Designing topical hyaluronic acid technology-Size does matter .

INTRODUCTION: Hyaluronic acid (HA) plays an important role in cellular and extracellular matrix (ECM) homeostasis. Recent studies demonstrate that low molecular weight (MW) HA has pro-inflammatory characteristics while high MW HA is considered anti-inflammatory and regenerative. In formulating a topical HA product, the possibility of creating a focused high MW HA technology was posed, combining external surface high MW HA constituents with active agents promoting fibroblast production of high MW in the depths of the dermis. METHODS: Human dermal fibroblasts and keratinocytes were treated with various agents, and RNA sequencing (RNA-seq) was conducted to identify genes involved in HA synthesis. HA production by fibroblasts was assessed by collecting the culture supernatant, concentrating the protein, and conducting polyacrylamide gel electrophoresis (PAGE). The gel was stained with Stains-All to identify bands relative to known HA products of different MWs. Subsequently, the supernatants were treated with hyaluronidase to confirm the bands corresponded to HA. RESULTS: The RNA-seq results revealed a variety of agents upregulated HA-related genes. However, a potent upregulation of HA synthesis gene was observed by hexapeptide-11 in the keratinocytes and a newly identified proprietary octapeptide in the fibroblasts. PAGE demonstrated not only robust production of HA by octapeptide, but significantly, the HA produced was ~2 Mega Daltons in size. Octapeptide was the most potent stimulator among the tested agents. CONCLUSION: Comprehensive in vitro testing identified a group of active agents that stimulated high MW HA production. This novel approach to HA topical application with exclusively high MW HA production should maximize hydration capacity while encouraging regenerative activity within the ECM. Multi-center trials are underway.

Physician survey on pre-/postprocedure measures for injectable treatments.

INTRODUCTION: Every year in the United States, over 1 billion dollars are spent on aesthetic injectables, such as soft tissue fillers and neurotoxins. In 2018, the total amount of injectable treatments performed surpassed 2 671 130 procedures. While often mild and transient, adverse events (AEs) can occur following these procedures. AEs may include common side effects such as bruising, or rare, but serious AEs such as infections. While previous investigators have evaluated methods of reducing risks of AEs due to the treatment procedure itself, few investigations have evaluated measures employed before and/or after treatment (ie, peri-procedure). METHODS: An electronic survey was sent to aesthetic clinicians with experience performing injectable treatments. The survey collected information regarding general information (eg, demographics and specialty), type of injectable devices used, current peri-procedures, and an exploration of future options for peri-procedural measures. RESULTS: Most aesthetic clinicians did not use prophylactic topical or systemic antimicrobials, nor prophylactic topical antiviral therapy. However, approximately 65% of clinicians reported using prophylactic systemic antivirals for patients with a history of herpes simplex virus. A variety of products were used to prepare the skin prior to injectable procedures. Postprocedure, multiple over-the-counter wound repair products were recommended by >70% of injectors. However, there was a large variety of products recommended with no majority consensus. CONCLUSIONS: Currently, there are no peri-procedural standards of practice when performing aesthetic injectable treatments. Efforts are underway for the development of best-practice algorithms.

Pre-/postprocedure measures for minimally invasive, nonenergy aesthetic treatments: A survey.

BACKGROUND: Non-energy based devices used in aesthetic medicine include treatments such as microdermabrasion, microneedling, threads, and chemical peels. Practitioners may use these devices to address signs of facial photo- and chronological aging (fine lines, wrinkles, pigmentary, and skin textural changes). Currently, consensus papers or guidelines are lacking in peri-procedural measures or their potential role in the prevention or treatment of adverse events in non-energy based aesthetic procedures. AIMS: To explore current practices using non-energy devices, a survey was developed to identify trends in peri-procedure treatment measures. PATIENTS/METHODS: The survey was sent electronically to 2000 dermatologists and 388 plastic surgeons. Randomly selected sites included those practicing medical aesthetics using non-energy devices for facial rejuvenation. The survey gathered information related to practitioner demographics, types of devices used, and peri-procedural measures for non-energy device-based treatments. RESULTS: The survey was active from February to May 2019. Nine hundred and twenty clinicians opened the survey, and 109 surveys were completed, providing a total response rate of 11.8%. The results revealed inconsistencies with regards to skin preparation strategies and post-procedure care. While the majority of clinicians indicated a need for topical treatments to reduce inflammation, prevent scarring, and shorten time to healing, a standard of care was not observed. CONCLUSIONS: The results of this survey confirm a lack of standardized measures for peri-procedural care when using non-energy based devices for aesthetic medicine treatments. These findings emphasize the need for evidence-based recommendations for optimizing patient outcomes, reducing and managing adverse events, and shortening time to healing.