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Massidda E, Ciampa S, Iozzo I, Emanuele E, Minoretti P. Real-World Outcomes of Lip Augmentation Using a Hyaluronic Acid-Based Filler With Low 1,4- Butanediol Diglycidyl Ether Content: A Prospective, Open-Label, Multicenter, Post-marketing Study. Cureus 2024; 16:e53513. [PMID: 38439998 PMCID: PMC10911686 DOI: 10.7759/cureus.53513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Background 1,4-butanediol diglycidyl ether (BDDE) is the most common cross-linker used to produce hyaluronic acid (HA)-based dermal fillers. However, BDDE may have cytotoxic and potentially mutagenic effects, raising safety concerns. Consequently, manufacturers are developing new HA filler formulations with reduced BDDE levels to mitigate potential biological risks. Here, we sought to evaluate the clinical outcomes of lip augmentation performed using an HA-based filler with a reduced BDDE content (Agex Fill Volume®; Biodue SpA, Barberino Tavarnelle, Italy) in a real-world clinical setting. Methods This was a prospective, open-label, multicenter, post-marketing study conducted over six months. Thirty adult subjects (29 women and one man) who desired a ≥1-point improvement on the validated Lip Fullness Scale 2 (LFS2) were enrolled. The primary efficacy endpoint was the post-procedural increase in the investigator-reported LFS2 compared to baseline. Other endpoints included self-perceived happiness assessed using the Happiness Measure Scale (HMS) and safety. Results Of the study participants, 73% (22/30) demonstrated an improvement of at least one point in their LFS2 scores immediately after treatment compared to baseline, thus qualifying as responders. Six months later, the responder rate, based on LFS2 scores, remained steady at 66.7% (20/30). Importantly, these aesthetic improvements were consistently associated with a positive impact on subject-reported HMS, with a significant difference (p < 0.001) between post-treatment and baseline scores. All adverse events (AEs) reported after treatment were mild. Conclusions Agex Fill Volume®, a HA filler with low BDDE content, provides a safe and effective option for enhancing lip volume in real-world aesthetic settings.
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Affiliation(s)
- Enrico Massidda
- Dermatology, Italian Society of Aesthetic Medicine, Cagliari, ITA
| | - Sonia Ciampa
- Dermatology, Poliambulatorio Rimedical, Santarcangelo di Romagna, ITA
| | - Ivano Iozzo
- Dermatology, Iozzo Antonucci Medical Center, Bologna, ITA
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Hinsenkamp A, Ézsiás B, Pál É, Hricisák L, Fülöp Á, Besztercei B, Somkuti J, Smeller L, Pinke B, Kardos D, Simon M, Lacza Z, Hornyák I. Crosslinked Hyaluronic Acid Gels with Blood-Derived Protein Components for Soft Tissue Regeneration. Tissue Eng Part A 2020; 27:806-820. [PMID: 32854588 DOI: 10.1089/ten.tea.2020.0197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hyaluronic acid (HA) is an ideal initial material for preparing hydrogels, which may be used as scaffolds in soft tissue engineering based on their advantageous physical and biological properties. In this study, two crosslinking agents, divinyl sulfone (DVS) and butanediol diglycidyl ether, were used to investigate their effect on the properties of HA hydrogels. As HA hydrogels alone do not promote cell adhesion on the scaffold, fibrin and serum from platelet-rich fibrin (SPRF) were combined with the scaffold; the aim was to create a material intended to be used as soft tissue implant that facilitates new tissue formation, and degrades over time. The chemical changes were characterized and cell attachment capacity of the protein-containing gels was examined using human mesenchymal stem cells, and viability was assessed using live-dead staining. Fourier-transform infrared measurements revealed that linking fibrin into the gel was more effective than linking SPRF. The scaffolds were found to be able to support cell adherence onto the hydrogels, and the best result was achieved when HA was crosslinked with DVS and contained fibrin. The most promising derivative, 5% DVS-crosslinked fibrin-containing hydrogel, was injected subcutaneously into C57BL/6 mice for 12 weeks. The scaffold was proven to be biocompatible, remodeling, and vascularization occurred, while shape and integrity were maintained. Impact statement Fibrin was combined with crosslinked hyaluronic acid (HA) for regenerative application, the structure of the combination of crosslinked HA with blood-derived protein was analyzed and effective coating was proven. It was observed that the fibrin content led to better mesenchymal stem cell attachment in vitro. The compositions showed biocompatibility, connective tissue and vascularization took place when implanted in vivo. Thus, a biocompatible, injectable gel was produced, which is a potential candidate for soft tissue implantation.
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Affiliation(s)
- Adél Hinsenkamp
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Ézsiás
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Éva Pál
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - László Hricisák
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Fülöp
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Balázs Besztercei
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Somkuti
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - László Smeller
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Balázs Pinke
- Department of Polymer Engineering, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
| | - Dorottya Kardos
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Melinda Simon
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zsombor Lacza
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary.,Orthosera GmbH, Krems an der Donau, Austria.,Institute of Sport and Health Sciences, University of Physical Education, Budapest, Hungary
| | - István Hornyák
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary.,Orthosera GmbH, Krems an der Donau, Austria
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