Bioestimuladores de colágeno injetáveis na região da face: revisão de escopo

Abstract

Collagen biostimulators can stimulate collagen neogenesis by a subclinical inflammatory response. The main commercial injectable products are based on calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), and polycaprolactone (PCL). The objective of this review was to map the literature and identify studies that used these products in facial treatments. A systematic search was performed in six databases by independent evaluators. Clinical studies published in English between 2002 and 2022 were included. Reviews, product analyses, and other non-original articles were excluded. A pre-tested Excel spreadsheet was used for data extraction. Extracted items included study characteristics and details of product application. Data were summarized descriptively. From 6140 unique records found, 6039 were excluded by title/abstract, and 49 were excluded in full-text reading, resulting in 52 included articles. The studies were published in 17 scientific journals, especially by authors from the USA (53.8%) and Germany (11.5%). A predominance of prospective studies (32.7%) and randomized trials (25%) was observed, but case series (15.4%) and case reports (13.5%) also were included. There was a higher prevalence of studies involving CaHA (51.9%) and PLLA (38.5%) and brands Radiesse (50%), Sculptra (28.8%), and Ellansé (9.6%). Most studies were sponsored by companies (51.9%), and conflicts of interest were infrequently reported (11.5%). The sample included 3025 patients; follow up times ranged from 2 to 108 months. The application was performed in various facial areas, with the most frequent being the nasolabial fold (67,3%), cheek (32,7%), malar and mandible (23,1%) and marionette line (21,2%). The most common diluent was water or saline + anesthetic (42.9%), the dilution volume ranged from 0.1 to 10 mL. For injection, 75% of the studies used a needle. The most common injection depths were dermal (44.2%) and subcutaneous (38.5%) applied mainly using linear/threads (34.6%) and fannning (23,1%). The studies reported various clinical outcomes, especially related to product safety (42.3%), skin improvement (30.8%), changes in skin volume or thickness (26.9%), and satisfaction or quality of life (26.9%). In total, 51.9% of the studies reported only favorable results for the use of products, while 28.8% reported complications, with the most frequent being edema (23.3%) and temporary pain (20%). In conclusion, collagen CaHA-, PLLA-, and PCL-based biostimulators have been evaluated in dozens of studies, with varying levels of evidence, applied to different regions of the face with good results overall. This review identified that the products are used in different ways, including off-label use in some cases, with varied technical application details.