The perioral region plays a crucial role in facial aesthetics and is susceptible to age-related changes, such as wrinkles and fine lines due to its dynamic nature. Type I collagen is crucial in providing structural integrity and resilience to the skin. Calcium hydroxylapatite (CaHA-CMC) is a widely used dermal filler whose particles stimulate fibroblastic responses within the skin. When diluted, CaHA-CMC has emerged as a useful treatment for collagen stimulation. The objective of the study is to evaluate the efficacy and safety of hyperdilute CaHA-CMC at a 1:3 ratio, specifically administered in the perioral area, to assess its impact on deep rhytids and overall skin quality. Females aged 40 to 70 years with moderate-to-severe wrinkles in the perioral region based on a validated wrinkle scale were injected with hyperdilute CaHA-CMC throughout the perioral region at 2 separate injection intervals (Weeks 1 and 8). This was followed by an injection of hyaluronic acid (CPM-HA22.5) into the perioral region at Week 16. The primary endpoint was a ≥1-point improvement from baseline on the wrinkle grading scale. Twelve female participants were treated. Investigator and patient ratings based on the 5-point Merz perioral/lip wrinkle grading scale showed at least 1 grade improvement in 83% of the patients with a P-value of .0156. A majority of both investigators and patients rated their lip wrinkles as improved in appearance compared with their baseline. Hyperdilute CaHa-CMC at a 1:3 dilution may be a safe and effective treatment for improving the depth and overall appearance of perioral rhytids.

This study evaluated the thermal properties, crystallinity, particle size, morphology, and in vivo local inflammation and persistence of two poly-L-lactic acid (PLLA) injectable implants, Sculptra^® (PLLA-SCA) and GANA V^® (PLLA-GA). PLLA-SCA and PLLA-GA underwent differential scanning calorimetry and X-ray powder diffraction to evaluate their thermal properties and degree of crystallinity. X-ray powder diffraction spectra displayed a sharper, more intense peak for PLLA-GA than PLLA-SCA, with smaller peaks on either side of the main peak of PLLA-GA but not PLLA-SCA. Differential scanning calorimetry thermograms indicated three thermal events for both PLLA-SCA and PLLA-GA. For PLLA-SCA, the first two events occurred between 65 °C and 90 °C, and the third event occurred at 165 °C. For PLLA-GA all three events occurred between 156 °C and 169 °C. Heating samples to 120 °C and cooling to room temperature prior to differential scanning calorimetry resulted in no thermal events being observed between 65–90 °C with either product, while three events were observed with PLLA-GA and one event with PLLA-SCA between 156 °C and 169 °C. The median volume distribution diameter was 46.4 µm for PLLA-SCA and 31.7 µm for PLLA-GA. Scanning electron microscopy showed PLLA-GA particles were irregular in shape, had no sharp edges and had a wrinkled and crimped surface, while PLLA-SCA particles displayed plate-like shapes and had smoother surfaces. In vivo inflammatory reactivity scores indicated a slight reaction for PLLA-SCA at all time points (3.7 ± 1.1, 6.1 ± 1.6, 5.7 ± 1.2 and 6.2 ± 1.2 at 2, 12, 26 and 52 weeks, respectively), while for PLLA-GA, a moderate reaction was observed at 12 and 26 weeks (2.9 ± 1.5, 10.1 ± 1.0, 9.4 ± 0.7 and 7.1 ± 1.3 at 2, 12, 26 and 52 weeks, respectively). PLLA-SCA and PLLA-GA had similar persistence scores at 2, 12 and 26 weeks, while at 52 weeks the score was markedly higher for PLLA-SCA versus PLLA-GA (1.9 ± 0.2 versus 0.7 ± 0.2). In conclusion, PLLA-SCA is more amorphous than PLLA-GA. The single melting point of PLLA-SCA contrasts with the broader spectrum of melting points for PLLA-GA suggests a more homogenous formulation of PLLA-SCA. This, and its less crystalline structure, result in the slower degradation rate and more sustained biological response of PLLA-SCA compared with PLLA-GA. The physiochemical properties of PLLAs affect the biological response in clinical practice and should be taken into consideration when selecting a PLLA treatment for aesthetic use.

The objective of this study was to evaluate thermal properties and crystallinity of two poly-L-lactic acid (PLLA) injectable implants, Sculptra® (PLLA-SCA) and GANA V® (PLLA-GA), and the extent to which these properties might impact their biological response. PLLA-SCA and PLLA-GA (800mg/sample) underwent differential scanning calorimetry and X-ray powder diffraction to evaluate their thermal properties and degree of crystallinity. X-ray powder diffraction spectra displayed a sharper, more intense peak for PLLA-GA than PLLA-SCA, with smaller peaks on either side of the main peak of PLLA-GA but not PLLA-SCA. Differential scanning calorimetry thermograms indicated three thermal events for both PLLA-SCA and PLLA-GA. For PLLA-SCA, the first two events occurred between 65°C and 90°C and the third event occurred at 165°C. For PLLA-GA all three events occurred between 156°C and 169°C. Heating samples to 120°C and cooling to room temperature prior to differential scanning calorimetry resulted in no thermal events being observed between 65–90°C with either product, while three events were observed with PLLA-GA and one event with PLLA-SCA between 156°C and 169°C. In conclusion, PLLA-SCA is more amorphous than PLLA-GA. The single melting point of PLLA-SCA contrasts with the broader spectrum of melting points for PLLA-GA suggests a more homogenous formulation of PLLA-SCA. This, and its less crystalline structure, result in the slower degradation rate and more sustained biological response of PLLA-SCA compared with PLLA-GA. The physiochemical properties of PLLAs affect the biological response in clinical practice and should be taken into consideration when selecting a PLLA treatment for aesthetic use.

Plastic and Aesthetic Research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery.