Developing a Topical Adjunct to Injectable Procedures

April 2020 | Volume 19 | Issue 4 | Original Article | 398 | Copyright © April 2020

Published online March 24, 2020

Alan D. Widgerow MBBCH MMed,a,e Melanie D. Palm MD MBA,b Carolyn Jacob MD,c John A. Garruto BS,d Michaela Bell BS MBAe

aDepartment of Plastic Surgery, University of California, Irvine, CA bArt of Skin MD, Solana Beach, CA; University of California San Diego, San Diego, CA cChicago Cosmetic Surgery and Dermatology, Chicago, IL; Northwestern's Fienberg School of Medicine, Chicago, IL dFree Radical Technology, Inc., Oceanside, CA eAlastin Skincare Inc., Carlsbad, CA

tions appear to be small and active, and this size and activity have been seen to be synergistic and in line with good elastin formation.29 In other words, large, mature adipocytes have been associated with diminished elastin—manifesting as aged sagging skin—whereas younger, smaller, newly synthesized adipocytes are accompanied by increased elastin levels. PGC1a stimulators are thus useful candidates for increasing adipogenesis, providing small active adipocytes through this PPARγ activation pathway.


Fillers and injection therapy are the most frequently performed aesthetic procedures. Inevitably, a certain amount of discomfort and more significantly occasional bruising is an undesired consequence of medical or cosmetic procedures to the face and body. Additionally, the introduction of synergistic volume replacement of collagen, elastin, hyaluronic acid, and fat, particularly at a more superficial extracellular matrix level serves as an excellent adjunct to the injection therapy. Active agents have been selected that have been demonstrated to improve the efficiency of macrophage phagocytosis of RBCs and heme using a unique in vitro model.

The plasminogen system is essential for dissolution of fibrin clots. Lactoferrin, an iron-binding milk glycoprotein, blocks plasminogen activation on the cell surface by direct binding to human plasminogen, decreasing conversion to plasmin (it is a plasmin inhibitor). It also has anti-microbial activity.3-5 Lactoferrin effects range from antimicrobial to anti-inflammatory and immune-modulator activities; however, its most striking physicochemical feature is its high iron-binding affinity.6 Only transferrin has the ability to retain this metal over a wide range of pH values. Thus, it is essential in the process of bruising resolution and in the prevention of post-inflammatory pigmentation. 6 It also induces phagocytosis of cells, microbes and debris.7 Phosphatidylserine (PS) resides on the inner cell membrane of red blood cells and induces phagocytosis of the RBCs.8 Tripeptide-1 and hexapeptide-12 in combination have been tested comprehensively in previous in vitro and human studies and have shown important synergistic benefits, particularly in the area of extracellular matrix recycling and neocollagenesis and neoelastogenesis.9 Hexapeptide-11 is a potent stimulator of autophagy and macrophage clustering.10

Volumetric advantages and efficacy of the actives have been previously demonstrated in clinical trials30 and this combination together with anti-inflammatory, anti-biofilm, bacteriostatic and anti-bruising actives create a comprehensive and unique topical adjunct to injection therapy. Validation of hastened bruising resolution has been achieved using in vitro and in vivo studies.


Alan Widgerow is Chief Medical Office Alastin Skincare Inc.Michaela Bell is Director Clinical Research Alastin Skincare Inc. John Garruto is consultant to Alastin Skincare Inc. Dr. Palm and Dr. Jacob are consultants to Alastin Skincare Inc.


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