CHICAGO – Adding epinephrine to a specific formulation of hyaluronic acid already mixed with lidocaine failed to reduce the severity of adverse events following correction of perioral lines in a blinded study.
"Our results using split-face comparison did not reveal a large difference in bruising and pain scores," Dr. Azadeh Shirazi of Scripps Clinic in La Jolla, Calif., reported at the American Academy of Dermatology summer meeting.
Three groups of 10 women with mild to severe lip wrinkles were treated with 1.0 mL of cohesive polydensified matrix hyaluronic acid (CPMHA) alone; CPMHA plus 0.3 mL of lidocaine HCl 1%; or CPMHA plus lidocaine and epinephrine 1:100,000. The volumes in each syringe were adjusted to 1 mL in total.
All injections were performed in the dermis, using serial punctures and linear threading techniques. An entire syringe of one mixture was used on one side, followed by injection of a different mixture on the contralateral side.
Outside evaluators, physician investigators, and patients were blinded to treatment. Bruising was assessed on a 4-point, nonvalidated scale, with 0 being "no visible bruising" and 3 "severe" bruising.
On day 1 post procedure, outside evaluators gave the lowest bruising score to CPMHA alone at about 1.375, followed by CPMHA plus lidocaine and epinephrine at about 1.4, and CPMHA plus lidocaine at about 1.45.
Physicians favored the hyaluronic acid with both pain medications, while patients rated the lidocaine formulation as causing the least bruising.
By day 7, bruising was lower in all groups. The outside evaluators again rated CPMHA alone as causing the least bruising on day 7, while patients and physicians perceived less bruising with the CPMHA-lidocaine formulation. Pain scores followed a similar pattern.
Although not a variable in the study, short-lived edema also was noted in most patients.
It’s possible that there was not enough time for the epinephrine to take full effect as a vasoconstrictor to decrease bruising, Dr. Shirazi said in an interview.
Larger studies are warranted to determine differences between the different formulations, the Dr. Shirazi and her colleagues concluded in the poster.
The study was supported by Merz North America, makers of the CPMHA formulation. Dr. Shirazi has served as an investigator for Allergan, Medicis, and Merz, and as an advisory board member for several pharmaceutical and device companies.