A double-blind, clinical evaluation of facial augmentation treatments: a comparison of PRI 1, PRI 2, Zyplast and Perlane.
ABSTRACT Facial wrinkles are caused by weakening of the sub-dermal collagen support layer. Dermal fillers can be used to treat wrinkles, and this double-blind, randomised, single-centre study compared four fillers: PRI 1, PRI 2 (both porcine collagen), Zyplast (purified bovine collagen) and Perlane (cross-linked hyaluronic acid gel).
79 females (aged 25-55 years) with wrinkles in the upper lip line border were randomised to PRI 1 (19 patients), PRI 2 (19 patients), Perlane (23 patients), Zyplast (18 patients). Patients were assessed at 1 week and 1, 3, 6, 9 and 12 months using 2D images and by mathematically derived facial volume changes using 3D stereophotogrammetry.
All treatments produced larger, less wrinkled, more prominent lips. PRI 1, PRI 2 and Zyplast showed similar lip volume gains, with Perlane showing the greatest upper lip volume increase. All treatments were comparable for rates of decrease in upper lip volume post-treatment, however, Perlane maintained higher lip volume gains at each time point. Investigators indicated PRI 1 was significantly easier to deliver than Zyplast. Patient satisfaction scores were similar, though there was a trend towards greater dissatisfaction for PRI 1 and PRI 2 at month 9 (p=0.052). Treatment was well-tolerated, with 'cold sore' being the most common adverse event.
Results showed that PRI 1 and PRI 2 were comparable to Perlane and Zyplast as dermal fillers. Further rigorous studies are required to establish the performance of dermal fillers and patient acceptability. We propose the utilisation of stereophotogrammetry for assessment of volume changes.
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ABSTRACT: public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.Archives of Dermatology 04/1996; 132(4):395-402. · 4.79 Impact Factor
- Aesthetic Surgery Journal. 01/1999; 19(6):505-507.
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ABSTRACT: To supply information about (1) sex-related dimensions (linear distances and ratios, vermilion area, volume) of normal adult lips, (2) presence of sexual dimorphism, and (3) correlations between anthropometric characteristics of the lip and nose. The three-dimensional coordinates of soft tissue landmarks on the lips and nose were obtained using an optoelectronic instrument in 90 healthy young adult women and 90 healthy young adult men. From the landmarks, several linear distances (mouth width, total vermilion height, nose height, anatomic nose width, total lip height, upper lip height), the ratio of vermilion height to mouth width, and some areas (vermilion of the upper lip, vermilion of the lower lip, total vermilion) and volumes (upper lip volume, lower lip volume, total lip volume) were calculated. Linear correlation analyses between pairs of variables were also conducted within each sex. All lip dimensions (distances, areas, and volumes) were significantly larger in men than in women (p<.005), but no sex differences were found in the vermilion height to mouth width ratio. Overall, mouth and nose dimensions were not significantly correlated, with the exceptions of the upper and lower lip volumes in both sexes and of the mouth and nose widths in the female sample, in which a modest part of the variance in one measurement could be explained by the other. The dimensions of the mouth and the nose did not seem to be strictly related. Data collected in the present investigation could represent a database for the quantitative description of human lip morphology in adult subjects.The Cleft Palate-Craniofacial Journal 01/2000; 37(1):48-54. · 1.24 Impact Factor