BackgroundThe range of fillers currently available for soft-tissue augmentation is constantly expanding. The latest advances in filler technology include collagen biostimulators that exert their esthetic effect by promoting neocollagenesis. One such product is the next-generation collagen biostimulator (Ellansé®) that demonstrates properties as yet unseen in soft-tissue fillers. It is composed of polycaprolactone (PCL) microspheres in an aqueous carboxymethylcellulose gel carrier. Given its specific characteristics and the number of areas that can be treated with this innovative product, experts’ recommendations were deemed necessary and are therefore presented in this paper with a specific focus on the indications, treatment areas and procedures as well as injection techniques.MethodsA multinational, multidisciplinary group of plastic surgeons and dermatologists convened to develop recommendations with a worldwide perspective. This publication provides information on the specific characteristics of the product and focuses on the recommendations on the injection techniques.ResultsRecommendations on injection techniques are provided for the upper face, mid-face and lower face and zone by zone for each of these areas, as well as hands. Based on the particular anatomy of each area, the focus is on the techniques and devices of injection and the volume and depth of injection. The information is tabulated, and photos are presented for illustration.ConclusionThese recommendations provide a guideline for physicians who wish to perform safe and efficacious treatment with the PCL collagen stimulator for face and rejuvenation with volume augmentation.

Um polissacarídeo extracelular foi produzido por via microbiológica, através da bactéria ZSP isolada no Laboratório de Microbiologia Industrial da Estação Experimental de Cana-de-Açúcar do Carpina/UFRPE, apresentando excepcional capacidade de processo. Os principais monossacarídeos presentes na fração solúvel foram glicose (87,6%), xilose (8,6%), manose (0,8%), ribose (1,7%), galactose (0,1%), arabinose (0,4%) e o ácido glucurônico (0,8%). Devido ao alto índice de traumatismos que acomete os animais domésticos e a busca por alternativas simples, econômicas e capazes de proporcionar condições ideais para cicatrização, foram realizados os testes com o biopolímero produzido a partir da cana-de-açúcar em animais portadores de feridas cutâneas, a fim de avaliar a reepitelização. Observou-se o aumento do tecido de granulação, controle da infecção e diminuição do tempo de cicatrização, permitindo concluir que o biopolímero contribui para o processo cicatricial, podendo ser utilizado em feridas cutâneas.

Background: Combinations of minimally invasive procedures (MIPs) are often used in aesthetic treatments and are increasingly considered as the new standard of care. Three agents with specific properties are available in this perspective: a polycaprolactone (PCL)based collagen stimulator, a poly-L-lactic acid (PLLA)-and a poly-glycolic acid (PLGA)based resorbable suspension suture with a 3D-cone technology, and a cross-linked hyaluronic acid (HA). Objective: To develop the first practice guidelines on rejuvenation treatment of the face and the neck using combinations of these agents, whether associated or not with other widely used MIPs such as botulinum neurotoxins or energy-based devices. Methods: A multidisciplinary , multinational board of plastic surgeons and dermatologists convened to develop guidelines using a predefined consensus method. The consensus was defined as ≥83% agreement rate between participants. Results: Practice guidelines and algorithms, describing optimal procedure sequence and spacing, are proposed for the treatment of upper-, mid-, lower-face and neck, combining the PCL collagen stimulator, the PLLA/PLGA suspension sutures, and the cross-linked HA, whether associated or not with other MIPs. Conclusion: These new guidelines provide general support to optimal management strategies. Individual treatment plans should be adapted according to the physician's individual competence and the patient's preferences.

IntroductionIn esthetic treatments with dermal fillers, increasing numbers of physicians are using the technique of mixing an anesthetic agent into the dermal filler before treatment to increase the comfort of the patients. This study aimed at evaluating the effects on the physical properties of a polycaprolactone (PCL)-based dermal filler after mixing with lidocaine.MethodsA range of 2.0% lidocaine and 2.0% lidocaine/epinephrine concentrations was mixed with the PCL dermal filler to evaluate the changes in dynamic viscosity and elasticity, extrusion force, pH, and needle jam rates. The number of passes back to forth for optimal homogeneity of lidocaine and PCL dermal filler was determined.ResultsWith 15 mixing strokes the lidocaine solution can effectively be mixed into dermal filler resulting in a homogenous blend. The viscosity, elasticity, and the extrusion force decrease with increasing lidocaine volume. The viscosity and elasticity of the dermal filler is sufficient to keep the PCL microspheres in suspension. There were no needle jams. The pH of the PCL dermal filler mixed with lidocaine solution is equivalent to that of the original dermal filler.ConclusionIt is concluded that mixing of lidocaine into the PCL-based dermal filler can safely be performed without harmful changes in the physical properties of the original dermal filler.

PURPOSE:To evaluate the biocompatibility and local sensibility reaction to bacterial cellulose hydrogel (0.8%) implanted in subcutaneous tissue of rabbits. METHODS:Fifteen New Zeland rabbits were randomly allocated into three groups: T 1 , 7 days, T 2 , 21 days, and T 3 , 84 days. The new material was implanted in the subcutaneous tissue of the ear; on the scalp over the periosteum; and on the outer and inner surfaces of the thighs, in the aponeurosis of the muscle. At 7, 21 and 84 postoperative days, the material was collected for histological study.The clinical signs, inflammatory response, angiogenesis and fibrogenesis were variables used for analysis of the biocompatibility and biological reactivity to BCH. Analyses were performed with an AXIO ® Imager. The statistical tests were performed using the GraphPad