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Martina Kerscher,1 Sylvia Wagner-Schiffler,2 Ernst Magnus Noah,3 Tanja Fischer,4 Daniela Greiner-Krüger,5 Sonja Sattler,6 Tanju Kaptan,7 Attyla Drabik,8 Glyn Hamed,9 Julio Reinecke,7 Jana Wehling10 1Division of Cosmetic Sciences, University of Hamburg, Hamburg, Germany; 2Dermatologische Praxis, Aachen, Germany; 3Noahklinik und Klinik für Plastische Chirurgie, Kassel, Germany; 4Haut und Lasercentrum, Potsdam, Germany; 5MediCorium, Zentrum für Dermatologie und Ästhetik, Oberursel, Germany; 6Rosenpark Klinik, Darmstadt, Germany; 7ORTHOGEN AG, Düsseldorf, Germany; 8Clinical Trial Support, Münster, Germany; 9Practice Dr. Wehling and Partner, Düsseldorf, Germany; 10Krankenhaus Neuwerk, Mönchengladbach, GermanyCorrespondence: Glyn Hamed, Email glyn.hamed@doctor-wehling.comBackground: The “Inflammation Theory of Ageing” identifies pro-inflammatory cytokines and oxidative damage as one cause of cellular and mitochondrial deterioration and aging. Cell-free blood cell secretome (BCS) also known as autologous conditioned serum (ACS) has shown anti-inflammatory and regenerative mode of action in musculoskeletal disorders and radicular compression.Aim: To confirm that BCS can improve signs of skin aging from a previous study in a multi-center setting.Methods: Prospective, one-armed, multi-center interventional therapeutic study. Ninety-five women with skin firmness loss were treated with four intra-dermal injection sessions in both cheeks at 0, 2, 4 and 6 weeks. BCS was processed with Exokine® medical device according to manufacturer’s instructions. Primary endpoints were cutometric R0 and R3 at 12 and 24 weeks. GAIS, FACE-QTM, Patient Attractivity Self-Assessment and safety were evaluated.Results: Mean skin firmness (R0) improved significantly from baseline 0.40 mm to 0.38 mm at week 12 and to 0.36 mm at week 24. Mean skin tiring (R3) improved significantly from baseline 0.45 mm to 0.42 mm at week 12 and to 0.40 at week 24. FACE-QTM “Satisfaction with Skin” significantly improved from baseline to weeks 12, 24 and 48. So did “Satisfaction with Facial Appearance” and “Psychological and Social Function”. “Satisfaction with Decision” and “Satisfaction with Outcome” were stable at week 24 and 48. At week 48 patients assessed their age 1.68 years younger vs Baseline. FACE-QTM aging appraisal improves from Baseline 52.94 to 65.23 at week 48. GAIS, by both physicians and patients, confirm improvement of skin.Conclusion: For up to 48 weeks four intra-dermal injections with cell-free BCS increase facial skin firmness and resilience to tiring and patients’ satisfaction with their facial appearance and skin. Patients perceive their face as younger. BCS has the ability to sustainably rejuvenate facial skin safely.Study Registration: Registration on German clinical trials register: DRKS00013014.Keywords: cell-free blood cell secretome, BCS, autologous conditioned serum, ACS, skin quality, regeneration, autologous, rejuvenation

Jani van Loghem,1 Sonja Sattler,2 Gabriela Casabona,3 Sebastian Cotofana,4 Sabrina Guillen Fabi,5 Kate Goldie,6 Uliana Gout,7 Martina Kerscher,8 Ting Song Lim,9 Carla de Sanctis Pecora,10 Gerhard Sattler,2 Ada Trindade de Almeida,11 Rungsima Wanitphakdeedecha,12 Philip Werschler,13 Tatjana Pavicic14 1Falck Clinic, Aesthetic Medicine Centre, Amsterdam, the Netherlands; 2Rosenpark Clinic, Darmstadt, Germany; 3Ocean Clinic, Marbella, Spain; 4Albany Medical College, Albany, NY, USA; 5Cosmetic Laser Dermatology and University of California, San Diego, CA, USA; 6European Medical Aesthetics Ltd, London, UK; 7Aesthetic Medicine Clinic, London, UK; 8University of Hamburg, Hamburg, Germany; 9Clique Clinic, Kuala Lumpur, Malaysia; 10Dermatologie-Clínica, Cirurgia, Cosmiatria e Laser, São Paulo, Brazil; 11Clínica de Dermatologia do Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil; 12iSKY Innovative Skin & Laser Surgery Center, Bangkok, Thailand; 13Premier Clinical Research, Spokane, WA, USA; 14Private Practice for Dermatology and Aesthetics, Munich, GermanyCorrespondence: Jani van LoghemFalck Clinic, Aesthetic Medicine Centre, Falckstraat 51, Amsterdam, 1017 VV, the NetherlandsEmail jani@falckclinic.comBackground: As the treatment indications for the Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) portfolio continue to expand and diversify, injectors new to the range or those who are expanding the treatments they offer may be unsure of the optimal product and injection technique for specific facial areas. Each product in the CPM-HA portfolio has been intentionally designed to provide the best physical properties for a specific indication and target tissue. This document has been developed to provide a comprehensive, one-stop reference for clinicians using the portfolio.Methods: An international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.Results: Consensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.Conclusion: The recommendations in this consensus document are provided to assist clinicians in the selection of CPM-HA products, administration techniques and depths of injection with the aim of providing seamless and natural treatment results, enhanced safety and patient satisfaction.Keywords: anatomy, Belotero, cohesive polydensified matrix, consensus, hyaluronic acid, injection technique

Kate Goldie,1,* Martina Kerscher,2,* Sabrina Guillen Fabi,3 Cyro Hirano,4 Marina Landau,5 Ting Song Lim,6 Heather Woolery-Lloyd,7 Kavita Mariwalla,8 Je-Young Park,9 Yana Yutskovskaya10 1European Medical Aesthetics Ltd, London, UK; 2Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany; 3Department of Dermatology, University of California, San Diego, CA, USA; 4Division of Dermatology General Polyclinic of Rio de Janeiro, Private Practice, CD Clinica Dermatologica, Rio de Janeiro, Brazil; 5Dermatology Unit, Wolfson Medical Center, Holon, Israel; 6Clique Clinic, Kuala Lumpur, Malaysia; 7Department of Ethnic Skin Care, University of Miami Cosmetic Medicine and Research Institute, Miami Beach, FL, USA; 8Mariwalla Dermatology, New York, NY, USA; 9Apkoo-Jung Department, Oracle Dermatology Center, Seoul, Republic of Korea; 10Dermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia*These authors contributed equally to this workCorrespondence: Martina KerscherDivision of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, GermanyEmail martina.kerscher@uni-hamburg.deIntroduction: Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened.Methods: A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement.Results: There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person’s chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy.Conclusion: This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients’ perception for the need for aesthetic treatment.Keywords: aesthetic treatment, consensus, emergent perceptual skin quality categories, EPCs, skin quality

Gerhard Sattler,1 Martina Kerscher,2 Ernst Magnus Noah,3 Welf Prager,4 Tanja C Fischer,5 Patricia Ogilvie,6 Matthias Hofmann,7 Hanna Dersch,7 Gemma Odena8 1Rosenparkklinik GmbH, Darmstadt, Germany; 2Division of Biochemistry and Molecular Biology, Cosmetic Science, University of Hamburg, Hamburg, Germany; 3Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kassel, Germany; 4Prager & Partner Dermatologische Praxis, Hamburg, Germany; 5Haut- Und Lasercentrum Berlin-Potsdam, Potsdam, Germany; 6SkinConcept, Munich, Germany; 7Merz Pharmaceuticals GmbH, Frankfurt Am Main, Germany; 8Merz North America, Inc., Raleigh, NC, USACorrespondence: Gerhard Sattler Email gerhard.sattler@rosenparkklinik.deBackground: Facial aging is characterized by increased prominence of nasolabial folds (NLFs), marionette lines, and thinning of the lips. Cross-linked hyaluronic acid injection is a very effective method for the temporary correction of these areas.Objective: To confirm the clinical performance and the safety of Etermis 3 (ET3) and/or Etermis 4 (ET4) in the treatment of moderate and severe wrinkles/folds, as well as lip volume enhancement.Methods: Subjects were treated in at least two facial areas (NLFs, marionette lines, lips). ET3 was used in facial moderate wrinkles while ET4 was used in severe facial skin volume loss. An optional touch-up 1 month after treatment was possible. A blinded investigator assessed improvement on Merz Aesthetic Scales (MAS). Subjects were followed-up for 12 months after the last treatment.Results: In total, 154 healthy subjects were enrolled. The proportion of subjects achieving ≥ 1 score improvement in MAS after treatment was above 60% for ET4 (Month 6/7: NLFs 94.9% and marionette lines 81.4%, p≤ 0.0004; Month 3/4: lips 63.0%, p=0.39) and ET3 (Month 6/7: marionette lines 79.4%, p=0.0005; Month 3/4: lips 65.5%, p=0.31). Facial improvement was still visible at Month 12/13 for ET4 (NLFs ≥ 76.6%, marionette lines ≥ 61%, lips ≥ 36%) and ET3 (marionette lines ≥ 50% and lips ≥ 21.9%). No treatment-related serious AEs occurred. The most frequent AEs were injection-site reactions.Conclusion: Etermis 3 and Etermis 4 demonstrated good clinical performance and safety for NLFs and marionette lines volume enhancement for up to 12 months. Both products can also be used safely to treat lips for volume augmentation.Keywords: hyaluronic acid, wrinkles, facial volume enhancement

Dominique Hertz-Kleptow,1 Angelika Hanschmann,2 Matthias Hofmann,2 Tilmann Reuther,1 Martina Kerscher11University of Hamburg, Division of Biochemistry and Molecular Biology, Cosmetic Science, D-20146 Hamburg, Germany; 2Global Clinical Development, Merz Pharmaceuticals GmbH, Frankfurt, GermanyBackground: Hyaluronic acid (HA) fillers are popular for the treatment of signs of facial skin aging.Objective: The objective of this study was to confirm the performance and safety of a new cohesive polydensified matrix HA filler ([CPM®-HA20G, Belotero Revive,® lidocaine-free], Merz Pharmaceuticals GmbH, Frankfurt, Germany) for the treatment of early signs of facial skin aging by use of biophysical measurements as well as subject and investigator satisfaction.Methods: Twenty-five healthy female subjects with signs of facial skin aging were enrolled in this open-label, rater-blinded, observational post-market clinical follow-up study, and received 20 micropuncture treatments of 50 μL CPM®-HA20G each into the lower cheek area at three injection visits 4 weeks apart. Objective biophysical assessments were conducted to demonstrate effects on viscoelastic properties of the skin, surface roughness, tone and radiance, and hydration, at baseline and at all follow-up visits up to 36 weeks.Results: CPM®-HA20G significantly increased gross elasticity of the skin (at weeks 9 and 12), skin firmness (up to week 24), skin tone and radiance and skin hydration (all up to 36 weeks). Significant reduction of skin fatigue (up to 9 weeks), skin roughness (up to 28 weeks), and redness (up to 36 weeks) was also observed. Subjects and blinded investigator were highly satisfied with the treatment outcomes. The treating investigator reported a high level of satisfaction with the ease of injection and the clinical performance of the device. Moreover, data demonstrated a good safety profile of the device.Conclusion: CPM®-HA20G is considered to be an effective and safe HA injectable for skin revitalization in patients suffering from signs of skin aging and loss of skin elasticity. It seems to be a perfect early intervention approach in patients that do not need volumizing treatment and a combination approach in older patients with more pronounced aging.Keywords: hyaluronic acid, filler, cohesive polydensified matrix, skin revitalization

Martina Kerscher,1 Arti Tania Nurrisyanti,1 Christine Eiben-Nielson,1 Susanne Hartmann,2 Judith Lambert-Baumann2 1University of Hamburg, Division of Cosmetic Sciences, Hamburg, Germany; 2Merz Pharmaceuticals, Frankfurt/Main, Germany Purpose: The efficacy of microfocused ultrasound with visualization (MFU-V; Ultherapy®) has been demonstrated in clinical studies and daily practice. However, data addressing skin physiology after MFU-V treatment are lacking. This observational evaluation was aimed to assess skin physiology before and after MFU-V treatment using noninvasive biophysical measurements. Patients and methods: Twenty-two female patients with moderate-to-severe skin sagging at the jawline and submental region on the Merz Aesthetics Scale obtained a single MFU-V treatment according to protocol. Skin function measurements focused on short-term effects up to 3 days and long-term effects up to 24 weeks after treatment. Skin temperature, transepidermal water loss, skin hydration, erythema, elasticity, and skin thickness and density were evaluated under standardized conditions. Pain was assessed using a validated numeric visual analog scale.Results: Skin temperature remained in a physiologic range and no significant increase was noted at day 3 after MFU-V treatment. Transepidermal water loss, hydration, and erythema values were fairly stable and showed no significant differences at short- and long-term measurements vs baseline. At week 4 after a single MFU-V treatment, gross and net elasticity values were significantly decreased (P=0.003 and P=0.0001, respectively), followed by significantly increased values at week 12 (P=0.015, P=0.046) and week 24 (P=0.001, P=0.049). Edema due to MFU-V treatment resolved without sequelae. For all patients, pain diminished shortly after treatment. No adverse events occurred during the 24-week follow-up period. Conclusions: MFU-V treatment is well tolerated and it does not alter the epidermal barrier function or physiology of skin. Significant increase in the elasticity of skin was observed at 12 and 24 weeks after a single treatment, which reflects improvement in dermal tissue function. These short- and long-term effects are congruous with the mode of action of MFU-V due to a proven intrinsic tissue remodeling process. Keywords: skin lifting, tightening, neocollagenesis, epidermal barrier, elasticity, energy-based device

Martina Kerscher,1 Karla Agsten,2 Maria Kravtsov,3 Welf Prager4 1Department of Cosmetic Science, University of Hamburg, 2SCIderm GmbH, Hamburg, Germany; 3Anteis S.A., Geneva, Switzerland; 4Prager & Partner Dermatologische Praxis, Hamburg, Germany Background: Enhancement of the midface can be achieved with volumizing hyaluronic acid (HA) fillers.Objective: The objective of this study was to compare the safety and effectiveness of Cohesive Polydensified Matrix® 26 mg/mL HA gel (CPM-26) and Vycross® 20 mg/ml HA gel (VYC-20) in a controlled, randomized, evaluator-blind, split-face clinical study.Patients and methods: Subjects with moderate-to-severe malar volume loss on the Merz Aesthetics Scale (MAS) received CPM-26 on one side and VYC-20 on the contralateral side of the face. Effectiveness assessments were performed by blinded evaluators including photographic and live MAS ratings and live Global Aesthetic Improvement Scale (GAIS) ratings. Calculations of anatomical volume variations at month 3 (M3), month 6 (M6), month 12 (M12) and month 18 (M18) were also performed.Results: Non-inferiority of CPM-26 versus VYC-20 was demonstrated at M3 (primary end point) based on MAS. GAIS rating showed that significantly more subjects had better improvement with CPM-26 than with VYC-20 at month 1, M3, M12 and M18 (p=0.0032, p=0.0074, p=0.0384 and p=0.0110, respectively). Standardized evaluation of volume variations from baseline to M3, M12 and M18 showed that CPM-26 created more volume augmentation at all time points, and the difference was significant at M3.Conclusion: CPM-26 was non-inferior to VYC-20 based on MAS ratings at M3 and demonstrated a favorable safety and effectiveness profile for midfacial volume enhancement with results lasting up to M18. Keywords: cohesive polydensified matrix, hyaluronic acid fillers, Belotero® Volume, Modélis® SHAPE, Juvéderm® VOLUMA®, volumizing

Welf Prager,1 Jürgen Huber-Vorländer,2 A Ziah Taufig,3 Matthias Imhof,4 Ulrich Kühne,4 Ruth Weissberg,5 Lars-Peter Kuhr,6 Volker Rippmann,3 Wolfgang G Philipp-Dormston,7 Thomas M Proebstle,8 Claudia Roth,9 Martina Kerscher,10 Claudius Ulmann,11 Tatjana Pavicic121Dermatologikum, Hamburg, 2Fort Malakoff Klinik, Mainz, 3Praxisklinik für Plastische und Ästhetische Chirurgie, Cologne, 4Ästhetische Dermatologie im Medico Palais, Bad Soden, 5Taimerhofstrasse 28, Munich, 6Aqua Medical Spa, Munich; 7Hautzentrum Köln, Cologne, 8Privatklinik Proebstle GmbH, Mannheim, 9Kö-Klinik, Düsseldorf, 10MIN Fakultät/Department Chemie/Kosmetikwissenschaft, Hamburg, 11Kosmas Klinik, Bad Neuenahr-Ahrweiler, 12Klinik und Poliklinik für Dermatologie und Allergologie, Munich, GermanyBackground: Botulinum toxin type A treatment has been used for over 20 years to enhance the appearance of the face. There are several commercially available botulinum toxin type A products used in aesthetic clinical practice. The aim of this retrospective analysis was to compare the clinical efficacy of the most commonly used botulinum toxin type A preparations in daily practice.Methods: Physicians from 21 centers in Germany completed questionnaires based on an inspection of subject files for subjects 18 years of age or over who had received at least two, but not more than three, consecutive treatments with incobotulinumtoxinA, onabotulinumtoxinA, or abobotulinumtoxinA within a 12-month period in the previous 2 years. Data on subject and physician satisfaction, treatment intervals, dosages, and safety were collected from 1256 subjects.Results: There were no statistically significant differences between incobotulinumtoxinA and onabotulinumtoxinA with respect to physician and subject satisfaction, dosages, and adverse effects experienced. Both botulinum toxin type A preparations were well tolerated and effective in the treatment of upper facial lines. Due to low treatment numbers, abobotulinumtoxinA was not included in the statistical analysis.Conclusion: The results of this retrospective analysis confirm the results of prospective clinical trials by demonstrating that, in daily practice, incobotulinumtoxinA and onabotulinumtoxinA are used at a 1:1 dose ratio and display comparable efficacy and safety.Keywords: NT 201, incobotulinumtoxinA, onabotulinumtoxinA, abobotulinumtoxinA, upper face, retrospective analysis

After the dynamics of microemulsions adjacent to a planar hydrophilic wall have been characterized using grazing incidence neutron spin echo spectroscopy, the model of Seifert was employed to explain the discovered acceleration for the surface near lamellar ordered membranes. Reflections of hydrodynamic waves by the wall – or the volume conservation between the membrane and the wall – explain faster relaxations and, therefore, a lubrication effect that is important for flow fields in narrow pores. The whole scenery is now spectated by using different scenarios of a bicontinuous microemulsion exposed to clay particles and of a lamellar microemulsion adjacent to a planar wall. The Seifert concept could successfully be transferred to the new problems.