PEER-REVIEW | DERMATOLOGY |
observed after 4 weeks in almost all of the patients studied (20 patients with score 4, 75–100%; six patients with score 3, 50–75%). One patient had score 1, 0–25% improvement, while no subjects scored either 0 or 5. At the 6-month assessment 12 patients (44% of total) had score 4 (75–100% improvement) and 11 patients (40%) had score 3 (50–75% ). At 12-month evaluation, six patients (22%) showed 75% improvement; 14 patients (48%) showed between 50% improvement, and five patients (18%) showed a 25% improvement in treated atrophic scars. Thirteen patients entered the 12-month HA study.
Moderate-to-excellent clinical improvement was observed after the initial treatments in almost all of the HA patients studied At 4-week assessment, nine patients still showed moderate-to-excellent results, but this had fallen off dramatically at 3-month assessment: only two patients had score 4 (75–100% improvement) and two patients (23% of total) had score 3 (50–75% improvement). At 6-month evaluation, 12 patients (92%) showed a 0–25% improvement. The author felt both of
the fillers initially provided a simple physical volumising effect. There was a longevity associated with the therapeutic effect of the calcium hydroxylapatite (CaHA), probably secondary to the duration of the filler and some level of neocollagenesis noted in other studies. There was little evidence of delayed biostimulatory effect of collagen formation owing to HA injections, although the physical act of injection and subcision was of some benefit to the patient. Side-effects of treatment were mostly limited in the
CaHA is
biosynthetically produced and does not elicit a chronic
inflammatory or immune
response.
group to mild transient erythema, bruising or localised oedema. Some patients required top-up or remodelling on initial review. One 23-year-old male patient (skin type
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23. Product used to enlarge lips can cause bumps. Bioform does not recommend using this product on the red portion of lips.
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Key points
■ Although fractional laser skin resurfacing is still the most popular therapeutic modality for the correction of acne scars, it is not always effective in all types of atrophic lesions
■ Soft tissue filler use for acne scarring would be an attractive option to most practitioners, as they require little invasive technique and could be used in combination with other modalities, such as microneedling or laser resurfacing
■ Many studies have established the biocompatibility and safety of CaHA in facial filling techniques. The product has gained popularity in the US and Europe for this indication, and more recently in the treatment of acne scarring
■ This study documents the efficacy of CaHA in the treatment of atrophic acne scars. The author is aware that these benefits may last 18 months or more
4, of Asian origin) with minimally active acne on a previous trial developed cellulitis and later desquamation.
Discussion There are many methods that can be used in the treatment of atrophic acne scarring. Most tend to replace the volume lost by the atrophic effects of the acne. Newer injectable fillers are biocompatible and safer, and can provide an alternative means of treating acne scarring in patients not opting for laser resurfacing. The author has used the HA-based filler Matridex (BioPolymer GmbH & Co., Germany), CaHA, and the polyalkylimide Bio-Alcamid (Polymekon, Brindisi, Italy) for this purpose over the years. Some of these fillers simply provide a physical filling effect, while others induce a delayed collagen stimulatory effect (e.g. CaHA and poly-L-lactic acid). An ideal filling agent should restore atrophic volume and stimulate the dermis to synthesise new collagen for a long-lasting effect.
Based on the experience of this study, the author feels CaHA is a suitable product for this purpose, showing a clearly demonstrable benefit still present at 6–12 months. A comparative study performed with HA preparations showed the compound was not of medical or commercial benefit to either the physician or patient, with most of the product disappearing at only 6–12 weeks. More viscous forms of HA, such as HyaCorp (BioScience GmbH, Germany) showed no extra benefit.
Conclusions CaHA is biosynthetically produced and does not elicit a chronic inflammatory or immune response. In vivo and in vitro studies have established the biocompatibility and safety of CaHA. No evidence of granuloma formation, ossification, or foreign body reactions have been found in long-term animal studies. CaHA implants have persisted intact at the injection site in areas such as the face at up to
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