Skip to main content

Advertisement

SpringerLink
Log in

The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study

  • Original Article
  • Non-Surgical Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

A novel auto-cross-linked hyaluronic acid formulation (HA-ACP) has been proposed as a treatment for skin rejuvenation. This prospective pilot study aims to assess its tolerability and performance in the treatment of skin aging of the décolletage.

Methods

Fifteen women (mean age 49.0 ± 8.0  (range 30–65)) who complained about the appearance of their décolletage were prospectively enrolled and treated with three sets of HA-ACP (IAL-SYSTEM ACP®) intradermal injections, administered three weeks apart. Control visits followed at 80 and 120 days from enrollment. The rejuvenating effect was assessed using the Beagley–Gibson and Fabi–Bolton scores. The investigators and the subjects also subjectively assessed skin appearance using a 1–10 scale. The rejuvenating effect and its persistence were assessed comparing the scores collected at the different experimental times by means of Wilcoxon rank tests. Adverse events and their duration were recorded and compared to those reported in the literature.

Results

The HA-ACP formulation provided a significant improvement according to the Beagley–Gibson score (p < 0.005) at all time points. At the 120-day follow-up, the Fabi–Bolton score was significantly improved with respect to baseline (p < 0.05). The rejuvenating effect persisted unaltered between the 80-day and the 120-day visits. At the 120-day visit, the subjects’ and investigators’ subjective scores were between 8 and 10 in most cases. No unexpected adverse effects were observed. All adverse effects were well tolerated and disappeared over a short period.

Conclusions

The HA-ACP treatment under investigation is safe, well tolerated, and provides effective and long-lasting décolletage rejuvenation.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Peterson JD, Goldman MP (2011) Rejuvenation of the aging chest: a review and our experience. Dermatol Surg 37:555–571

    Article  CAS  PubMed  Google Scholar 

  2. Peterson JD, Kilmer SL (2016) Three-Dimensional Rejuvenation of the Décolletage. Dermatol Surg 42(Suppl 2):S101–S107

    Article  CAS  PubMed  Google Scholar 

  3. Mazzuco R, Hexsel D (2009) Poly-L-lactic acid for neck and chest rejuvenation. Dermatol Surg 35:1228–1237

    Article  CAS  PubMed  Google Scholar 

  4. Otberg N, Richter H, Schaefer H, Blume-Peytavi U, Sterry W, Lademann J (2004) Variations of hair follicle size and distribution in different body sites. J Invest Dermatol 122(1):14–19

    Article  CAS  PubMed  Google Scholar 

  5. Hwang K, Kim JY, Lim JH (2017) Anatomy of the platysma muscle. J Craniofac Surg 28(2):539–542

    Article  PubMed  Google Scholar 

  6. Becker-Wegerich PM, Rauch L, Ruzicka T (2002) Botulinum toxin A: successful décolleté rejuvenation. Dermatol Surg 28(2):168–171

    Article  PubMed  Google Scholar 

  7. Wlaschek M, Tantcheva-Poor I, Naderi L, Ma W, Schneider LA, Razi-Wolf Z, Schuller J, Scharffetter-Kochanek K (2001) Solar uv irradiation and dermal photoaging. J Photochem Photobiol B 63:41–51

    Article  CAS  PubMed  Google Scholar 

  8. Kammeyer A, Luiten RM (2015) Oxidation events and skin aging. Ageing Res Rev 21:16–29

    Article  CAS  PubMed  Google Scholar 

  9. Yaar M, Eller MS, Gilchrest BA (2002) Fifty years of skin aging. J Investig Dermatol Symp Proc 7(1):51–58

    Article  PubMed  Google Scholar 

  10. Rittié L, Fisher GJ (2015) Natural and sun-induced aging of human skin. Cold Spring Harb Perspect Med 5(1):a015370

    Article  PubMed  PubMed Central  Google Scholar 

  11. Quan T, Fisher GJ (2015) Role of age-associated alterations of the dermal extracellular matrix microenvironment in human skin aging: a mini-review. Gerontology 61(5):427–434

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sherratt MJ (2013) Age-related tissue stiffening: cause and effect. Adv Wound Care (New Rochelle) 2(1):11–17

    Article  Google Scholar 

  13. Kurban RS, Bhawan J (1990) Histologic changes in skin associated with aging. J Dermatol Surg Oncol 16(10):908–914

    Article  CAS  PubMed  Google Scholar 

  14. El-Domyati M, Attia S, Saleh F, Brown D, Birk DE, Gasparro F, Ahmad H, Uitto J (2002) Intrinsic aging vs. photoaging: a comparative histopathological, immunohistochemical, and ultrastructural study of skin. Exp Dermatol 11(5):398–405

    Article  CAS  PubMed  Google Scholar 

  15. Gniadecka M, Nielsen OF, Wessel S, Heidenheim M, Christensen DH, Wulf HC (1998) Water and protein structure in photoaged and chronically aged skin. J Invest Dermatol 111(6):1129–1133

    Article  CAS  PubMed  Google Scholar 

  16. Lee DH, Oh JH, Chung JH (2016) Glycosaminoglycan and proteoglycan in skin aging. J Dermatol Sci 83(3):174–181

    Article  CAS  PubMed  Google Scholar 

  17. Oh JH, Kim YK, Jung JY, Shin JE, Kim KH, Cho KH, Eun HC, Chung JH (2011) Intrinsic aging- and photoaging-dependent level changes of glycosaminoglycans and their correlation with water content in human skin. J Dermatol Sci 62(3):192–201

    Article  CAS  PubMed  Google Scholar 

  18. Tzellos TG, Klagas I, Vahtsevanos K, Triaridis S, Printza A, Kyrgidis A, Karakiulakis G, Zouboulis CC, Papakonstantinou E (2009) Extrinsic ageing in the human skin is associated with alterations in the expression of hyaluronic acid and its metabolizing enzymes. Exp Dermatol 18(12):1028–1035

    Article  CAS  PubMed  Google Scholar 

  19. Fraser JR, Laurent TC, Laurent UB (1997) Hyaluronan: its nature, distribution, functions and turnover. J Int Med 242(1):27–33

    Article  CAS  Google Scholar 

  20. Cowman MK, Matsuoka S (2005) Experimental approaches to hyaluronan structure. Carbohydr Res 340(5):791–809

    Article  CAS  PubMed  Google Scholar 

  21. Dea IC, Moorhouse R, Rees DA, Arnott S, Guss JM, Balazs EA (1973) Hyaluronic acid: a novel, double helical molecule. Science 179(4073):560–562

    Article  CAS  PubMed  Google Scholar 

  22. Tezel A, Fredrickson GH (2008) The science of hyaluronic acid dermal fillers. J Cosmet Laser Ther 10(1):35–42. Erratum in: J Cosmet Laser Ther. 2014;16(1):45

  23. Matarasso SL (2004) Understanding and using hyaluronic acid. Aesthet Surg J 24(4):361–364

    Article  PubMed  Google Scholar 

  24. Collins MN, Birkinshaw C (2008) Physical properties of crosslinked hyaluronic acid hydrogels. J Mater Sci Mater Med 19(11):3335–3343

    Article  CAS  PubMed  Google Scholar 

  25. Highley CB, Prestwich GD, Burdick JA (2016) Recent advances in hyaluronic acid hydrogels for biomedical applications. Curr Opin Biotechnol 40:35–40

    Article  CAS  PubMed  Google Scholar 

  26. Beasley KL, Weiss MA, Weiss RA (2009) Hyaluronic acid fillers: a comprehensive review. Facial Plast Surg 25(2):86–94

    Article  CAS  PubMed  Google Scholar 

  27. Greene JJ, Sidle DM (2015) The hyaluronic acid fillers: current understanding of the tissue device interface. Facial Plast Surg Clin North Am 23(4):423–432

    Article  PubMed  Google Scholar 

  28. Sparavigna A, Fino P, Tenconi B, Giordan N, Amorosi V, Scuderi N (2014) A new dermal filler made of cross-linked and auto-cross-linked hyaluronic acid in the correction of facial aging defects. J Cosmet Dermatol 13(4):307–314

    Article  PubMed  Google Scholar 

  29. Alessandrini A, Fino P, Giordan N, Amorosi V, Scuderi N (2015) Evaluation of a new hyaluronic acid dermal filler for volume restoration. J Cosmet Laser Ther 17(6):335–342

    Article  PubMed  Google Scholar 

  30. Pluda S, Pavan M, Galesso D, Guarise C (2016) Hyaluronic acid auto-crosslinked polymer (ACP): reaction monitoring, process investigation and hyaluronidase stability. Carbohydr Res 433:47–53

    Article  CAS  PubMed  Google Scholar 

  31. Renier D, Bellato P, Bellini D, Pavesio A, Pressato D, Borrione A (2005) Pharmacokinetic behaviour of ACP gel, an autocrosslinked hyaluronan derivative, after intraperitoneal administration. Biomaterials 26(26):5368–5374

    Article  CAS  PubMed  Google Scholar 

  32. Wohlrab J, Wohlrab D, Neubert RH (2013) Comparison of noncross-linked and cross-linked hyaluronic acid with regard to efficacy of the proliferative activity of cutaneous fibroblasts and keratinocytes in vitro. J Cosmet Dermatol 12(1):36–40

    Article  PubMed  Google Scholar 

  33. Alessandrini A, Di Bartolo C, Pavesio A, Pressato D (2006) ACP gel: a new hyaluronic acid-based injectable for facial rejuvenation. Preclinical data in a rabbit model. Plast Reconstr Surg 118(2):341–346

    Article  CAS  PubMed  Google Scholar 

  34. Di Pietro A, Colomba DM, Giordan N (2007) Facial wrinkles correction and skin rejuvenation (biostimulation) by auto-cross-linked hyaluronic acid. J Plast Dermatol 3:2–5

    Google Scholar 

  35. Holman CD, Armstrong BK, Evans PR, Lumsden GJ, Dallimore KJ, Meehan CJ, Beagley J, Gibson IM (1984) Relationship of solar keratosis and history of skin cancer to objective measures of actinic skin damage. Br J Dermatol 110(2):129–138

    Article  CAS  PubMed  Google Scholar 

  36. Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871

    Article  CAS  PubMed  Google Scholar 

  37. Rubin M (1995) Manual of chemical peels: superficial and medium depth. Lippincott & Williams, Philadelphia

    Google Scholar 

  38. Fabi S, Bolton J, Goldman MP, Guiha I (2012) The Fabi–Bolton chest wrinkle scale: a pilot validation study. J Cosmet Dermatol 11(3):229–234

    Article  PubMed  Google Scholar 

  39. Russo T, Piccolo V, Lallas A, Argenziano G (2016) Recent advances in dermoscopy. F1000Res. 2016, 5. pii: F1000 Faculty Rev 184

  40. Lallas A, Giacomel J, Argenziano G, García-García B, González-Fernández D, Zalaudek I, Vázquez-López F (2014) Dermoscopy in general dermatology: practical tips for the clinician. Br J Dermatol 170(3):514–526

    Article  CAS  PubMed  Google Scholar 

  41. Choi YH, Kim D, Hwang E, Kim BJ (2014) Skin texture aging trend analysis using dermoscopy images. Skin Res Technol. 20(4):486–497

    Article  PubMed  Google Scholar 

  42. Isik B, Gurel MS, Erdemir AT, Kesmezacar O (2013) Development of skin aging scale by using dermoscopy. Skin Res Technol 19(2):69–74

    Article  PubMed  Google Scholar 

  43. Vanaman M, Fabi SG (2015) Décolletage: regional approaches with injectable fillers. Plast Reconstr Surg 136(5 Suppl):276S–281S

    Article  CAS  PubMed  Google Scholar 

  44. Kerscher M, Bayrhammer J, Reuther T (2008) Rejuvenating influence of a stabilized hyaluronic acid-based gel of nonanimal origin on facial skin aging. Dermatol Surg 34(5):720–726

    CAS  PubMed  Google Scholar 

  45. Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J (2009) Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg 35(Suppl 1):302–312

    Article  CAS  PubMed  Google Scholar 

  46. Wang F, Garza LA, Kang S, Varani J, Orringer JS, Fisher GJ, Voorhees JJ (2007) In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 143(2):155–163

    Article  CAS  PubMed  Google Scholar 

  47. Chiang YZ, Pierone G, Al-Niaimi F (2017) Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol 31(3):405–413

    Article  CAS  PubMed  Google Scholar 

  48. Salval A, Ciancio F, Margara A, Bonomi S (2017) Impending facial skin necrosis and ocular involvement after dermal filler injection: a case report. Aesthetic Plast Surg. 2017 May 31. [Epub ahead of print]

Download references

Author information

Authors and Affiliations

  1. School of Aesthetic Medicine, International Foundation Fatebenefratelli Rome, Lungotevere de’ Cenci 5/7, 00186, Roma, Italy

    Andrea Alessandrini

  2. Aesthetic Surgery and Medicine, Anti Ageing Center, Viale Liegi, 34, 00198, Roma, Italy

    Andrea Alessandrini

  3. Graduate at International Foundation Fatebenefratelli Rome, School of Aesthetic Medicine, Private Practice Aesthetic Medicine, Rome, Italy

    Kseniya Tretyakova

Authors
  1. Andrea Alessandrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kseniya Tretyakova
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Alessandrini.

Ethics declarations

Conflict of interest

The authors declare they have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alessandrini, A., Tretyakova, K. The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study. Aesth Plast Surg 42, 520–529 (2018). https://doi.org/10.1007/s00266-017-1022-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-017-1022-9

Keywords

Search

Navigation