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Eficácia e durabilidade do ácido Poli-L-Láctico (PLLA) na região facial : uma revisão sistemática
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Advisor(s)
Abstract(s)
Objetivo. O principal objetivo desta revisão sistemática foi avaliar a eficácia, durabilidade e efeitos adversos do tratamento com PLLA para fins estéticos. Material e Métodos. A estratégia da busca foi realizada na base de dados MEDLINE (Ovid). A busca da literatura foi realizada em cinco bases de dados, desde a sua criação até 12 de fevereiro de 2024. O objetivo era identificar ensaios clínicos randomizados que avaliassem o tratamento com Ácido Poli-L-Láctico em adultos com sinais de envelhecimento facial e/ou lipoatrofia. A avaliação do viés foi realizada usando a Ferramenta de Avaliação de Viés da Cochrane para Ensaios Clínicos Randomizados (RoB 2). Resultados. Foram incluídos onze estudos de um total de 1467 citações identificadas. Quatro estudos demonstraram aumento na espessura dérmica e melhora significativa na severidade da lipoatrofia facial após o tratamento com PLLA, com efeitos mantidos por pelo menos 25 meses. Dois estudos evidenciaram a superioridade do PLLA sobre o colagénio humano injetável. Além disso, três estudos mostraram resultados favoráveis ao PLLA em comparação com o gel de PH quanto à lipoatrofia, perda de água trans-epidérmica, qualidade da pele, elasticidade e satisfação do paciente. Todos os eventos adversos foram de intensidade leve a moderada, sendo os principais relacionados ao processo de injeção e formação de nódulos. Cinco dos onze estudos incluídos foram considerados com alto risco de viés. Conclusão. O PLLA demonstrou eficácia, com efeitos que podem durar até 2 anos. No entanto, a evidência atual sobre a eficácia e segurança do PLLA para rejuvenescimento facial é de baixa qualidade; portanto, a alta eficácia, segurança e efeitos duradouros relatados devem ser investigados com mais profundidade.
Objective. The primary objective of this systematic review study was to investigate the effectiveness, durability, and adverse events of PLLA treatment for aesthetic indications. Material and methods. The search strategy was performed in MEDLINE (Ovid). The electronic literature search of five databases was performed, from the inception of the databases until 12th of February 2024. This was to identify randomized clinical trials that assessed Poly-L-Lactic Ácid 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). Results. 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, trans epidermal 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 11 studies were considered as high risk of bias. Conclusion. PLLA has demonstrated efficacy, with effects that can last up to 2 years. However, the current 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 when used for this purpose, should be further investigated.
Objective. The primary objective of this systematic review study was to investigate the effectiveness, durability, and adverse events of PLLA treatment for aesthetic indications. Material and methods. The search strategy was performed in MEDLINE (Ovid). The electronic literature search of five databases was performed, from the inception of the databases until 12th of February 2024. This was to identify randomized clinical trials that assessed Poly-L-Lactic Ácid 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). Results. 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, trans epidermal 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 11 studies were considered as high risk of bias. Conclusion. PLLA has demonstrated efficacy, with effects that can last up to 2 years. However, the current 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 when used for this purpose, should be further investigated.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Ácido Poli-L-Lático Estética facial Bioestimulador Revisão sistemática