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Review
. 2020 May 5:13:333-344.
doi: 10.2147/CCID.S248280. eCollection 2020.

Minimally Invasive Aesthetic Treatment of the Face and Neck Using Combinations of a PCL-Based Collagen Stimulator, PLLA/PLGA Suspension Sutures, and Cross-Linked Hyaluronic Acid

Francisco de Melo  1 , Alieksiéi Carrijo  2 , Kyungkook Hong  3 , Bruno Trumbic  4 , Franco Vercesi  5 , Heidi A Waldorf  6 , Sabine Zenker  7
Affiliations
Review

Minimally Invasive Aesthetic Treatment of the Face and Neck Using Combinations of a PCL-Based Collagen Stimulator, PLLA/PLGA Suspension Sutures, and Cross-Linked Hyaluronic Acid

Francisco de Melo et al. Clin Cosmet Investig Dermatol. .

Abstract

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 multi-disciplinary, multi-national 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.

Keywords: botulinum toxins; combined modality therapy; dermal fillers; energy-based device; practice guideline; rejuvenation.

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Conflict of interest statement

Dr Francisco de Melo reports personal fees, non-financial support from Sinclair Pharma. Dr Alieksiéi Carrijo, Dr Kyungkook Hong, and Dr Bruno Trumbic report personal fees from Sinclair Pharma. Dr Franco Vercesi was the International Trainer and Key Opinion Leader for Sinclair Pharma. Dr Heidi A Waldorf reports being a honorarium advisory board member for Sinclair Pharma and reports personal fees from Allergan, Endo, Galderma, Merz, Revance, Sinclair Pharma, and Suneva. Dr Sabine Zenker reports personal fees from L’Oréal Paris, Merz, Mesoestetic, Quantificare, and Sinclair Pharma. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Algorithm for upper-face rejuvenation when using cross-linked HA or PCL collagen stimulator injections for eyebrow elevation. (B) Algorithm for upper-face rejuvenation when using PLLA/PLGA sutures for eyebrow elevation. Note: aSpacing between steps 2 and 3: 4–6 weeks if step 1 treatment was PCL Collagen stimulator or 2 weeks if step 1 treatment was cross-linked HA. Abbreviations: BoNT, botulinum neurotoxin; HA, hyaluronic acid; PCL, polycaprolactone; PLLA/PLGA, poly-L-lactic acid/poly-glycolic acid.
Figure 2
Figure 2
Algorithm for mid-face rejuvenation. Note: aSpacing between steps 2 and 3: 4–6 weeks if step 1 treatment was PCL Collagen stimulator or 2 weeks if step 1 treatment was cross-linked HA. Abbreviations: BoNT, botulinum neurotoxin; HA, hyaluronic acid; PCL, polycaprolactone; PLLA/PLGA, poly-L-lactic acid/poly-glycolic acid.
Figure 3
Figure 3
Algorithm for lower-face rejuvenation. Note: aSpacing between steps 3 and 4: 2 weeks if step 1.1 is cross-linked HA, or 4 to 6 weeks if step 1.1 is PCL collagen stimulator. Abbreviations: BoNT, botulinum neurotoxin; DAO, depressor anguli oris; HA, hyaluronic acid; PCL, polycaprolactone; PLLA/PLGA, poly-L-lactic acid/poly-glycolic acid.
Figure 4
Figure 4
Algorithm for neck rejuvenation. Note: aPossible touch up with a HA filler indicated for neck rejuvenation 2 weeks after PLLA/PLGA sutures. Abbreviations: BoNT, botulinum neurotoxin; EBD, energy-based device; HA, hyaluronic acid; PLLA/PLGA, poly-L-lactic acid/poly-glycolic acid.
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