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交联透明质酸真皮填充剂可注射性的临床观点:一种通过注射者间评估对商业产品进行基准测试的标准化方法。

Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments.

作者信息

Micheels Patrick, Porcello Alexandre, Bezzola Thierry, Perrenoud Daniel, Quinodoz Pierre, Kalia Yogeshvar, Allémann Eric, Laurent Alexis, Jordan Olivier

机构信息

Private Medical Practice, CH-1224 Chêne-Bougeries, Switzerland.

School of Pharmaceutical Sciences, University of Geneva, CH-1211 Geneva, Switzerland.

出版信息

Gels. 2024 Jan 26;10(2):101. doi: 10.3390/gels10020101.


DOI:10.3390/gels10020101
PMID:38391431
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10888303/
Abstract

The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM, Restylane, BELOTERO, TEOSYAL RHA, and STYLAGE brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.

摘要

交联透明质酸(HA)真皮填充剂的可注射性受聚合物浓度、聚合物交联类型和程度、利多卡因或其他功能性辅料的存在、注射器类型以及注射技术的影响。成品的可注射性是临床注射者的关键质量属性,因为它对美容医学中产品的适用性和易用性有很大影响。虽然各设备制造商提供了可注射产品的挤压力规格,但对于希望从可注射性角度比较产品品牌和技术的注射者来说,这些数据集的定性信息价值较低。因此,本研究使用各种可注射性基准设置对28种交联HA真皮填充剂(乔雅登、瑞蓝、贝洛特罗、泰奥菲洛RHA和丝丽品牌)进行了比较评估,以增强临床相关性。由三名专业且经验丰富的临床医生进行手动产品注射,而使用纹理分析仪进行自动产品挤出。将各种水凝胶产品注射到离体人体皮肤和SimSkin皮肤等效物中,以适当考虑注射相关的反压力。可注射性结果显示,产品品牌之间和品牌内部存在重要差异,局部麻醉剂利多卡因、HA含量和针规尺寸有很大影响。对所研究的产品进行了批判性评估,特别是从基于制造工艺和基于临床应用便利性的角度,以各自的实验可注射性质量水平为中心。一般来说,已证实每种基于HA的真皮填充剂产品都需要特定的专业知识才能实现最佳注射,这主要是由于其粘弹性特征和可注射性属性不同。总体而言,本研究提出了基于证据和以临床为导向的基本原理要素,证实了注射者使用他们有经验且操作舒适的可注射产品对于优化临床结果的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/87d1de0e808b/gels-10-00101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/46c715dc72af/gels-10-00101-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/0115fbcd293b/gels-10-00101-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/ebf126d839db/gels-10-00101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/44d6ec2cdcfd/gels-10-00101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/87d1de0e808b/gels-10-00101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/46c715dc72af/gels-10-00101-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/0115fbcd293b/gels-10-00101-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/ebf126d839db/gels-10-00101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/44d6ec2cdcfd/gels-10-00101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a7/10888303/87d1de0e808b/gels-10-00101-g005.jpg

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本文引用的文献

[1]
Investigation of Crosslinking Parameters and Characterization of Hyaluronic Acid Dermal Fillers: From Design to Product Performances.

Gels. 2023-9-9

[2]
The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis.

Aesthetic Plast Surg. 2024-2

[3]
Head-to-head comparison of 4 hyaluronic acid dermal fillers for lip augmentation: A multicenter randomized, quadruple-blind, controlled clinical trial.

J Am Acad Dermatol. 2023-4

[4]
The Rheology and Physicochemical Characteristics of Hyaluronic Acid Fillers: Their Clinical Implications.

Int J Mol Sci. 2022-9-10

[5]
Hyaluronic Acid Basics and Rheology.

Facial Plast Surg Clin North Am. 2022-8

[6]
Evaluating hyaluronic acid dermal fillers: A critique of current characterization methods.

Dermatol Ther. 2022-6

[7]
Chemical Modification of Hyaluronan and Their Biomedical Applications.

Front Chem. 2022-2-11

[8]
The Degradation of Hyaluronan in the Skin.

Biomolecules. 2022-2-3

[9]
Rheologic and Physicochemical Characteristics of Hyaluronic Acid Fillers: Overview and Relationship to Product Performance.

Facial Plast Surg. 2022-4

[10]
Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products).

Aesthet Surg J. 2022-8-1

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