BACKGROUND: The objective of this experiment was to investigate the thermal effects on hyaluronic acid fillers, PCL fillers, and PDO threads when exposed to controlled heat. This study aims to provide insights into how these materials respond to thermal energy, which is crucial for safe and effective cosmetic procedures involving combined modalities.
METHODS: Cadaveric tissue was utilized to simulate clinical conditions. Hyaluronic acid fillers were injected at approximately 1 mm and 5 mm thicknesses, with variations in G\' value (high and low). PCL fillers were similarly injected in 1 mm and 5 mm thicknesses. PDO threads were also inserted. All materials were injected at a depth of 2 cm. A thermometer was used to measure heat penetration, and a multi-wavelength laser was applied to the tissue. The temperature was maintained at 60°C for 5 min to assess whether heat penetrated more than 3 cm in thickness. Observations were made regarding the heat distribution and any physical changes in the fillers and threads.
RESULTS: In thick layers, heat accumulated above the PCL filler without penetrating deeper layers. In thin layers, heat penetration was observed. For the HA fillers, heat energy was not blocked, regardless of the G\' value or thickness. For the threads, no significant heat blockage effect was observed. For all materials, no visual changes were detected in any of the materials due to temperature exposure.
CONCLUSIONS: The findings suggest that the thickness and composition of fillers significantly influence heat penetration. Thick PCL fillers act as a thermal barrier, whereas thin PCL fillers allow deeper heat penetration. Hyaluronic acid fillers do not impede heat transfer, regardless of their physical properties. PDO threads do not exhibit any notable thermal resistance. These insights are essential for optimizing the safety and efficacy of combined filler and energy-based device treatments in esthetic medicine.

Hyaluronic acid (HA) filler, a transient injectable used for rejuvenating facial treatments, has become increasingly popular over time since it doesn\'t require surgery. Although these procedures are generally safe, there are some application-related complications. These issues fall into three categories: reactions with early, delayed, or late onset. This case report features a 55-year-old female patient who developed widespread facial edema as a result of a delayed hypersensitivity reaction that happened after HA filler was applied.

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A new injectable solution containing low-molecular-weight hyaluronic acid (HA) and a specific amino acid mixture was formulated with proper aesthetic performance for the main signs of facial skin photoaging. The present study aimed to investigate its new application for rejuvenating and augmenting labia majora using clinical and biometric assessments. Three sessions of intradermal injections were performed using 3 ml of test extracellular matrix (ECM) for 10 eligible post-menopause female subjects (age 53.6 ± 7.93 years). The effectiveness of the intervention was assessed by an independent physician using before-and-after pictures based on the physician\'s global assessment score. Objective biophysical skin assessments, including skin hydration, skin erythema, and melanin index, as well as elasticity parameters including firmness (R0), gross elasticity (R2), and net elasticity (R5), were also performed before the first injection and then on the 2nd and 12th weeks after the last session. Patients\' satisfaction and all reported or observed adverse events were documented. At week 12, all the subjects reported an aesthetic improvement of 25% or more in rejuvenation and sagging of the labia major area. A statistically significant improvement was also detected in R0 and R5 at week 12 (p-values 0.005 and 0.022, respectively). Patient satisfaction surveys revealed a median score of 8 at both follow-up visits. The results showed a new indication of the tested HA ECM for providing a beneficial, durable, rejuvenating effect on the labia majora with a good safety profile.

The authors present a case of a 29-year-old female patient with a recurrent submental abscess formation after chin augmentation with highly reticulated hyaluronic acid filler. We evaluate the possible cause of this complication and the result after clinical management with ultrasound-guided injection of hyaluronidase. We highlight the prevention, assessment and treatment with real-time imaging of hyaluronidase injection in the affected area, as a predictable approach for both the patient and the physician.

BACKGROUND: The advances of self-crossing hyaluronic acid (SC-HA) fillers combination use with polydioxanone thread in minipigs were examined for compatibility, effectiveness, and immune response.
METHODS: A 12-week experiment was conducted using 6 minipigs (3 male and 3 female each) to evaluate the effects of SC-HA filler. The molecular weight of SC-HA filler was fixed at 200 kDa and alternative storage modulus of G80, G250, and G500 were examined. The procedure involved injecting SC-HA filler and polydioxanone threads into the skin tissue of anesthetized minipigs, and tissue sampling after 1 month (three minipigs), and 3 months (three minipigs) for histological staining and analysis. The immune reaction was observed during the experiment.
RESULTS: The practitioner reported it was easy to inject the SC-HA filler in combination with polydioxanone threads. All four storage modulus of SC-HA fillers were injectable within the polydioxanone thread containing cannula. Also, during the procedure, there were no immune responses at the treated sites. The results of the histological tissue examination confirmed that there was no chemical interaction between SC-HA filler and the existing polydioxanone thread, and it was observed that SC-HA filler was more uniformly distributed within the tissue with lower storage modulus, resulting in a higher production of collagen in the surrounding filler. When combined with scaffold polydioxanone thread, the scaffold polydioxanone thread helped spread the filler evenly, resulting in a more evenly distributed collagen around the filler.
CONCLUSIONS: Today, the combination therapy of filler and polydioxanone thread in one procedure is challenging due to the high viscosity of conventional fillers. However, this study confirmed that combination therapy of filler and polydioxanone thread is possible with SC-HA fillers. Additionally, it was found that polydioxanone thread does not seem to interfere with the crosslinking reaction of SC-HA filler, and if used with a higher pH of polydioxanone, it may enhance the cross-linking reaction and achieve a higher viscosity value. Finally, the study resulted in the idea of concrete as SC-HA filler and reinforcing rod for polydioxanone thread.

BACKGROUND: The concept of \"skin boosters\" has evolved, marking a shift from traditional uses of hyaluronic acid (HA) fillers primarily for augmenting skin volume to a more diverse application aimed at improving dermal conditions. Restylane Vital and other HA fillers have been repurposed to combat skin aging and wrinkles by delivering HA directly to the dermis.
OBJECTIVE: This review aims to define the term \"skin booster\" and to discuss the various components that constitute skin boosters. It seeks to provide a comprehensive overview of the different ingredients used in skin boosters, their roles, and their impact on enhancing dermal conditions.
METHODS: A comprehensive review was conducted, focusing on representative skin booster ingredients. The approach involved analyzing the different elements used in skin boosters and their specific roles in enhancing dermal improvement.
RESULTS: The findings indicate that skin boosters, encompassing a range of ingredients, are effective in improving the condition of the skin\'s dermis. The review identifies key ingredients in skin boosters and their specific benefits, including hydration, elasticity improvement, and wrinkle reduction.
CONCLUSIONS: Skin boosters represent a significant development in dermatological treatments, offering diverse benefits beyond traditional HA fillers. This review provides valuable insights into the constituents of skin boosters and their effectiveness, aiding readers in making informed decisions about these treatments. The potential of skin boosters in dermatological practice is considerable, warranting further research and application.

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient\'s immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient\'s immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

Background  Hyaluronic acid fillers can be manufactured using various processes. They have multiple properties, including their concentration, degree of modification, and rheological data. Cohesion is one such property to evaluate gel integrity; however, there is no standardized method for calculating this parameter. This study aimed to evaluate different tests for calculating hyaluronic acid cohesion and discuss the importance of hyaluronic acid cohesion as a consideration when selecting fillers. Methods  The cohesion levels of five different hyaluronic acid fillers with different rheological properties were evaluated and compared using the drop weight, compression, tack, and dispersion time tests. Results  The cohesion tests yielded different results in the samples. Samples 2 and 4 showed approximately two times the number of droplets when compared with Sample 5 in drop weight test. Samples 1, 2, 3, and 4 were superior to Sample 5 in tack test. Samples 1, 2, and 3 showed cohesive appearances at 95 seconds in most cases in dispersion test. Rheological test results did not reflect the measures of cohesion. Conclusion  Although there are no definite standardized tests to evaluate the cohesion of hyaluronic acid fillers, our proposed tests showed similar results for different hyaluronic acid filler products. Further studies are needed to evaluate the cohesion of hyaluronic acid fillers and determine the clinical use of this distinguishing characteristic for clinicians selecting the product of choice. Level of evidence statement: These data are Level IV evidence.

BACKGROUND: Throughout the last decade, a notable increase in HA-filler-related complications have been observed, owing to the increase in demand for filler injections and availability of multiple products.
OBJECTIVE: The aim is to provide practical advice on the best way to prevent and treat HA-filler-related complications.
METHODS: Thirty patients who experienced visible and/or symptomatic complications localized within the facial area were treated according to our algorithm. Patients with inflammatory lesions underwent antibiotic and anti-inflammatory therapy, followed by hyaluronidase injections. Patients with abscesses were treated with antibiotics, incision, and drainage. Each patient completed the dermatology-specific quality of life questionnaire (DLQI) at the first and last examinations.
RESULTS: Among the 29 patients who received antibiotic therapy, 3 healed without further treatment. However, 18 received hyaluronidase injections, 9 underwent incision and drainage, and 5 presented with fistulas and developed retracted scars. Moreover, 80% of the patients were completely healed, 13% significantly improved, and 3% did not show any improvement. The DLQI scores analysis showed a notable impact of patients\' diseases on their quality of life, mainly in the terms of personal relationships and symptoms, with minor impacts on intimate relationships, ability to work, and study. We demonstrated that our algorithm resulted in a significant improvement in the overall quality of life at the last follow-up (p < 0.001).
CONCLUSIONS: The use of filler injections requires caution and specific training because they can lead to serious complications. If these complications are recognized promptly, healing can be optimized. Our treatment algorithm demonstrated high rate of healing and significant improvement in the patients\' quality of life.