top of page



Quest’anno Agorà, con l’obiettivo della ricerca di un costante miglioramento e progresso scientifico, ha voluto approfondire la bibliografia di riferimento per le tematiche delle Sessioni Coordinate e metterle disposizione dei partecipanti alla Sessione in Sede Congressuale.

In questa pagina troverete a disposizione gli abstract degli articoli che Agorà ha selezionato come bibliografia di riferimento per la sessione coordinata "BIOSTIMOLAZIONE VS BIORIVOLUMETRIA DEL VOLTO". I Soci Agorà avranno inoltre la possibilità di scaricare gli articoli originali in versione integrale.



Facial Plastic Surgery

2016 June; 32(3):253-260

PMID: 27248022

The anatomy of the aging face: a review

Sebastian Cotofana, Aliana A. M. Fratila, Thilo L. Schenck, Wolfgang Redka-Swoboda, Isaac Zilinsky, Tatjana Pavicic

ABSTRACT: Rejuvenative procedures of the face are increasing in numbers, and a plethora of different therapeutic options are available today. Every procedure should aim for the patient's safety first and then for natural and long-lasting results. The face is one of the most complex regions in the human body and research continuously reveals new insights into the complex interplay of the different participating structures. Bone, ligaments, muscles, fat, and skin are the key players in the layered arrangement of the face.Aging occurs in all involved facial structures but the onset and the speed of age-related changes differ between each specific structure, between each individual, and between different ethnic groups. Therefore, knowledge of age-related anatomy is crucial for a physician's work when trying to restore a youthful face.This review focuses on the current understanding of the anatomy of the human face and tries to elucidate the morphological changes during aging of bone, ligaments, muscles, and fat, and their role in rejuvenative procedures.

Aesthetic Plastic Surgery

2014 October; 38(5):1011-1016

PMID: 25028117

Role of antioxidants in dermal aging: an in vitro study by q-RT-PCR

A. Avantaggiato, G. Bertuzzi, U. Vitiello, G. Iannucci, M. Pasin, M. Pascali, V. Cervelli, F. Carinci

BACKGROUND: Reactive oxygen species production is the final step in skin aging. These unstable molecules can damage and destroy DNA, proteins, and membrane phospholipids. The aim of this study was to test the in vitro effect of an antioxidant precursor, N-acetylcysteine (NAC), on human dermal fibroblasts. NAC alone and a solution of NAC and amino acids together, used in aesthetic medicine as intradermal injection treatment, were tested.

METHODS: The expression levels of some connective related genes (HAS1, HYAL1, ELN, ELANE, DSP, GDF6, and IGF1) were analyzed on cultures of dermal fibroblasts using real-time reverse-transcription polymerase chain reaction (real time RT-PCR).

RESULTS: All genes were upregulated after 24 h of treatment.

CONCLUSIONS: An interesting effect of gene induction by administration of NAC and amino acids in vitro was demonstrated. Upregulation of elastin-, hyaluronic acid-, and GDF6-encoding genes supports the evidence of clinical improvement induced by NAC biostimulation in the prevention and correction of skin aging.

Journal of Clinical and Aesthetic Dermatology

2021 November; 14(11):44-57

PMID: 34980960

PMCID: PMC8675348

Platelet-rich plasma: a comprehensive review of emerging applications in medical and aesthetic dermatology

Christopher White, Allyson Brahs, David Dorton, Kristin Witfill

ABSTRACT: Platelet-rich plasma (PRP) has been integrated into numerous treatment regimens for medical and aesthetic dermatology. While some of these approaches are well-established, many uses are underreported in the literature. We sought to identify and summarize the emerging dermatologic applications for PRP by conducting a comprehensive PubMed search of studies published between 2000 and 2020. These studies were reviewed to synthesize collection methods, treatment schedule, adverse effects, and the impact of therapy for new and emerging uses for PRP. In general, we identified positive treatment outcomes for skin rejuvenation, scar revision, alopecia, pigmentary disorders, lichen sclerosus, leprosy-induced peripheral neuropathy, plaque psoriasis, and nail disorders. Widely, therapy was well-tolerated and suitable for all reported phototypes. The variations in collection and application sequences make concrete recommendations difficult to discern, underscoring the need for a standardized approach to preparation and treatment methods. We hope this review serves as an outline for new and interesting uses for PRP and will help readers familiarize themselves with this exciting technology for comfortable integration into their practices.

Dermatologic Surgery

2019 May; 45(5):718-724

PMID: 30741790

Randomized, controlled, multicentered, double-blind investigation of injectable poly-L-lactic acid for improving skin quality

Krista Bohnert, Andrew Dorizas, Paul Lorenc, Neil S. Sadick

BACKGROUND: Poly-L-lactic acid (PLLA) is an injectable filler used for restoring facial fat volume loss.

OBJECTIVE: To evaluate the effect of repeated PLLA injections on skin quality.

METHODS: Forty healthy women were enrolled in this randomized, controlled, double-blind, multicenter study. Eligible subjects received 3 treatments every 4 weeks with either PLLA (treatment group) or saline (control group) injections, into both sides of the face. Follow-up visits were at 6, 9, and 12 after the last treatment. Assessments included biophysical measuring instruments, live ratings, patient questionnaires, and rating of standardized pictures by a blinded evaluator.

RESULTS: At the 12-month follow-up, there was a statistically significant increase of skin elasticity and hydration in PLLA-treated subjects and a decrease in transepidermal water loss in both groups. Pigmentation, erythema, and pore size were significantly decreased, whereas radiance and smoothness were significantly increased at 12 months per blinded investigator rating in this group. No treatment-related adverse events occurred.

CONCLUSION: Repeated PLLA treatments may improve skin quality in a time-dependent manner.

Clinical Interventions in Aging

2015 March; 10:147-155

PMID: 25609932

PMCID: PMC4293293

New-generation filler based on cross-linked carboxymethylcellulose: study of 350 patients with 3-year follow-up

Mauro Leondardis, Andrea Palange

PURPOSE: In recent years there has been a growing interest in nonsurgical procedures for facial rejuvenation. Hyaluronic acid is currently the most widely used dermal filler for the treatment of facial wrinkles. However, new products with interesting features are being introduced into the market. Cross-linked carboxymethylcellulose is one of these and represents a new alternative for the correction of wrinkles and facial defects.

PATIENTS AND METHODS: The retrospective, multicenter, open-label study on nasolabial folds reported here was carried out between January 2010 and April 2014 on 350 subjects between 22 and 67 years of age for a 36-month follow-up period in order to consistently and extensively assess the safety and performance of this treatment.

RESULTS: The study revealed effective and durable correction of nasolabial wrinkles for periods of 9–12 months. Product reapplication over a 36-month period did not lead to an increase in adverse effects, which always remained rare and of little clinical significance, usually consisting of bruising and redness.

CONCLUSION: Cross-linked carboxymethyl cellulose has been shown to be a safe and effective alternative to the resorbable products currently on the market.

Dermatologic Surgery

20218 November; 44(1):S32-S41

PMID: 30358631

Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening

Kate Goldie, Wouter Peeters, Mohammed Alghoul, Kimberly Butterwick, Gabriela Casabona, Yates Yen Yu Chao, Joana Costa, Joseph Eviatar, Sabrina Guillen Fabi, Mary Lupo, Gerhard Sattler, Heidi Waldorf, Yana Yutskovskaya, Paul Lorenc

BACKGROUND: Calcium hydroxylapatite (CaHA) is approved to correct moderate-to-severe wrinkles and folds and soft-tissue volume loss in the face and hands. More recently, subdermal injection using diluted CaHA has been used to improve skin laxity.

OBJECTIVE: To review evidence for the safe and effective use of diluted CaHA in the face and body and provide best practice recommendations.

METHODS: A global panel of expert aesthetic physicians convened to develop consensus-based guidelines for treating laxity and superficial wrinkles using diluted (ratio of 1:1) and hyperdiluted (≥1:2) CaHA.

RESULTS: Diluted and hyperdiluted CaHA stimulates targeted neocollagenesis in the injection area to improve laxity and skin quality in the mid- and lower face, neck, décolletage, upper arms, abdomen, upper legs, and buttocks. Treatment can be used as an adjunct to volume augmentation or combined with additional modalities for optimal results. Adverse events are related to the injection and include bruising, swelling, mild pain, and induration. In thinner and darker skin, too-superficial injections of less diluted CaHA can lead to more adverse events.

CONCLUSION: This report provides preliminary guidelines for the novel off-label use of CaHA for biostimulation in the face and body. Further trials will provide additional clarity regarding treatment paradigms for optimal outcomes.

Journal of Cosmetic Dermatology

2021 February; 20(2):442-450

PMID: 33320420

Single-center, prospective comparison of calcium hydroxylapatite and Vycross-20L in midface rejuvenation: efficacy and patient-perceived value

Alan Durkin, Alexandra Lackey, Alyssa Tranchilla, Maxwell Poling, Gabriella Glassman, Nick Woltjen

BACKGROUND: Numerous fillers can be used for midface revolumization. While rheological data, physiochemical properties, and durability measured in clinical studies can inform selection, direct comparisons between equal volumes of different fillers are lacking.

AIMS: To compare aesthetic improvement achieved with 3 cc of either calcium hydroxyapatite with integral lidocaine CaHA(+) or VYC-20L in the midface.

PATIENTS/METHODS: In this prospective, single-center study, 17 patients with midface volume loss received 3 cc of either CaHA(+) or VYC-20L. Outcomes at post-treatment days 1, 7, 30, 90, 180, and 365 were measured by Subject and blinded Physician using the Global Aesthetic Improvement Scale (SGAIS and PGAIS). Cost per point improvement on SGAIS over time was determined.

RESULTS: Outcomes were globally positive, with a large majority of subjects at least improved at all time points. A higher proportion of subjects were at least "very improved" in the CaHA(+) treatment group at each time point, a difference that reached significance at day 90 (100% vs 50%, P = .02), day 180 (89% vs 37.5%, P = .03), and day 360 (89% vs 37.5%, P = .03). For both SGAIS and PGAIS, only subjects within the VYC-20L cohort had "unaltered" appearance within 1 year. At 1 year, the average cost per point of SGAIS improvement for VYC-20 was approximately twice that of CaHA-20L.

CONCLUSION: The results of this study indicate that CaHA(+) supports better, more durable outcomes than an equal volume of VYC-20L in the midface, providing a higher value to the patient.

Aesthetic Surgery Journal

2017 January; 37(1):14-23

PMID: 27241362

Skin rejuvenation and volume enhancement with the micro superficial enhanced fluid fat injection (M-SEFFI) for skin aging of the periocular and perioral regions

Alessandro Gennai, Alessandra Zambelli, Erica Repaci, Rodolfo Quarto, Ilaria Baldelli, Giulio Fraternali, Francesco P. Bernardini

BACKGROUND: Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited.

OBJECTIVES: Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions.

METHODS: Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect.

RESULTS: Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively.

CONCLUSIONS: M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging.

Aesthetic Plastic Surgery

2022 February; 46(1):373-381

PMID: 34341855

PMCID: PMC8831259

Combining calcium hydroxylapatite and hyaluronic acid fillers for aesthetic indications: efficacy of an innovative hybrid filler

Nabil Fakih-Gomez, Jonathan Kadouck

BACKGROUND: Limited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA).

METHODS: The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors' aesthetic practices. The midface and lower face were injected. Patients' records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded.

RESULTS: A total of 41 patients were included, all females with a mean age of 47.5 years (range 21-63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28-1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43-0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported.

CONCLUSION: The results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline.

Aesthetic Plastic Surgery

2021 August; 45(4):1792-1801

PMID: 33876290

Comparative evaluation of safety and efficacy of a novel hyaluronic acid-polynucleotide/poly-L-lactic acid composite dermal filler

Hyunsuk Oh, Sangno Lee, Jungtae Na, Ju Hee Kim

BACKGROUND: Poly-L-lactic acid (PLLA) is widely used in tissue engineering. The natural polymer hyaluronic acid (HA) shows excellent biocompatibility and affects cell signaling, proliferation, and differentiation. In addition, a polynucleotide (PN) induces cell growth of human skin fibroblasts and osteoblasts.

OBJECTIVE: In this study, we evaluated the properties, safety, and efficacy of a novel composite filler consisting of cross-linked HA with PN in combination with monodisperse PLLA microspheres manufactured using Inventage Lab Precision Particle Fabrication method.

MATERIALS AND METHODS: The composition of the filler and characteristics of the microspheres were examined via scanning electron microscopy, particle size analysis, gel permeation chromatography, and rheology and osmolality measurement. Additionally, safety and efficacy of HA-PN/PLLA composite filler were conducted in in vitro and in vivo.

RESULTS: Analysis of PLLA microspheres revealed spherical surfaces and a narrower particle size distribution than that in PLLA filler. HA-PN/PLLA composite filler had higher viscosity and elasticity values and similar osmolality as compared to those of HA and PN fillers. The nontoxicity in in vitro and in vivo tests reflected that the composite filler may be safe for human use. In addition, the composite filler maintained a more stable volume than did HA filler for 24 weeks after administration in HWY/Slc hairless rats. Furthermore, the results support the effect of HA-PN/PLLA in restoring skin structure.

CONCLUSION: Altogether, these data suggest that the novel composite filler might be a safe and effective option in terms of tissue integration, clinical management during delivery and high esthetic durability.



Questo contenuto appartiene alla categoria riservata ai Soci Agorà:

clicca su "Punto di accesso sezione riservata ai Soci" per prendere visione dell'articolo in versione integrale.

Non sei ancora socio?

Clicca sull'immagine per prendere visione dei servizi associativi ed entrare a far parte della Società Scientifica Agorà

Gruppo di medici associati - Agorà Scuola di Medicina Estetica a Milano


bottom of page