Clinical Validation of Superficial Lip Injections Utilizing Cohesive Polydensified Matrix Hyaluronic Acid-Based Soft Tissue Fillers

September 2021 | Volume 20 | Issue 9 | Original Article | 940 | Copyright © September 2021


Published online August 31, 2021

Katherine Goldie MDa*, Daria Voropai MD DSa*, Nikolay Tzaribachev MD PhDa, Paulien Hilven MDa, Konstantin Frank MDb, Sebastian Cotofana MD PhDc, Afshin Mosahebi MD PhDd,e

aAegis Research Institute, London, UK
bDepartment for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
cDepartment of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
dFaculty of Medical Sciences, University College London
eDepartment of Plastic Surgery, Royal Free Hospital, London, UK

*Both authors contributed equally to this work

Abstract
Background: A combination of optimal injection technique and dermal filler choice is key for improving lip architecture with natural and long-lasting results.
Objective: To investigate the positioning of Cohesive Polydensified Matrix™ (CPM) hyaluronic acid (HA) fillers after superficial lip injections and document their tissue integration and effects on lip architecture and shape.
Methods: Eligible patients underwent lip contouring and volumization using a superficial direct tissue action technique. All injections were performed with CPM-HA lip fillers using a 30G needle and retrograde microthreading. Total injected volume was 0.8-1.2 mL. High-resolution ultrasound (US) imaging, 3D surface scanning, and Global Aesthetic Improvement Scale (GAIS) assessments were performed before, and 1, 3 and 6 months post-injection to define the anatomy, positioning, longevity and patient satisfaction.
Results: Sixteen patients were injected (mean age, 33.2 years). US measurements revealed an increased skin–orbicularis oris muscle distance up to 1 month post-injection after which measurements returned to baseline values. This observation correlated with complete product integration into the surrounding tissue visualized by US at 3 months. An increased dry mucosa thickness (vermilion body) remained at 6 months, and GAIS scores revealed 70% of patients continued to experience visible lip improvements. 3D analyses revealed significantly increased total lip surface area at 3 months with increased Cupid’s bow distance, philtral height, and anterior upper lip projection.
Conclusion: Superficial injection of CPM-HA fillers offers an effective and safe tool for improving lip architecture and volume. Results showed homogeneous dermal integration of the product and aesthetic outcomes maintained up to 6 months.

J Drugs Dermatol. 2021;20(9):940-945. doi:10.36849/JDD.6011

INTRODUCTION

Non-surgical cosmetic treatments with short or no downtime remain popular, particularly those with the hyaluronic acid (HA) dermal fillers. According to surveys of the International Society of Aesthetic Plastic Surgery there is an average yearly growth of 10% in minimally invasive treatments such as dermal fillers.1 Lip augmentation is a popular procedure in all age groups. However, this orofacial area is highly dynamic and requires a meticulous approach to the choice of HA filler and injection technique. There are many different HA fillers on the market, each claiming specific rheological properties based on manufacturing processes such as crosslinking technology, uniformity, size of the HA particles, and the HA concentration of the filler which will also determine the viscoelastic properties and therefore the clinical effect.2 As a result, an individualized approach for each patient can be provided by selecting specific filler characteristics for the treatment area, skin structure and quality, and the patient’s desired result.

Although rare, serious adverse events can occur with lip treatments, and choice of product, injection depth and technique can all play a role in their occurrence. Serious adverse events include: nodule formation, often as a result of accumulation of product with muscle activity; inflammatory product-related responses, such as early- and late-onset granulomas; or injection technique-related complications, such