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      Collagenase Clostridium Histolyticum-aaes for Treatment of Cellulite: A Pooled Analysis of Two Phase-3 Trials

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          Abstract

          Background:

          Collagen-rich fibrous septae and subcutaneous adipose protrusions play a role in cellulite pathophysiology. Collagenase clostridium histolyticum-aaes (CCH-aaes) injection causes enzymatic release of septae to resolve cellulite depressions and create a skin smoothing effect. This analysis pooled data from two identically designed, phase-3, randomized, double-blind, placebo-controlled studies to examine the efficacy and safety of CCH-aaes.

          Methods:

          Adult women with moderate/severe cellulite (3–4 on Clinician Reported Photonumeric Cellulite Severity Scale and Patient Reported Photonumeric Cellulite Severity Scale) on the buttocks received up to three treatment sessions (Days 1, 22, and 43) of subcutaneous CCH-aaes 0.84 mg or placebo per treatment area. Composite and individual component response (≥2-level or ≥1-level improvement from baseline in Patient Reported Photonumeric Cellulite Severity Scale and/or Clinician Reported Photonumeric Cellulite Severity Scale) and additional patient-reported outcomes were determined at Day 71.

          Results:

          Analysis included 424 CCH-aaes−treated and 419 placebo-treated women. CCH-aaes−treated women were 5.9 times more likely than placebo-treated women to be ≥2-level composite responders at Day 71 (odds ratio [95% confidence interval], 5.9 [2.2–15.4]; P < 0.001). A significantly greater percentage of CCH-aaes−treated women versus placebo-treated women were ≥1-level composite responders at Day 71 (39.4% versus 14.6%; P < 0.001). Subgroup analyses indicated no apparent impact of Fitzpatrick skin type category and baseline cellulite severity (moderate/severe) on CCH-aaes efficacy. An inverse relationship between age and CCH-aaes response was observed in those with a body mass index less than 32 kg per m 2. The most common adverse events with CCH-aaes were injection-site bruising and injection-site pain.

          Conclusion:

          CCH-aaes treatment significantly improved moderate-to-severe buttock cellulite appearance and was generally well tolerated.

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          Most cited references19

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          Molecular Mechanisms of Dermal Aging and Antiaging Approaches

          The dermis is primarily composed of the extracellular matrix (ECM) and fibroblasts. During the aging process, the dermis undergoes significant changes. Collagen, which is a major component of ECM, becomes fragmented and coarsely distributed, and its total amount decreases. This is mainly due to increased activity of matrix metalloproteinases, and impaired transforming growth factor-β signaling induced by reactive oxygen species generated during aging. The reduction in the amount of collagen hinders the mechanical interaction between fibroblasts and the ECM, and consequently leads to the deterioration of fibroblast function and further decrease in the amount of dermal collagen. Other ECM components, including elastic fibers, glycosaminglycans (GAGs), and proteoglycans (PGs), also change during aging, ultimately leading to a reduction in the amount of functional components. Elastic fibers decrease in intrinsically aged skin, but accumulate abnormally in photoaged skin. The changes in the levels of GAGs and PGs are highly diverse, and previous studies have reported conflicting results. A reduction in the levels of functional dermal components results in the emergence of clinical aging features, such as wrinkles and reduced elasticity. Various antiaging approaches, including topicals, energy-based procedures, and dermal fillers, can restore the molecular features of dermal aging with clinical efficacy. This review summarizes the current understanding of skin aging at the molecular level, and associated treatments, to put some of the new antiaging technology that has emerged in this rapidly expanding field into molecular context.
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            Cellulite: a review of its physiology and treatment.

            Cellulite affects 85-98% of post-pubertal females of all races. While not a pathologic condition, it remains an issue of cosmetic concern to a great number of individuals. Despite its high prevalence, there have been few scientific investigations into the physiology of cellulite. There have only been a few dozen peer-reviewed articles devoted to cellulite in the medical literature in the past 30 years. There is no definitive explanation for its presentation. This greatly complicates the ability to treat or improve it. The four leading hypotheses that purport to explain the physiology of cellulite include: sexually dimorphic skin architecture, altered connective tissue septae, vascular changes and inflammatory factors. Treatment modalities can be divided into four main categories: attenuation of aggravating factors, physical and mechanical methods, pharmacological agents and laser. There are no truly effective treatments for cellulite.
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              Cellulite: a review with a focus on subcision

              Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to review the background, potential pathophysiology, and potential treatment options for cellulite, highlighting subcision as an ideal therapeutic option for this cosmetically distressing condition.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2169-7574
                25 May 2022
                May 2022
                : 10
                : 5
                : e4306
                Affiliations
                From [* ]Bass Plastic Surgery PLLC, New York, N.Y.
                []Skin Associates of South Florida, Coral Gables, Fla.
                []John H. Joseph Facial Plastic and Reconstructive Surgery, Encino, Calif.
                [§ ]SkinCare Physicians, Chestnut Hill, Mass.
                []Charlottesville Medical Research, Charlottesville, Va.
                []Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, Calif.
                [** ]Tennessee Clinical Research Center, Nashville, Tenn.
                [†† ]Juva Skin & Laser Center, New York, N.Y.
                [‡‡ ]The Education & Research Foundation, Lynchburg, Va.
                [§§ ]Skin Specialists, P.C., Omaha, Neb.
                [¶¶ ]Mercy Health Research, Washington, Mo.
                [‖‖ ]Endo Pharmaceuticals, Inc., Malvern, Pa.
                Author notes
                Lawrence S. Bass, MD, Bass Plastic Surgery, PLLC, 568 Park Avenue, New York, NY 10065, E-mail: drbass@ 123456drbass.net
                Article
                00057
                10.1097/GOX.0000000000004306
                9132528
                35646496
                599b5548-edc0-412a-ba93-dd5351edf72c
                Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 29 September 2021
                : 7 March 2022
                Categories
                Cosmetic
                Original Article
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                UNITED STATES
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