Cross-sectional study of the microbiological safety profile of reusing hyaluronic acid fillers

ViSCNOVAS: A Novel Classification System for Hyaluronic Acid-Based Gels in Orthobiologic Products and Regenerative Medicine

Hyaluronic acid (HA), a naturally occurring polysaccharide, holds immense potential in regenerative medicine due to its diverse biological functions and clinical applications, particularly in gel formulations. This paper presents a comprehensive exploration of HA, encompassing its origins, molecular characteristics, and therapeutic roles in gel-based interventions. Initially identified in bovine vitreous humor, HA has since been found in various tissues and fluids across vertebrate organisms and bacterial sources, exhibiting consistent physicochemical properties. The synthesis of HA by diverse cell types underscores its integral role in the extracellular matrix and its relevance to tissue homeostasis and repair. Clinical applications of HA, particularly in addressing musculoskeletal ailments such as osteoarthritis, are examined, highlighting its efficacy and safety in promoting tissue regeneration and pain relief. Building upon this foundation, a novel classification system for HA-based interventions is proposed, aiming to standardize treatment protocols and optimize patient outcomes. The ViSCNOVAS classification system refers to viscosity, storage, chain, number, origin, volume, amount, and size. This classification is specifically designed for HA-based orthobiologic products used in regenerative medicine, including orthopedics, sports medicine, aesthetics, cosmetic dermatology, and wound healing. It aims to provide clinicians with a structured framework for personalized treatment strategies. Future directions in HA research are also discussed, emphasizing the need for further validation and refinement of the proposed classification system to advance the field of regenerative medicine. Overall, this manuscript elucidates the biological functions of hyaluronic acid and its potential in clinical practice while advocating for standardization to enhance patient care in various regenerative applications.

Hyaluronic Acid Fillers, Needle Contamination by Fastidious Microorganisms, and Risk of Complications

BACKGROUND

Complications are becoming ever more common with the increased use of hyaluronic acid (HA) fillers in aesthetic medicine. Complications due to needle contamination with fastidious microorganisms are no exception.

OBJECTIVE

To perform, in a top Italian aesthetic medicine facility, what the authors think is the first monitoring program of microbial needle contamination of cross-linked HA gel fillers after the prefilled syringes with gel residues were stored for retouches after the first aesthetic procedure.

METHODS

Needle contamination monitoring study, performed between January and November 2019, on 35 needles (caliber, 30 and 27 G) stored at 4°C in their resealed filler packages for possible retouch after a first aesthetic treatment involving the middle and lower facial thirds. Women's age: 35 to 70 years old.

RESULTS

The search for contaminating agents of the 3 monitored bacterial contaminants ( Staphylococcus aureus , Streptococcus pyogenes , and anaerobes) as well as yeasts and molds always tested negative. In the days and months after treatment, no patients in post-treatment controls showed evidence of infection in the treated areas.

CONCLUSION

The observational retrospective study confirms that good storage conditions, including monitored refrigeration, avoid the risk of contamination of partially used HA gel fillers by fastidious microorganisms.

Review of sterility of reused stored dermal filler

OBJECTIVE

This review is primarily focusing on the legitimate concern about bacterial contamination after reuse of stored filling syringes and its associated risk of infections.

METHODS

A comprehensive literature review was done through searching the PubMed, Medline, Google Scholar, and ResearchGate without setting a time limit. The following search terms were used soft tissue filler, hyaluronic acid, or calcium hydroxylapatite AND sterility, safety, retouch, touch up, or reuse.

RESULT

Immediate replacing needles used in injection with a sterile substitute before storage was associated with no growth in one study (Archives of Facial Plastic Surgery, 11, 2009, 271) and growth in another study (Dermatologic Surgery, 2017, 43, 967). There was no reported infection in the only patient-based study that examined the adverse events among patients injected with stored hyaluronic acid filler syringes.

CONCLUSION

All published research showed that stored fillers are safe and do not increase the risk of biofilm formation.