limited detail on patient characteristics and follow-up. Conclusions: DIRs associated with viral infections or vaccinations remain uncommon but clinically relevant complications of HA filler use. Limited case-based evidence indicates potential effectiveness of corticosteroids and hyaluronidase, though management practices remain inconsistent. Larger prospective studies are needed to clarify underlying mechanisms and to establish standardized guidelines for treatment. Full article

Polydeoxyribonucleotides (PDRN), highly purified DNA-derived polymers, were approved by the Italian Medicines Agency (AIFA) in 1994 to treat superficial wounds, skin ulcers, and dystrophic connective tissue disorders. Since then, PDRN have gained considerable attention as regenerative biomaterials. Beyond their established role in wound healing, they have also been approved as dermal fillers in several countries, with growing clinical evidence supporting their benefits for facial skin health. Recent clinical and preclinical studies suggest that PDRN may improve various skin conditions, including wrinkles, dryness, hyperpigmentation, hair loss, and barrier dysfunction. These findings have generated interest in their broader dermatological applications beyond traditional indications. This review aims to explore the therapeutic potential of PDRN for the treatment of skin disorders. We examine the efficacy and safety of PDRN-based drugs and medical devices in dermatology, with a focus on their clinical applications, pharmacological effects, and underlying molecular mechanisms. Given that PDRN consists of over 90% purified DNA, we further examine the biological functions of extracellular DNA (exDNA) and propose potential mechanisms by which PDRN may function as exDNA, beyond its classical action via the A2A receptor pathway. Collectively, current evidence highlights PDRN as safe and effective biopolymers with promising potential as DNA-based therapeutics in dermatology. Full article

Crosslinked hyaluronic acid dermal fillers are widely used for non-permanent aesthetic enhancement, offering safe and effective solutions for facial volume restoration. Specific formulations are designed for targeted facial regions, with highly crosslinked hydrogels often recommended for volumizing areas such as the jawline, chin, and cheeks due to their structural properties. While elasticity and viscosity are commonly evaluated, broader comparative analyses remain limited. In this study, we assess five commercially available HA-based fillers with similar HA concentrations, all optimised for volume enhancement. Alongside widely used reference products, we evaluate BtHCROSS 2%^®, a novel formulation not previously compared to established fillers. We examined the degree of chemical modification, mechanical viscoelastic behaviour, susceptibility to enzymatic degradation by hyaluronidase, and injection force. While all tested fillers are suitable for volume restoration, BtHCROSS 2%^® demonstrates a distinctive combination of mechanical adaptability, structural support, enzymatic resistance, and low injection force, making it a versatile option for practitioners. Full article

Background: The growing demand for minimally invasive aesthetic procedures highlights the need for innovative injectable solutions that target skin aging beyond volumization. Hyaluronic acid (HA)-based fillers remain a cornerstone of aesthetic treatments, but traditional formulations often offer limited benefits in improving skin quality parameters such as elasticity. This study evaluated the efficacy and safety of an injectable formulation composed of 2.6% high molecular weight hyaluronic acid (H-HA) and 3.2% sorbitol, designed to improve skin biomechanical properties through subcutaneous administration. Methods: In this single-center, open-label, single-arm clinical trial, 86 participants aged 35 to 70 years received a single injection in the facial region. Clinical outcomes were assessed at baseline (day 0), one month (M1), and four months (M4) post-injection using the Global Aesthetic Improvement Scale (GAIS), instrumental Cutometer^® measurements of skin elasticity and recovery, and patient satisfaction questionnaires. Results: Significant improvements in skin elasticity and recovery were observed at M4 following a single administration. The product was well tolerated, with only mild and transient injection site reactions observed. Conclusions: These exploratory findings support the clinical benefit of combining high-concentration H-HA with sorbitol to enhance skin quality in a safe and minimally invasive manner. These preliminary results position this formulation as a promising option for facial rejuvenation, targeting biomechanical improvement through a single-session injectable protocol. Full article

Various biomaterials are currently employed for dermal biostimulation and filling purposes, with hyaluronic acid (HA)-based fillers among those with the most favorable safety profile, albeit exhibiting a limited biostimulatory effect. This study suggests that hyaluronic acid and succinic acid (SA) can significantly induce beneficial effects on skin cells by targeting key aging hallmarks. Human dermal senescent fibroblasts and aged adipocytes were treated with HA + SA, and various aging characteristics were examined through gene expression analysis and microscopy staining. HA was found to stimulate autophagy gene expression, while SA modulated senescence-gene expression, and the combination of these compounds induced mitophagy in senescent fibroblasts. Additionally, the HA + SA promoted adipogenesis, increased IGF1, and decreased TNFA gene expression in aged adipocytes. Furthermore, the conditioned medium from adipocytes treated with HA + SA upregulated key dermal genes such as COL3A1 and EGF. The findings of this study suggest that HA and SA compounds can be used for the biostimulation of aged skin through the regulation of senescence-associated gene expression and cell communication between dermal fibroblasts and subcutaneous adipocytes. Full article

Minimally invasive cosmetic procedures, such as dermal fillers, botulinum toxin injections, autologous fat grafting, intense pulsed light (IPL) treatments, and platelet-rich plasma (PRP) treatments, are increasingly popular worldwide due to their convenience and aesthetic benefits. While generally considered safe, these procedures can result in rare but serious ophthalmological complications. The most catastrophic adverse events include central retinal artery occlusion and ischemic optic neuropathy, which may lead to irreversible vision loss. Other complications include diplopia, ptosis, dry eye, and orbital cellulitis, with varying degrees of severity and reversibility. Awareness of potential ocular risks, appropriate patient selection, and adherence to safe injection techniques are crucial for preventing complications. This narrative review summarizes the incidence, mechanisms, clinical features, risk factors, diagnostic approaches, and management strategies of ocular complications associated with aesthetic medical procedures. A narrative literature review was conducted, emphasizing data from clinical studies, case series, and expert consensus published between 2015 and 2025. Special attention is given to anatomical danger zones, the pathophysiological pathways of filler embolization, and the roles of hyaluronidase and hyperbaric oxygen therapy in acute management. Although many complications are self-limited or reversible, prompt recognition and intervention are critical to prevent permanent sequelae. The increasing prevalence of these procedures demands enhanced education, informed consent, and interdisciplinary collaboration between aesthetic providers and ophthalmologists. Full article

Poly-L-lactic acid (PLLA) filler, which increases volume and collagen synthesis, is used for skin rejuvenation. Subcutaneous adipose tissue (SAT) contains precursors that differentiate into mature adipocytes that secrete adiponectin, which modulates SAT function and increases adipogenesis. During aging, adiponectin and precursor cell functions decrease, reducing adipogenesis and facial volume. Adiponectin also increases collagen synthesis by stimulating fibroblasts. After hydrogen peroxide treatment to induce senescent adipocytes (3T3-L1) and aged skin, follow-up PLLA treatment increased adipogenesis by stimulating the nuclear factor erythroid-2-related factor 2 (NRF2)/peroxisome proliferator-activated receptor gamma (PPARγ)/CCAAT/enhancer binding protein alpha (C/EBPα) pathway. This resulted in increased adiponectin secretion, which promoted collagen synthesis and mitigated the loss of SAT volume. In the senescent adipocyte, PLLA increased NRF2/PPARγ/C/EBPα, adipogenesis factors (fatty acid binding protein 4, lipoprotein lipase, and cluster of differentiation 36), lipogenesis factors (ATP citrate lyase, acetyl-CoA carboxylase, and fatty acid synthase), adiponectin, and lipid droplet size. Treatment of senescent fibroblasts with conditioned medium from PLLA-treated adipocytes increased collagen1 and 3 and decreased matrix metalloproteinase1 and 3 expressions. Similarly, PLLA increased NRF2/PPARγ/C/EBPα, adipogenesis, and lipogenesis factors in aged mouse SAT. Also, PLLA increased adiponectin and adipocyte numbers without hypertrophy and increased collagen accumulation and dermal thickness. In summary, PLLA increased adipogenesis and adiponectin, which increased the volume of SAT and collagen synthesis, thereby rejuvenating aged skin. Full article

Facial aging is a complex process manifesting as skin hyperpigmentation, textural irregularities, and a diminished elasticity, hydration, and evenness of tone. The escalating demand for minimally invasive aesthetic interventions has driven the development of advanced hydrogel-based injectable formulations. This clinical study assessed the safety and efficacy of Hydragel A1, an injectable hydrogel containing hyaluronic acid (HA), niacinamide, and tranexamic acid (TXA), designed to simultaneously address multiple facets of facial skin aging. A cohort of 49 female participants underwent a series of objective and subjective assessments, including the Global Aesthetic Improvement Scale (GAIS), instrumental measurements (Antera 3D, Chromameter, Cutometer, Dermascan, Corneometer), and standardized photographic documentation at baseline (Day 0) and 14, 28, and 70 days post-treatment. The results demonstrated statistically significant improvements in skin hydration, texture, elasticity, and pigmentation following Hydragel A1 administration. Notably, no serious adverse events or significant injection site reactions were observed, confirming the favorable safety profile of the investigated device. Collectively, these findings underscore the potential of a combined HA, niacinamide, and TXA injectable formulation to provide a comprehensive approach to facial skin rejuvenation, effectively targeting multiple aging-related mechanisms. Full article

Hyaluronic acid (HA) dermal fillers represent a cornerstone of modern esthetic medicine, providing a minimally invasive solution for facial volume restoration and skin rejuvenation. However, the diversity of available products, each utilizing distinct crosslinking technologies, presents a challenge for objective comparison and clinical decision making. This study introduces a scientific framework to evaluate and categorize the physicochemical properties of HA fillers based on two key parameter groups: dynamic parameters (e.g., rheology and gel content) and consistency parameters (e.g., extrusion force, water uptake, and gel particle size). Using standardized methodologies, 23 commercially available fillers from five major manufacturers were analyzed, enabling cross-technology comparisons. The findings reveal how specific crosslinking approaches influence the rheological behavior, handling characteristics, and potential clinical applications. By offering an integrated and reproducible assessment, this work helps practitioners select the most suitable filler for individualized treatment plans and encourages manufacturers to enhance product transparency through harmonized testing protocols. Full article

Biopolymer-based dermal fillers have gained attention in facial aesthetics due to their biocompatibility, gel-forming properties, and capacity to stimulate tissue regeneration. However, evidence regarding their clinical performance remains scattered and inconsistent. This systematic review evaluates the current scientific literature on the effectiveness and safety of injectable biopolymers used in facial aesthetic procedures. A systematic search was conducted in PubMed, MEDLINE, and Embase databases for studies published between 2016 and 2024. Only human studies in English assessing clinical efficacy, safety, adverse events, and patient satisfaction were included. Of the 280 articles initially identified, 9 met the inclusion criteria. The selected studies showed improvements in facial volume and wrinkle reduction with gel-based biopolymers such as poly-L-lactic acid (PLLA), polycaprolactone (PCL), and polymethylmethacrylate (PMMA). Most studies reported high patient satisfaction and a low incidence of serious adverse effects. However, methodological heterogeneity and limited long-term data reduced the strength of the evidence. While injectable biopolymers appear to be effective and generally safe, current evidence is limited and variable. Further multicenter randomized trials with standardized protocols and longer follow-up periods are needed. Clinicians should apply these materials with caution, ensuring individualized treatment planning and careful risk assessment. Full article

Tyre wear particles (TWPs), generated from tyre-road abrasion, are a pervasive and under-regulated environmental pollutant, accounting for a significant share of global microplastic contamination. Recent estimates indicate that 1.3 million metric tons of TWPs are released annually in Europe, dispersing via atmospheric transport, stormwater runoff, and sedimentation to contaminate air, water, and soil. TWPs are composed of synthetic rubber polymers, reinforcing fillers, and chemical additives, including heavy metals such as zinc (Zn) and copper (Cu) and organic compounds like polycyclic aromatic hydrocarbons (PAHs) and N-(1,3-dimethylbutyl)-N′-phenyl-p-phenylenediamine (6PPD). These constituents confer persistence and bioaccumulative potential. While TWP toxicity in aquatic systems is well-documented, its ecological impacts on terrestrial environments, particularly in agricultural soils, remain less understood despite global soil loading rates exceeding 6.1 million metric tons annually. This review synthesizes global research on TWP sources, environmental fate, and ecotoxicological effects, with a focus on soil–plant systems. TWPs have been shown to alter key soil properties, including a 25% reduction in porosity and a 20–35% decrease in organic matter decomposition, disrupt microbial communities (with a 40–60% reduction in nitrogen-fixing bacteria), and induce phytotoxicity through both physical blockage of roots and Zn-induced oxidative stress. Human exposure occurs through inhalation (estimated at 3200 particles per day in urban areas), ingestion, and dermal contact, with epidemiological evidence linking TWPs to increased risks of respiratory, cardiovascular, and developmental disorders. Emerging remediation strategies are critically evaluated across three tiers: (1) source reduction using advanced tyre materials (up to 40% wear reduction in laboratory tests); (2) environmental interception through bioengineered filtration systems (60–80% capture efficiency in pilot trials); and (3) contaminant degradation via novel bioremediation techniques (up to 85% removal in recent studies). Key research gaps remain, including the need for long-term field studies, standardized mitigation protocols, and integrated risk assessments. This review emphasizes the importance of interdisciplinary collaboration in addressing TWP pollution and offers guidance on sustainable solutions to protect ecosystems and public health through science-driven policy recommendations. Full article