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.

Background Aging signs can be corrected through volume restoration in multiple soft tissue layers and in the supraperiosteal plane using hyaluronic acid (HA) or nonhyaluronic acid (non‐HA) fillers. The non‐HA bioresorbable polycaprolactone (PCL)‐based filler with collagen‐stimulating properties has a proven safety profile, but rare potential complications such as nodules and granuloma can occur. Furthermore, PCL‐based fillers cannot be immediately removed by injection of an enzyme. These potential drawbacks have yet to be described in the literature. Aims The author performed 1111 treatments between 2015 and 2018. This study aims to review and analyze these treatments to ascertain the complication rates of the PCL‐based filler. Suggestions for complication prevention and management are also discussed. Methods 780 patients treated with the PCL‐based filler were reviewed by the physician between April 2015 and May 2018. During this period, 5595 syringes were used in 1111 treatments. All complication data were acquired by phone interviews, reports by patients, or observation at follow‐up visits. Complications were subdivided into early‐onset (occurring up to 2 weeks after treatment) and late‐onset events (occurring more than 2 weeks to years after treatment). Results Among the 1111 treatments, there were 50 cases (4.5%) of edema that lasted longer than 2 weeks, 30 cases (2.7%) of bruising, 8 cases (0.72%) of malar edema, 5 cases (0.45%) of temporarily palpable lumps and 2 cases (0.18%) of discoloration. There were no cases of intravascular injection, nodules/granulomas, or infection. Conclusion The complication rate of the PCL‐based filler was found to be low, and there were no cases of intravascular injection, nodules, and/or granulomas during the 3‐year observation. Longer‐lasting edema was associated with a higher injection volume and malar edema was related to lymphatic compression.

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SummaryA 46-year-old Asian women was treated with a next-generation bioresorbable biostimulatory polycaprolactone (PCL)-based dermal filler to restore facial volume loss.Before-and after (12 weeks of follow-up)-treatment photographs were analyzed and compared. In addition, before-and after-treatment contour images were recorded using the Vectra â XT 3D imaging system (Canfield Scientific, Inc.).Improvement of facial volume in multiple tissue layers was observed at 4 and 12 weeks of follow-up. Total facial rejuvenation to correct descending soft tissue with a PCL-based dermal filler was achieved through volume restoration in multiple tissue layers of the face.

Cables or suspenders are the critical force-transmitting components of cable-supported bridges, and their timely tension monitoring is consequently the most important issue in the corresponding structural health monitoring. However, very few works regarding the full automation of vibration-based tension estimation have been reported in the literature. To develop a monitoring system of cable tension based on real-time vibration signals, this research first employs an efficient stochastic subspace identification (SSI) method with tailored parameter selection to continuously identify the three frequencies of adjacent modes for the cables of Mao-Luo-Hsi Bridge. More importantly, an automated sieving algorithm is delicately established to obtain the stable modal frequencies by making the best of the specific modal frequency distribution for cables. The ratios between the frequency values identified from SSI analysis are exhaustively checked to systematically extract the qualified cable frequencies and decide their corresponding mode orders. The tension is finally computed with one available cable frequency according to the priority order predetermined by the statistics of identification rate. Demonstrated by analyzing the vibration signals measured from the stay cable of Mao-Luo-Hsi Bridge in real time for two full years, the effectiveness and robustness of this real-time monitoring system have been extensively testified. The long-term success rates for the immediate determination of dependable tension are found to be perfect for 15 of the 18 investigated cables. As for the other three cables, their corresponding success rates are still higher than 99.99% with very few cases of absent or false tension values.