Search Results (11)

Background and Clinical Significance: Iatrogenic atrophy following intralesional corticosteroid injections represents a rare but potentially disfiguring complication, particularly when administered in the facial region for the treatment of inflammatory acne. Unlike conventional post-acne atrophic scarring, corticosteroid-induced tissue loss involves both dermal and subcutaneous compartments, resulting in a clinically distinct presentation that poses significant therapeutic challenges, with no established consensus on optimal management. Case Presentation: We report the case of a 26-year-old Caucasian female (Fitzpatrick phototype III) presenting with severe iatrogenic facial atrophy of the left cheek, resulting from multiple intralesional corticosteroid injections performed by a previous physician for papulo-pustular acne. The condition had been clinically stable for approximately two years at first evaluation. The patient underwent a stepwise multimodal protocol delivered over approximately 18 months (November 2023 to April 2025), combining non-ablative fractional laser remodelling (LightScan—Eufoton), Autologous Regenerative Therapy (ART, Seffiller technique, Seffiline srl), hyperdiluted calcium hydroxylapatite (CaHA—Radiesse, Merz Aesthetics) biostimulation, and additional non-ablative fractional photothermolysis sessions, supported by a topical cosmeceutical protocol. Documented follow-up extended to December 2024, 13 months after the initiation of treatment at our centre. Clinician-assessed severity of the post-acne atrophic scarring component improved from Goodman & Baron Grade 3 to Grade 2. Global aesthetic improvement of the treated area was rated as +2 (“much improved”) on the GAIS, with a patient satisfaction score of 5/5. No validated grading instrument was applied to the subcutaneous volume deficit itself, for which no such instrument is currently available. Conclusions: This case documents the clinical management and favourable outcome of a patient with severe iatrogenic steroid-induced facial atrophy treated with a personalised multimodal protocol. While the observed improvement is encouraging, the single-case design does not permit conclusions regarding the efficacy, reproducibility, or generalisability of this approach. Future controlled studies are needed to determine the therapeutic value of this multimodal strategy for this rare condition. Full article

Poly-l-Lactic acid (PLLA) is a synthetic, absorbable injectable implant widely used in both facial and body cosmetic applications. Originally approved by the Food and Drug Administration (FDA) for treating facial lipoatrophy in Human Immunodeficiency Virus (HIV) patients, PLLA is now also indicated for correcting facial wrinkles, and its use has been more recently evaluated to enhance body areas such as the cheeks, hands, neck, thighs, and gluteal region. This narrative review specifically examines PLLA’s versatility in rejuvenating not only the face but also a variety of body regions, reflecting its growing popularity as a minimally invasive, natural-looking solution for diverse patient groups including men and millennials. PLLA works by restoring lost volume and gradually stimulating collagen production, which improves skin quality and contour over time. The product’s effectiveness and safety are supported by clinical research, with most patients reporting satisfaction. Although differences in PLLA formulations may influence outcomes, direct comparative studies are still lacking. This article provides an updated overview of PLLA’s physicochemical properties, mechanism of action, and clinical uses for both face and body, aiming to encourage its broader integration into cosmetic practice. Full article

Background/Objectives: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists have revolutionised obesity and type 2 diabetes management through effective weight loss and metabolic regulation. However, their increasing use has led to reports of adverse aesthetic and functional effects, particularly affecting facial and ocular tissues. Methods: A comprehensive literature review was conducted in October 2025 across PubMed, Embase, and Medline using the terms “GLP-1 receptor agonist,” “Ozempic face,” “facial lipoatrophy,” “ocular surface disease,” “orbital fat,” and related combinations. Studies reporting facial, periorbital, orbital, or ocular surface changes associated with GLP-1 or GLP-1/GIP receptor agonists were included. Reference lists were screened to identify additional sources. Results: Evidence suggests that GLP-1 and dual GLP-1/GIP receptor agonists may contribute to rapid facial volume loss, dermal fat atrophy, and periocular hollowing—collectively termed “Ozempic face.” The mechanism is multifactorial, involving both weight-loss-related fat depletion and potential modulation of adipocyte differentiation. Ocular surface improvements have been observed in some studies. Radiologic data demonstrate preferential superficial midface fat loss, informing potential aesthetic correction strategies. Conclusions: GLP-1-based therapies, while clinically effective, can result in perceptible adnexal and periocular changes with aesthetic and functional implications. Awareness of these effects is crucial for multidisciplinary management. Future prospective studies are warranted to clarify mechanisms and guide individualised reconstructive and rejuvenative interventions. Full article

Semaglutide-induced facial changes, or “Ozempic face” popularized by media, have gained increasing recognition since the widespread and growing use of Ozempic (semaglutide) for weight loss. It refers to facial volume depletion and soft tissue laxity following rapid weight loss associated with this medication. Semaglutide use can also cause gastrointestinal side effects, volume loss, and decrease skin quality not only in the face but globally. As the use of Ozempic becomes increasingly popular, more patients are presenting to cosmetic clinics for these undesirable esthetic changes. While cosmetic changes following rapid weight loss is not new, such as those following bariatric interventions, the accessibility and ease of GLP-1, Glucose-like protein-1, makes this a growing concern among the community. It is important for clinicians to recognize these potential effects, counsel patients appropriately, and give options for treatment. This emerging esthetic concern highlights the need for further investigation into underlying causes, risk factors, and potential interventions. Full article

The primary objective of this systematic review study was to investigate the effectiveness, durability, and adverse events of PLLA treatment for aesthetic indications. The search strategy was performed in MEDLINE (Ovid). The electronic literature search of five databases was performed, from the inception of the databases until the 12th of February 2024. This was to identify randomized clinical trials that assessed PLLA treatment in adult individuals exhibiting facial aging and/or facial lipoatrophy. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Eleven RCTs out of 1467 identified citations were included. Four studies showed increased dermal thickness, significant improvement in facial lipoatrophy severity and aesthetic clinical scores, after PLLA treatment with its effects sustained for at least 25 months. Two studies demonstrated the superiority of PLLA over injectable human collagen. Also, three studies showed positive results favoring PLLA when compared with PH gel in lipoatrophy severity, transepidermal water loss, skin quality, elasticity, and patient satisfaction. All adverse events were mild-to-moderate in intensity, and the main ones worth noting were bruising, hematoma, tenderness, nodules, and edema. Five out of eleven studies were considered having high risk of bias. The evidence on the effectiveness and safety of PLLA for facial rejuvenation is of low quality; thus, the reported high effectiveness, safety, and long-lasting effects for this purpose should be further investigated. Full article

The PI3K enzymes modify phospholipids to regulate cell growth and differentiation. Somatic variants in PI3K are recurrent in cancer and drive a proliferative phenotype. Somatic mosaicism of PIK3R1 and PIK3CA are associated with vascular anomalies and overgrowth syndromes. Germline PIK3R1 variants are associated with varying phenotypes, including immunodeficiency or facial dysmorphism with growth delay, lipoatrophy, and insulin resistance associated with SHORT syndrome. There has been limited study of the molecular mechanism to unify our understanding of how variants in PIK3R1 drive both undergrowth and overgrowth phenotypes. Thus, we compiled genomic variants from cancer and rare vascular anomalies and sought to interpret their effects using an unbiased physics-based simulation approach for the protein complex. We applied molecular dynamics simulations to mechanistically understand how genetic variants affect PIK3R1 and its interactions with PIK3CA. Notably, iSH2 genetic variants associated with undergrowth destabilize molecular interactions with the PIK3CA receptor binding domain in simulations, which is expected to decrease activity. On the other hand, overgrowth and cancer variants lead to loss of inhibitory interactions in simulations, which is expected to increase activity. We find that all disease variants display dysfunctions on either structural characteristics or intermolecular interaction energy. Thus, this comprehensive characterization of novel mosaic somatic variants associated with two opposing phenotypes has mechanistic importance and biomedical relevance and may aid in future therapeutic developments. Full article

Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords “facial rehabilitation”, “acne scars”, “traumatic scars”, “oral restoration”, “facial lipoatrophy”, “facial asymmetry”, “periocular correction”, “nasal obstruction”, “ear lobe restoration”, “morphea”, AND “hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence. Full article

Lipodystrophy is an alteration of fat metabolism that commonly affects HIV-1 positive patients treated with antiretroviral therapy (ART). The facial area is most commonly affected by peripheral lipoatrophy, thus becoming a social stigma related to chronic HIV. Several treatments have been proposed, such as modification of diet, lifestyle and both surgical and nonsurgical procedures. The goal of our systematic review is to examine published clinical studies involving the use of polyacrylamide filler for the treatment of HIV FLA, and to provide evidence-based recommendations based on published efficacy and safety data. Our research was performed on published literature until April 2021. Polyacrylamide gel is a volumetric gel that has been proven stable, nontoxic, nonallergenic, nonembryotoxic and nonabsorbable. Poly-l-lactic acid (PLA) is a biocompatible, biodegradable, synthetic polymer derived from lactic acid. We believe it is essential to draft a pre- and post-injection and operative protocol to define an even setting for the clinical condition. It is desirable that such specifications are included in a large randomized controlled trial and the follow up is longer than the studies that we found, because as we have seen in the literature there are reported adverse events even 3 or 5 years after the injections. Full article

Since the advent of HIV antiretroviral therapies at the end of the 20th century, the morbidity and mortality rates associated with HIV infection have decreased dramatically. Unfortunately, these benefits are associated with substantial morphologic changes in the body, such as abnormal fat distribution with peripheral lipohypertrophy and facial lipoatrophy. Facial wasting is considered the major stigma for HIV–infected people and may result in reduced antiretroviral adherence. Patients suffering from the stigmata of HIV infection can benefit from non-surgical aesthetic treatments performed with fillers or lipolytic agents that provide a quick and reliable service for facial rejuvenation, with high patient satisfaction and a low risk of complications. In the present paper, a retrospective analysis of complications following non-surgical aesthetic treatments (calcium hydroxyapatite-based filler, hyaluronic acid filler, polyacrylamide hydrogel filler and dehoxycholic acid injections), in a cohort of 116 consecutive HIV+ patients, treated over a period of 12 years, was performed. With the exception of the tardive swelling reported after calcium hydroxyapatite injections, complications were recorded just after polyacrylamide hydrogel treatment as small, palpable, nonvisible nodules or aseptic abscess. Our experience is consistent with those already published in the literature and the complication rate seems to be comparable to non-infected patients. Full article

Poly-l-lactic acid (PLLA), a synthetic, biocompatible, biodegradable polymer, has been safely used in several clinical applications in recent decades. Typically, Sculptra^TM, the commercially injectable PLLA in the form of microparticles, has been used as facial volumizer in the treatment of lipoatrophy in HIV patients. It also has various applications in tissue engineering by improving cell proliferation and adhesion. Sculptra™ can be categorised as a stimulatory filler as it stimulates the synthesis and deposition of fibrous tissue and collagen. Collagen is one of the most significant components of the extracellular matrix and beneficial for the normal physiology. It is also the structural component of a human body. In most of the studies, the effect of Sculptra on collagen synthesis was investigated in vivo and the majority of the data were from clinical and histological reports. There is only one study reporting this effect in vitro using fibroblasts. Here, we investigated whether PLLA in the form of nanoparticles can provide the same effect on collagen synthesis in fibroblasts as Sculptra. We surprisingly found that there was no stimulation of collagen in fibroblasts alone, whereas the co-cultures of fibroblast and macrophage had shown collagen stimulation by PLLA nanoparticles. It is also confirmed that collagen synthesis was caused by fibroblasts but not macrophages. Although further study needs to be conducted to evaluate its mechanism, our findings showed that choosing an appropriate method is essential for investigating the effect of PLLA or other biomaterials on collagen synthesis by fibroblasts in vitro. Full article

The psychological and social impact of the lipodystrophy syndrome on HIV-infected individuals may be quite considerable and adversely affect their quality of life. Currently no validated assessment tool for facial lipoatrophy is available. The main objective of this paper is to evaluate the reliability of interactive anthropometric landmark localization based on digitized 3D facial images. By comparing both computed tomography (CT) and structured light scanning we try to demonstrate that surface scanning shows a higher sensitivity in measuring facial reference points. Besides, we evaluate the reproducibility of facial 3D white-light scans. Three HIVpositive men attending our plastic surgery outpatient clinic for treatment of facial lipodystrophy were enrolled in the study. Localization of anthropometric landmarks measurements was performed on the patients. All patients underwent a facial CT and a facial white-light scanning on the same day. The inter-landmark distances measured on facial models developed from CT aided with VirSSPA 3D software and structured light scanning were compared to the real human models. We found that facial distances measured in the CT 3D reconstruction showed a mean error margin of 0.357 cm from the real distances measured on patients. On the contrary, mean error margin with the white-light scanning was of 0.096 cm. In both cases, measurements were found to be statistically significant (p < 0.05). When compared to CT reconstructions, white-light surface scanning offers a more accurate landmark localization as well as reliable reconstructions of up to less than the tenth of a millimetre as average when compared to real measurements on facial human models. Full article