| VOLUMISATION TECHNIQUES | ARTICLE Key points


n The theory of skin boosting is based on enrichment of the dermis by injectable stabilised hyaluronic acid, followed by the induction of new collagen synthesis


n Skin boosters are injected as a ‘field’ treatment without targeting a specific wrinkle or scar


n Skin boosting comprises 3–4 monthly treatments


n Skin boosters are specifically designed hyaluronic acid-based products, such Restylane Vital and Restylane Vital Light


n Newly produced collagen has a long life span, explaining the long-lasting clinical results


the product using a blunt cannula. To place microdroplets repetitively to the same depth of the dermis, 32 gauge short (4 mm) mesotherapy needles are used. During each treatment session the patient receives approximately 25 regularly spaced 0.02 ml injections of Restylane Vital on each side (Figure 1). When using flexible blunt cannula, the product is delivered into the dermis through either a single hole or a few holes in a fan-like fashion (Figure 2). The preferred direction of the injection is perpendicular to the


Ôskin collapseÕ lines. Skin collapse lines are those which reflect imminent wrinkles. The use of a blunt cannula is advantageous to the needle, as it is less traumatic and less painful for the patient14


. The risk of bruising from 50 needle


injections is significantly higher when compared with two or three cannula insertion holes. Usually, a series of three monthly treatments is required (Figure 3). In each session 1–2 ml of a product is used. The most common areas in which to use this approach


are the cheeks, perioral area and dorsum of the hands. Neck, d• collet• and even the skin of the upper arms can be treated successfully13, 15


. For the face and dorsum of the


hands, the authorÕs preferred product is Restylane Vital, while for the thinner non-facial skin the author prefers Restylane Vital Light, which is of a more liquid nature as a result of the lower hyaluronic acid content (12 mg/ml rather than 20 mg/ml). In both cases, however, the implantation of the product should be in the dermis. Too superficial an injection may create small papules, which


References


1. Daly CH, Odland GF. Age-related changes in the mechanical properties of human skin. J Invest Dermatol 1979; 73(1): 84–7


2. Varani J, Dame MK, Rittie L et al. Decreased collagen production in chronologically aged skin: roles of age- dependent alteration in fibroblast function and defective mechanical stimulation. Am J Pathol 2006; 168(6): 1861–8


3. Millis AJ, Hoyle M, MCue HM, Martini H. Differential expression of metalloproteinase and tissue inhibitor of metalloproteinase genes in aged human fibroblasts. Exp Cell Res 1992; 201(2): 373–9


4. Fisher GJ, Wang ZQ, Datta SC, Varani J, Kang S, Voorhees JJ. Pathophysiology of premature skin aging induced by ultraviolet light. New Eng J Med 1997; 337(20): 1419–28


5. Kligman AM, Graham GF. Histological changes of facial skin after daily application of tretinoin for 5-6 years. J Dermatol Treat 1993; 4: 113–17


6. Moy LS, Peace S, Moy RL. Comparison of the effect of


various chemical peeling agents in a mini-pig model. Dermatol Surg 1996; 22(5): 429–32


7. Karimipour DJ, Kang S, Johnson TM et al. Microdermabrasion: a molecular analysis following a single treatment. J Am Acad Dermatol 2005; 52(2): 215–23


8. Alster TS, Kauvar AN, Geronemous RG. Histology of high-energy pulsed CO2 laser resufacing. Semin Cutan Med Surg 1996; 15(3): 189–93


9. Wang F, Garza LA, Kang S et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 2007; 143(2): 155–63


10. Reuther T, Bayrhammer J, Kerscher M. Effects of a three-session skin rejuvenation treatment using stabilized hyaluronic acid-based gel of non-animal origin on skin elasticity: a pilot study. Arch Dermatol Res 2010; 302(1): 37–45


11. Kerscher M, Bayrhammer J, Reuther T. Rejuvenating


influence of a stabilized hyaluronic acid–based gel of nonanimal origin on facial skin aging. Dermatol Surg 2008; 34(5): 720–6


12. Williams S, Tamburic S, Stensvik H, Weber M. Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands. J Cosmet Dermatol 2009; 8(3): 216–25


13. Ribé A, Ribé N. Neck skin rejuvenation: histological and clinical changes after combined therapy with a fractional non-ablative laser and stabilized hyaluronic acid-based gel of non-animal origin. J Cosmet Laser Ther 2011; 13(4): 154–61


14. Niamtu J 3rd. Filler injection with micro-cannula instead of needles. Dermatol Surg 2009; 35(12): 2005–8


15. Distante F, Pagani V, Bonfigli A. Stabilized hyaluronic acid of non-animal origin for rejuvenating the skin of the upper arm. Dermatol Surg 2009; 35(Suppl 1): 389–93


prime-journal.com | April/May 2012 ❚  Figure images 1–3 ç M. Landau


will persist for a number of months, especially when Restylane Vital is used. The skin boosting technique can be used for


improvement of acne sequellae, especially superficial acne scars on the cheeks. These scars become more visible with ageing owing to a decrease in skin elasticity. Boosting of the skin in the affected area improves the depth and visibility of the scars. The treatment protocol is the same as for skin enhancement, but a combination with focused injections into the scars should be used.


Conclusions In summary, skin boosting using NASHA-specific products is a novel concept based on scientific rationale and showing promising results for specific aesthetic indications.


 Declaration of interest Dr Landau is a speaker for QMed, A Galderma Division, at scientific meetings. This work was not supported by QMed, A Galderma Division.


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