A Case Series Report on Superficial Application of Polydensified Cohesive Matrix Hyaluronic Acid Through Biopsies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study carried out has been very interesting, because it understand the structural aspects of the skin, which are commonly altered by age and, if the treatment offered achieves the recovery of the histological components of the skin, the procedure is suitable and promising for who show grater deterioration of the skin.

 

 The approach, description and methodology are adequate for essential undertanding for those interested in skin regeneration.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The present manuscript is an in vivo study performed on four patients of different ages, which aims to highlight the importance of hyaluronic acid on the properties and content of skin components. The text draws the reader into the subject with an appropriate and focused introduction. The methods and experimental procedures are sufficiently specific and appropriately designed, except for the small number of women participating in the study. However, the results are interpreted and discussed appropriately with this deficiency in mind. The main conclusions are based on the results of the study conducted. These results can be considered novel and contribute to the state of knowledge in the field. There are no comments on the manuscript and I agree with the publication as presented.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

General comments

Hyaluronic acid (HA), also called Hyaluronan, is a non-sulfated glycosaminoglycan that is present in a variety of body tissues and organs. Hyaluronan, comprised of N-acetyl-glucosamine and D-glucuronic acid, distinguishes itself with superior qualities in skin regeneration, providing moisturizing and anti-aging benefits. The importance and usefulness of the practical application of Hyaluronic acid in various forms and their systematization is beyond doubt. However, it is necessary to take into account that this information is well known, and the methods of using HA have long been developed. Today, among various injection methods in cosmetology, one of the leading places is occupied by biorevitalization - a method of intradermal injections of hyaluronic acid (Hyaluronan), which allows achieving the restoration of the physiological environment and normalization of metabolic processes in the dermis. Currently, aesthetic medicine offers anti-age programs not only for the correction of existing disorders, but also for stimulation and optimization of the skin's own capabilities. In addition, the market of injection drugs for aesthetic medicine offers dozens of biorevitalizants, differing in concentration, molecular weight, source of hyaluronic acid and methods of its modification.

It is known that Hyaluronan has a wide range of biological activities that are influenced by molecular weight. The main properties of aqueous polysaccharide solutions with different molecular weights are different. Moreover, the therapeutic effect of hyaluronic acid-based preparations directly depends on the molecular weight of the biopolymer. HA molecular weight influences its penetration into the skin and its biological activity. In addition, it is known that excess hyaluronic acid is a stress factor and can cause disruption of the regulation of metabolism and regeneration of cellular structures of the dermis.

The above suggests that

1. the material used should be described in great detail in terms of origin, molecular weight, substances used for cross-linking, concentrations and doses used;

2. there should be references to works in which a specific modified Hyaluronan has already been tested. Without such information, the novelty of the research is unclear;

3. it is necessary to indicate how the studies conducted by the authors differ from previous works in the field of application of modified hydrogels in cosmetology.

In the manuscript under review there are only two phrases (in the introduction!?) describing the material used, and they are given with errors and inexactness:

Line 89: These include divinyl sulfone, DEO, and butanediol diglycidyl ether (BDDE) [19];

Line 95: We opted for a single-phase gel featuring a polydensified cohesive matrix (CPM technology) with a concentration of 20 mg/ml and a crosslinking level of +/4+.

It should be noted here that DEO is not divinyl sulfone. For example, the work (https://doi.org/10.1021/bc9002647)  says: Highly reactive cross-linkers for HA hydrogels are divinyl sulfone (DVS) for Hylaform, 1,4-butanediol diglycidyl ether (BDDE) for Restylane, and 1,2,7,8-diepoxyoctane (DEO) for Puragen.

The terms: CPM, +/4+ should be deciphered.

4. The conclusion should be rewritten. The consequences presented in the conclusion cannot be made on the basis of studies conducted on 4 patients selected by the authors. At the same time, the conclusions formulated in the abstract are acceptable.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

All comments have been taken into account. The work can be published.

Comments for author File: Comments.pdf