KEY WORDS: Elastosis, aged skin, Hyaluronic acid, Hyal ACP®, rejuvenation

Background: Aging of facial skin (loss of elasticity accompanied by wrinkle  formation) is associated with a rapid loss of hyaluronic acid content in the dermal matrix. We describe the treatment results after supplementation with Hyal ACP® (an auto-cross-linked fermentative hyaluronic acid) in a patient with severe elastotic aged skin.

Methods: A 73 years old female patient showing distinct signs of aged, photo-damaged and elastotic facial skin was treated by dermal injections of 2ml Hyal ACP® into the areas of cheek and chin at weeks 0, 2 and 4 respectively. The skin condition was assessed each week before the applications and finally at week 8 (4 weeks after the last treatment). Severity of elastosis was rated by the physician using an elastosis severity score ranging from 1 to 9 points. Other skin findings were judged using the categories “not present”, “mild”,   “moderate” and “severe”. Treatment satisfaction was self-assessed by the patient using a 6-point school notes system reaching from 1 (very good) to 6 (unsatisfactory).

Results: Already 2 weeks after the first and 4 weeks after the last application the visual appearance of the skin was distinctly rejuvenated. The elastosis score improved from 6 to 4 points. Skin moisture, severity of pale and thin skin, wrinkle deepness and age-related dryness were improved from severe/moderate to mild each. Treatment satisfaction was rated as very good (1.3) by the patient. Mild injection related punctual hematoma and erythema completely resolved within one week after application.

Conclusion: Use of Hyal ACP® resulted in a quickly visible smoothing of wrinkles and a sustained rejuvenated appearance of facial skin. The applications were shown to be very good tolerated, very easy manageable and well to be integrated into the daily praxis. Hyal ACP® has both a higher proliferation enhancing effect on fibroblasts and a 3-fold higher potency in stimulating   Keratinocytes related to native hyaluronic acid. Thus the use of Hyal ACP® provides a reasonable measure aiming at along-lasting regeneration of dermal skin structures in elastotic aged skin.