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Combination Therapy for Rejuvenation of the Lower Face and Neck

Primary Purpose

Laxity; Skin

Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Ultherapy
Xeomin
Belotero Balance
Dilute Radiesse
Neocutis Micro Firm Face and Neck Cream
Sponsored by
Nashville Centre for Laser and Facial Surgery
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Laxity; Skin

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • • Age at least 18 years

    • Ability to understand the informed consent process
    • Written informed consent is given prior to performing any study procedure
    • Moderate to severe changes of the jawline as per the Merz Jawline Scale (Grade 3 or 4)
    • Moderate to severe changes of the décolletage as per the Merz Decollete scale (Grade 3 or 4)
    • Presence of prominent platysmal bands
    • Presence of horizontal necklace lines is not mandatory for inclusion but, if present, will be assessed on a 5 point scale
    • Moderate to severe laxity of neck and decollete skin
    • Body mass index (BMI) less than or equal to 30 kg/m2 at screening
    • Female subjects are not pregnant (negative urine pregnancy test) and are willing to minimize the chance of becoming pregnant during the study period and follow up.
    • Willing and able as assessed by the PI to follow study instruction and likely to complete all study assessments and required visits
    • Willing to allow photographs to be used for educational and marketing purposes including on the internet and social media

Exclusion Criteria:

  • • Age greater than 65 years

    • Platysma neck bands at rest or excessively loose skin in lower face, neck, and décolletage area that, in the opinion of the Principal investigator (PI) or Subinvestigator (SI), may interfere with assessment
    • Presence of thyroid enlargement, neck masses, salivary gland pathology, scars, or other features of the lower face/neck/décolletage area (excessive pre- or subplatysmal fat, jowling, skin laxity, etc.) that, in the opinion of the PI or SI may interfere with study assessments or which render the potential subject a poor candidate for treatment on the basis of low likelihood to respond favorably.
    • Active dermatological disease or wounds, scarring, marked variation in pigmentation (poikiloderma of Civatte, focal hypopigmentation), or other anatomic characteristics in the lower face, neck or décolletage area that, in the opinion of the PI or SI, may interfere with study assessments.
    • History of dysphagia
    • Any medical condition that would represent a contraindication to Xeomin
    • Facial or neck hair (beard) that would interfere with photography or clinical assessments
    • Any known uncontrolled systemic disease
    • History of superficial aesthetic treatments to the face, neck or décolletage area (including but not limited to microdermabrasion, superficial chemical peels, microneedling, PRP, or topical retinoid use) 3 months prior to Day 0
    • History of treatment to the face, neck or decolletage area with IPL, ablative or nonablative lasers, skin tightening devices, medium depth chemical peels, cryolipolysis or deoxycholic acid injections 6 months prior to Day 0
    • History of soft tissue filler injection with HA in the lower face/neck/décolletage region 12 months prior to Day 0
    • History of soft tissue filler injection with Radiesse or Sculptra in the lower face/neck/décolletage region 24 months prior to Day 0
    • History of lower face/neck lifting, treatment with permanent fillers, jaw surgery, placement of implants or repair of jaw or LeFort type fractures in the mid or lower face/neck/décolletage region.
    • Any planned surgical intervention in the lower face/neck/décolletage region during the study period
    • Current enrollment in any other investigational trial
    • History of weight loss surgery or procedures
    • Females who are pregnant or nursing
    • Known immunization or failure to respond to any botulinum toxin product
    • History of Alpha Gal
    • Known allergy or sensitivity to any of the components of the study treatments or any materials used in the study procedures
    • Tattoos in the treatment area that may interfere with study assessments
    • Any condition or is in a situation which, in the investigator's opinion, may put the participant at significant risk, may confound the study results, or may interfere significantly with the participant's participation in the study.
    • Any subject who, in the PI's opinion, is not a good candidate to participate in this clinical trial
    • Subjects with allergies to eggs
    • Subjects with allergies to lidocaine
    • Subjects with neurological disorders or contra-indications for Botox such as ALS, Lambert-Eaton Syndrome and Myasthenia Gravis Syndrome.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Treatment

    Arm Description

    Subjects will receive a combination of Ultherapy, Xeomin, Beletero Balance, Dilute Radiesse and Neocutis MicroFirm Face and Neck Cream

    Outcomes

    Primary Outcome Measures

    Laxity of Jawline Scale
    Laxity of Jawline Scale, scale ratings are 0=no sagging, 1=mild sagging, 2=moderate sagging, 3=severe sagging, 4=very severe sagging
    Decollete (chest) Wrinkle Scale
    Decollete (chest) Wrinkle Scale, scale ratings are 0=no wrinkles, 1=mild wrinkles, 2=moderate wrinkles, 3=severe wrinkles, 4=very severe wrinkles

    Secondary Outcome Measures

    Laxity of Jawline Scale
    Laxity of Jawline Scale, scale ratings are 0=no sagging, 1=mild sagging, 2=moderate sagging, 3=severe sagging, 4=very severe sagging
    Decollete (chest) Wrinkle Scale
    Decollete (chest) Wrinkle Scale, scale ratings are 0=no wrinkles, 1=mild wrinkles, 2=moderate wrinkles, 3=severe wrinkles, 4=very severe wrinkles

    Full Information

    First Posted
    September 18, 2019
    Last Updated
    September 23, 2019
    Sponsor
    Nashville Centre for Laser and Facial Surgery
    Collaborators
    Merz North America, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04102670
    Brief Title
    Combination Therapy for Rejuvenation of the Lower Face and Neck
    Official Title
    Combination Therapy for Rejuvenation of the Lower Face and Neck
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2019
    Overall Recruitment Status
    Unknown status
    Study Start Date
    October 1, 2019 (Anticipated)
    Primary Completion Date
    December 1, 2020 (Anticipated)
    Study Completion Date
    December 1, 2020 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Nashville Centre for Laser and Facial Surgery
    Collaborators
    Merz North America, Inc.

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    An investigator initiated trial in which 20 subjects with moderate to severe changes of the jawline, neck and décolletage will undergo combination treatment to achieve comprehensive rejuvenation of the jawline and neck.
    Detailed Description
    Aging changes in the lower face, neck and decollete are complex and involve skin, subcutaneous tissue/SMAS and muscle. It follows therefore that rejuvenation of the jawline, neck and decollettage requires a multifactorial, combination approach. Microfocused Ultrasound (MFU-V, Ultherapy) has been demonstrated to noninvasively lift the skin of the submentum, neck, and reduce wrinkling of the décolletage.1-3 Injection of dilute calcium hydroxylapatite (Radiesse) has also demonstrated improvement of skin quality and reduction of wrinkles in the neck and décolletage skin.4 Combination therapy using MFU-V and Radiesse has been used successfully to improve the appearance of the neck and décolletage and botulinum toxin A has been used to improve jawline contouring and wrinkling of the décolletage.5,6 It is well recognized that skincare products such as MicroFirm Neck and Decollete Rejuvenating Complex improve skin quality and overall skin appearance. Further, Belotero Balance has been demonstrated to have optimal biophysical properties for placement in the superficial dermis and subsequent correction of etched lines.7 It is not surprising that horizontal "necklace lines" in the neck respond better to injection of Belotero Balance than any other reported treatment. Evaluation of the combination of skincare, botulinum toxin, MFU-V, and Radiesse for rejuvenation of the jawline, neck, and décolletage has not been studied. Proposal: I propose an investigator initiated trial in which 20 subjects with moderate to severe changes of the jawline, neck and décolletage will undergo combination treatment to achieve comprehensive rejuvenation of the jawline and neck. Adequate time will be allowed for follow up to determine the complete effects of all treatments administered. Materials and Methods: Neocutis MicroFirm Neck and Decollete treatment would be initiated at Day 0 and continued bid throughout the entire duration of the protocol. Ultherapy will be used to treat the the lower face/neck and décolletage and will also be provided at Day 0. Ultherapy treatments would of course be customized to meet each patient's needs. The general guidelines that would be used to treat the lower face/jawline/neck would be the 4-4.5 transducer (approx. 350 lines) and the 7-3.0 transducer (approx. 460 lines). The décolletage area would be treated with the following transducers: 4-4.5 (approx. 120 lines), 7-3.0 (approx. 120 lines), and 10-1.5 (approx. 40 lines). As per consensus recommendations, Ultherapy will be administered prior to injectables.8 Dilute Radiesse (1:2 with injectable saline and 1% lidocaine without epinephrine) will be injected into the neck and décolletage at days 30, 90, and 150. Radiesse will be injected as per standard protocol using sterile technique and administered via a subcutaneous fanning approach. A total of 3 Radiesse injections will be administered at 8 weeks intervals (Days 30, 90, and 150). The amount of Dilute Radiesse used will be at the discretion of the Investigator but will not exceed 4.5mls for both treatment areas, the neck and décolletage. Xeomin will be injected in a "Nefertiti Lift" pattern horizontally, parallel to the jawline, vertically in the platysma bands, and extending into the décolletage as indicated based on platysma muscle anatomy. A total dose of no more than 70U of Xeomin will be utilized. The first Xeomin injection will also be administered at Day 30. Additional Xeomin injections will be administered at Day 120. Subjects will be assessed at Day 44 +/- 3 days, and Day 134 +/- 3 days to assess outcomes of Xeomin injections and provide touch up injections if indicated. Belotero Balance will be injected in horizontal necklace lines if present at Day 30 with reassessment for optional injection Follow up and possible touch up treatment will be offered at Day 44+/- 3 days.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Laxity; Skin

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Model Description
    Subjects will receive a combination of Ultherapy, Xeomin, Beletero Balance, Dilute Radiesse and Neocutis MicroFirm Face and Neck Cream
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    20 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment
    Arm Type
    Experimental
    Arm Description
    Subjects will receive a combination of Ultherapy, Xeomin, Beletero Balance, Dilute Radiesse and Neocutis MicroFirm Face and Neck Cream
    Intervention Type
    Device
    Intervention Name(s)
    Ultherapy
    Intervention Description
    Subjects will be treated with Ultherapy, which is a microfocused ultrasound, on the lower face, neck, and chest.
    Intervention Type
    Device
    Intervention Name(s)
    Xeomin
    Intervention Description
    Vertical neckbands, also known as platysma bands, will be injected with Xeomin to relax the bands.
    Intervention Type
    Device
    Intervention Name(s)
    Belotero Balance
    Intervention Description
    Horizontal necklace lines will be filled using Beletero Balance.
    Intervention Type
    Device
    Intervention Name(s)
    Dilute Radiesse
    Intervention Description
    The chest area will be injected with dilute Radiesse to stimulate collagen.
    Intervention Type
    Other
    Intervention Name(s)
    Neocutis Micro Firm Face and Neck Cream
    Intervention Description
    Neocutis Micro Firm Face and Neck Cream will be provided to subjects for topical use at home.
    Primary Outcome Measure Information:
    Title
    Laxity of Jawline Scale
    Description
    Laxity of Jawline Scale, scale ratings are 0=no sagging, 1=mild sagging, 2=moderate sagging, 3=severe sagging, 4=very severe sagging
    Time Frame
    Day 60
    Title
    Decollete (chest) Wrinkle Scale
    Description
    Decollete (chest) Wrinkle Scale, scale ratings are 0=no wrinkles, 1=mild wrinkles, 2=moderate wrinkles, 3=severe wrinkles, 4=very severe wrinkles
    Time Frame
    Day 60
    Secondary Outcome Measure Information:
    Title
    Laxity of Jawline Scale
    Description
    Laxity of Jawline Scale, scale ratings are 0=no sagging, 1=mild sagging, 2=moderate sagging, 3=severe sagging, 4=very severe sagging
    Time Frame
    Day 180
    Title
    Decollete (chest) Wrinkle Scale
    Description
    Decollete (chest) Wrinkle Scale, scale ratings are 0=no wrinkles, 1=mild wrinkles, 2=moderate wrinkles, 3=severe wrinkles, 4=very severe wrinkles
    Time Frame
    Day 180

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: • Age at least 18 years Ability to understand the informed consent process Written informed consent is given prior to performing any study procedure Moderate to severe changes of the jawline as per the Merz Jawline Scale (Grade 3 or 4) Moderate to severe changes of the décolletage as per the Merz Decollete scale (Grade 3 or 4) Presence of prominent platysmal bands Presence of horizontal necklace lines is not mandatory for inclusion but, if present, will be assessed on a 5 point scale Moderate to severe laxity of neck and decollete skin Body mass index (BMI) less than or equal to 30 kg/m2 at screening Female subjects are not pregnant (negative urine pregnancy test) and are willing to minimize the chance of becoming pregnant during the study period and follow up. Willing and able as assessed by the PI to follow study instruction and likely to complete all study assessments and required visits Willing to allow photographs to be used for educational and marketing purposes including on the internet and social media Exclusion Criteria: • Age greater than 65 years Platysma neck bands at rest or excessively loose skin in lower face, neck, and décolletage area that, in the opinion of the Principal investigator (PI) or Subinvestigator (SI), may interfere with assessment Presence of thyroid enlargement, neck masses, salivary gland pathology, scars, or other features of the lower face/neck/décolletage area (excessive pre- or subplatysmal fat, jowling, skin laxity, etc.) that, in the opinion of the PI or SI may interfere with study assessments or which render the potential subject a poor candidate for treatment on the basis of low likelihood to respond favorably. Active dermatological disease or wounds, scarring, marked variation in pigmentation (poikiloderma of Civatte, focal hypopigmentation), or other anatomic characteristics in the lower face, neck or décolletage area that, in the opinion of the PI or SI, may interfere with study assessments. History of dysphagia Any medical condition that would represent a contraindication to Xeomin Facial or neck hair (beard) that would interfere with photography or clinical assessments Any known uncontrolled systemic disease History of superficial aesthetic treatments to the face, neck or décolletage area (including but not limited to microdermabrasion, superficial chemical peels, microneedling, PRP, or topical retinoid use) 3 months prior to Day 0 History of treatment to the face, neck or decolletage area with IPL, ablative or nonablative lasers, skin tightening devices, medium depth chemical peels, cryolipolysis or deoxycholic acid injections 6 months prior to Day 0 History of soft tissue filler injection with HA in the lower face/neck/décolletage region 12 months prior to Day 0 History of soft tissue filler injection with Radiesse or Sculptra in the lower face/neck/décolletage region 24 months prior to Day 0 History of lower face/neck lifting, treatment with permanent fillers, jaw surgery, placement of implants or repair of jaw or LeFort type fractures in the mid or lower face/neck/décolletage region. Any planned surgical intervention in the lower face/neck/décolletage region during the study period Current enrollment in any other investigational trial History of weight loss surgery or procedures Females who are pregnant or nursing Known immunization or failure to respond to any botulinum toxin product History of Alpha Gal Known allergy or sensitivity to any of the components of the study treatments or any materials used in the study procedures Tattoos in the treatment area that may interfere with study assessments Any condition or is in a situation which, in the investigator's opinion, may put the participant at significant risk, may confound the study results, or may interfere significantly with the participant's participation in the study. Any subject who, in the PI's opinion, is not a good candidate to participate in this clinical trial Subjects with allergies to eggs Subjects with allergies to lidocaine Subjects with neurological disorders or contra-indications for Botox such as ALS, Lambert-Eaton Syndrome and Myasthenia Gravis Syndrome.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Amanda Spear, CCRC
    Phone
    6153291110
    Email
    amanda@drbiesman.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Brian S Biesman, MD
    Organizational Affiliation
    The Practice of Brian S. Biesman, MD, PLLC
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Combination Therapy for Rejuvenation of the Lower Face and Neck

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