Ultrasound characteristics of hyaluronic acid fillers tissue integration and hyaluronidase-mediated degradation

Close metadata

BACKGROUND

Currently, the study of the efficacy and safety of hyaluronic acid (HA) fillers is not limited to clinical observations. Modern non-invasive techniques, in particular, ultrasound (US) imaging of soft tissues allows detailed assessment of the results of aesthetic treatment.

OBJECTIVE

To describe the processes of HA fillers tissue integration and hyaluronidase-mediated degradation.

MATERIAL AND METHODS

The study involved 8 patients who underwent aesthetic facial treatment with HA-based fillers produced by technology MCO. Tissue integration and degradation by hyaluronidase were assessed based on US examination.

RESULTS

After injection of HA fillers, US scan showed a globular pattern with anechoic zones indicating fluid content. There were no signs of vascularization or infiltration of surrounding tissues. The absence of signs of swelling and fibrosis and the appearance of hypoechoic inclusions along the periphery of the filler indicate a physiological process of integration of the filler into the surrounding tissues. Initial signs of tissue integration of the filler were observed 3—4 weeks after injection. The doses of hyaluronidase (bovhyaluronidase azoximer) that can be used to degrade 0.1 ml of HA filler ranged from 100 to 300 IU depending on the rheological properties of the gel. The dose of hyaluronidase can be increased 3 times in the case of vascular occlusion.

CONCLUSION

Tissue integration of the studied fillers occurs in the early stages without signs of an inflammatory response including edema, infiltration, proliferation of local vascular networks. HA fillers produced by MCO technology are rapidly degrades by exogenous hyaluronidase.

Keywords:

ultrasound

aesthetic medicine

dermal fillers

hyaluronidase

Authors:

Kapuler O.M.

Center of Cosmetology, Plastic and Reconstructive Surgery

ORCID: 0000-0001-5714-5495

Razumovskaya E.A.

Renaissance Cosmetology Clinic

ORCID: 0000-0001-7879-6625

Murakov S.V.

Academy of Postgraduate Education under Federal Scientific and Clinical Center of Federal Medical-Biological Agency of Russia;
Lotos 288, LLC

ORCID: 0000-0003-4330-2570

Glavnova A.M.

Lotos 288, LLC

ORCID: 0009-0008-6734-1674

Received:

27.03.2024

Accepted:

20.04.2024

List of references:

Brandt FS, Cazzaniga A. Hyaluronic acid gel fillers in the management of facial aging. Clin Interv Aging. 2008;3(1):153-159. https://doi.org/10.2147/cia.s2135
Wongprasert P, Dreiss CA, Murray G. Evaluating hyaluronic acid dermal fillers: A critique of current characterization methods. Dermatol Ther. 2022;35(6):e15453. https://doi.org/10.1111/dth.15453
Laurano R, Boffito M, Cassino C, Liberti F, Ciardelli G, Chiono V. Design of Injectable Bioartificial Hydrogels by Green Chemistry for Mini-Invasive Applications in the Biomedical or Aesthetic Medicine Fields. Gels. 2023;9(1):59. https://doi.org/10.3390/gels9010059
Vasvani S, Kulkarni P, Rawtani D. Hyaluronic acid: A review on its biology, aspects of drug delivery, route of administrations and a special emphasis on its approved marketed products and recent clinical studies. Int J Biol Macromol. 2020;151:1012-1029. Epub 2019 Nov 9. PMID: 31715233. https://doi.org/10.1016/j.ijbiomac.2019.11.066
Maytin EV. Hyaluronan: More than just a wrinkle filler. Glycobiology. 2016; 26(6):553-559. https://doi.org/10.1093/glycob/cww033
Vladimirova EV, Murakov SV, Sanches EA, Markova YuA, Bagramova GE. Hyaluronidase in cosmetology: a review of evidence-based medicine data. Meditsinskii vestnik Severnogo Kavkaza. 2020;15(3):456-460. (In Russ.). https://doi.org/10.14300/mnnc.2020.15108
Safran T, Swift A, Cotofana S, Nikolis A. Evaluating safety in hyaluronic acid lip injections. Expert Opin Drug Saf. 2021;20(12):1473-1486. https://doi.org/10.1080/14740338.2021.1962283
Urdiales-Gálvez F, Barres-Caballer J, Carrasco-Sánchez S. Ultrasound assessment of tissue integration of the crosslinked hyaluronic acid filler VYC-25L in facial lower-third aesthetic treatment: A prospective multicenter study. J Cosmet Dermatol. 2021;20(5):1439-1449. https://doi.org/10.1111/jocd.13632
Qiao J, Jia QN, Jin HZ, Li F, He CX, Yang J, Zuo YG, Fu LQ. Long-Term Follow-Up of Longevity and Diffusion Pattern of Hyaluronic Acid in Nasolabial Fold Correction through High-Frequency Ultrasound. Plast Reconstr Surg. 2019;144(2):189e-196e.
Granieri G, Oranges T, Morganti R, Janowska A, Romanelli M, Manni E, Dini V. Ultra-high frequency ultrasound detection of the dermo-epidermal junction: Its potential role in dermatology. Exp Dermatol. 2022;31(12): 1863-1871. https://doi.org/10.1111/exd.14664
Oranges T, Janowska A, Scatena C, Faita F, Lascio ND, Izzetti R, Fidanzi C, Romanelli M, Dini V. Ultra-High Frequency Ultrasound in Melanoma Management: A New Combined Ultrasonographic-Histopathological Approach. J Ultrasound Med. 2023;42(1):99-108. https://doi.org/10.1002/jum.16096
Izzetti R, Oranges T, Janowska A, Gabriele M, Graziani F, Romanelli M. The Application of Ultra-High-Frequency Ultrasound in Dermatology and Wound Management. Int J Low Extrem Wounds. 2020;19(4):334-340. https://doi.org/10.1177/1534734620972815
Izzetti R, Oranges T, Janowska A, Gabriele M, Graziani F, Romanelli M. The Application of Ultra-High-Frequency Ultrasound in Dermatology and Wound Management. Int J Low Extrem Wounds. 2020 Dec;19(4):334. https://doi.org/10.1177/1534734620972815
Janowska A, Oranges T, Granieri G, Romanelli M, Fidanzi C, Iannone M, Dini V. Non-invasive imaging techniques in presurgical margin assessment of basal cell carcinoma: Current evidence. Skin Res Technol. 2023;29(2):e13271. https://doi.org/10.1111/srt.13271
Herrmann JL, Hoffmann RK, Ward CE, Schulman JM, Grekin RC. Biochemistry, Physiology, and Tissue Interactions of Contemporary Biodegradable Injectable Dermal Fillers. Dermatol Surg. 2018;44(1):S19-S31. https://doi.org/10.1097/DSS.0000000000001582
Wortsman X. Common Applications of Ultrasound in Cosmetic and Plastic Surgery. In Atlas of Dermatologic Ultrasound, 1st ed.; Springer International Publishing: Berlin/Heidelberg, Germany; 2018;181-189.
Liang J, Jiang D, Noble PW. Hyaluronan as a therapeutic target in human diseases. Adv Drug Deliv Rev. 2016;97:186-203. https://doi.org/10.1016/j.addr.2015.10.017
King M, Convery C, Davies E. This month’s guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4). J Clin Aesthet Dermatol. 2018;11(6): E61-E68.
Kalmanson OA, Misch ES, Terella A. Hyaluronic acid fillers may be longer-lasting than previously described: A case report of delayed filler-associated facial cellulitis. JPRAS Open. 2022;33:37-41. https://doi.org/10.1016/j.jpra.2022.05.011
Josse G, Haftek M, Gensanne D, Turlier V, Mas A, Lagarde JM, Schmitt AM. Follow up study of dermal hyaluronic acid injection by high frequency ultrasound and magnetic resonance imaging. J Dermatol Sci. 2010;57(3): 214-216. https://doi.org/10.1016/j.jdermsci.2009.12.012
Kapuler OM, Razumovskaya EA, Chaikovskaya EA, Murakov SV. You can’t stop adding. Where should I put a comma in an injectable facial plastic surgery? Esteticheskaya meditsina. 2024;XXIII(1):48-54. (In Russ.).
Murakov SV, Vladimirova EV, Sanches EA., Markova YuA. Oslozhneniya in’ektsionnoi konturnoi plastiki. Uchebnoe posobie. M.: OOO «Print»; 2023. ISBN 978-5-9631-1048-5. (In Russ.).

Close metadata