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(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date 2 December 2010 (02.12.2010) WO 2010/136585 A2

(51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 47/32 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, (21) International Application Number: CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, PCT/EP2010/057469 DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, 28 May 2010 (28.05.2010) KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, (25) Filing Language: English NO, NZ, OM, PE, PG, PH, PL, PT, RO, RS, RU, SC, SD, (26) Publication Language: English SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: 61/213,322 29 May 2009 (29.05.2009) US (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (71) Applicant (for all designated States except US): GAL- GM, KE, LR, LS, MW, MZ, NA, SD, SL, SZ, TZ, UG, DERMA RESEARCH & DEVELOPMENT [FR/FR]; ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, MD, RU, TJ, 2400 Route des Colles, Les Templiers, F-06410 Biot TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, (FR). EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, LV, MC, MK, MT, NL, NO, PL, PT, RO, SE, SI, SK, (72) Inventor; and SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, (75) Inventor/Applicant (for US only): VILLARD, GW, ML, MR, NE, SN, TD, TG). Christophe [FR/FR]; 6 11, chemin de Ia Martourette, F-06530 Le Tignet (FR). Published: (74) Agent: ALLAB, Myriam; L'Oreal, D.I.P.I., 25-29 Quai — without international search report and to be republished Aulagnier, F-92665 Asnieres-Sur-Seine (FR). upon receipt of that report (Rule 48.2(gf)

(54) Title: COMBINATION OF ADRENERGIC RECEPTOR AGONIST - 1 OR -2, PREFERABLY WITH FILLERS, PREFERABLYHYALURONIC

(57) Abstract: The present invention provides a combination of quantity of adrenergic receptor agonist α- 1 or α- 2, and preferably product known as brimonidine with fillers and preferably with for decreasing or cutaneous reactions. COMBINATION OF ADRENERGIC RECEPTOR AGONIST α-1 OR α-2, PREFERABLY BRIMONIDINE WITH

FILLERS, PREFERABLYHYALURONICACID.

The present invention is in the surgical and dermatological domain. The present invention provides a combination of quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine with fillers and preferably with hyaluronic acid for decreasing skin or cutaneous reactions.

Superficial bruising and, to a lesser extent, bleeding are not uncommon consequences (reported on average, about one-third of the time) of many aesthetic procedures, including dermal fillers, botulinum toxins and laser resurfacing. More significant bruising occurs with surgical procedures such as liposuction, breast augmentations/lifts, face lifts and tummy tucks. The management of secondary immediate reactions due to subcutaneous or intradermic of fillers with vascular damages or vascular breaking wall inducing ecchymosis, bruising, leakage of blood components having immediate action on setting up, redness and oedema, are of particular interest. Although bruising and bleeding, as well as redness and erythema are not generally considered a big problem, most physicians prepare their patients for this possibility by alerting them to it prior to the procedure. Particularly, physicians often caution against using aspirin or other anticoagulant drugs before and after the procedure, extensively use ice packs immediately after the procedure and quite commonly recommend Arnica, an herb used to promote healing. This kind of drawbacks may discourage some patients and particularly towards aesthetic procedures. In particular with regards to the consequences of Bruising/Bleeding, Physicians report that one of the most significant concerns for patients is the amount of "downtime" and when bruising occurs, patients prefer to stay home rather than return to work and social activities

Therefore, there is a need for alleviating bruising/bleeding that occur during aesthetic or surgical procedures especially when fillers are injected.

The present invention is based on the demonstration by the Applicant that the topical application/ administration of an adrenergic receptor agonist together with aesthetic or surgical procedure, for instance filler injection, reduces the occurrence of skin/ cutaneous reactions.

The present invention provides a combination either an association of quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine with fillers and preferably with hyaluronic acid. Said combination is topically administrated to an individual in need.

The present invention provides the use in an individual in need, of a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine in combination or association with fillers and preferably with hyaluronic acid. More specifically, the invention provides the use in an individual in need, of a quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers intended for decreasing of alleviating cutaneous reactions.

In particular embodiment, the quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers are intended to be applied to the skin simultaneously or one after the other, in any order, or in a sequential order and more specifically the skin application of a quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers is within a time interval of less than 1 hour, preferably less than 30 minutes, preferably less than 15 minutes, more preferably less than 5 minutes. In preferred embodiments, the adrenergic receptor agonist α- 1 or

α-2 is brimonidine combination or association with filler(s) or the filler(s) in combination or association with adrenergic receptor agonist α- 1 or α-2 and preferably brimonidine, is hyaluronic acid.

In a most preferred embodiment the cutaneous reactions are selected from the following: bruising, bleeding, ecchymosis, erythema, oedema, necrosis, ulceration, swelling and/or inflammation.

The present invention provides a kit of part combining or associating a quantity of adrenergic receptor antagonist α- 1 or α-2, and preferably product known as brimonidine with fillers and preferably with hyaluronic acid. Said quantity of adrenergic receptor antagonist α- 1 or α-2 is in a form of a topical composition or formulation.

The invention provides also a method for diminishing or decreasing or avoid bruising and, to a lesser extent, bleeding and particularly in aesthetic procedures, including dermal fillers and preferably hyaluronic acid, Botulinum toxin and laser resurfacing, by providing to an individual in need thereof a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine. In another embodiment, the invention provides a method for alleviating or decreasing cutaneous reactions and particularly in aesthetic procedures, including injection of dermal fillers and preferably hyaluronic acid, Botulinum toxin and laser resurfacing, by providing to an individual in need thereof a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine. In a most preferred embodiment the cutaneous reactions are selected from the following: bruising, bleeding, ecchymosis, erythema, oedema, necrosis, ulceration, swelling and/or inflammation.

The expression "association" of adrenergic receptor antagonist or salts thereof with fillers means that the two active principles are formulated separately; or adrenergic receptor antagonist

(preferably brimonidine) or the salts thereof is thus present in a first composition, while the fillers

(preferably hyaluronic acid) is/are present in a second composition. In the context of the invention "combination" and "association" are interchangeable.

Thus, according to a another embodiment of the invention, the pharmaceutical composition is in the form of a composition A comprising adrenergic receptor antagonist, intended to be applied concomitantly with a composition B comprising the filler(s). Preferably, composition A and composition B are presented in the form of a kit, allowing concomitant administration of the two compositions, or alternatively in the form of a kit combining in the same presentation at least the two products (compositions A and B) in two separate packages, preferably in the form of tubes (co-packaging). The expression "concomitant" application means that the compositions are intended to be applied to the skin simultaneously or one after the other, in any order, or in a sequential order (for example, in which the application of a pharmaceutical composition B comprising precedes the application of the pharmaceutical composition A), but within a time interval of less than 1 hour, preferably less than 30 minutes, preferably less than 15 minutes, more preferably less than 5 minutes or even less than 1 minute.

The present invention provides a method for diminishing or decreasing or avoiding bruising and, to a lesser extent, bleeding and particularly in aesthetic procedures, including dermal fillers and preferably hyaluronic acid, Botulinum toxins and laser resurfacing, by providing to an individual in need thereof a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine.

As it is well known in the art, adrenergic receptors encompass both α and β receptors. Among α ( also noted a-) adrenoreceptors, α1 and oc2 receptors were distinguished in the 1970's. During the same decade, α2 receptors were found to occur on vascular smooth muscles and exhibit mediation of vasoconstrictor response ('Subtypes of functional ctr and α -adrenoceptors" JR Docherty; European Journal of Pharmacology 361 (1998) 1-15). Thus, molecules exhibiting α adrenergic agonism, advantageously α2 adrenergic agonism, possess peripheral vasoconstrictive activity. Among the α receptors, the agonist can be an agonist of both α1 and α2 receptors, or can be specific for α1 or oc2. Preferably, the chosen molecule displays more affinity for the α2 than for the

α1 receptor, and will generally be named, in the rest of the application, "an α2 adrenergic receptor agonist"

Agonists of the a-2 adrenoceptors have been used therapeutically for a number of conditions including hypertension, congestive heart failure, angina pectoris, spasticity, , diarrhea, and for the suppression of opiate withdrawal symptoms (J. P. Heible and R. R. Ruffolo

Therapeutic Applications of Agents Interacting with a-Adrenoceptors, p. 180-206 in Progress in

Basic and Clinical Pharmacology Vol. 8, P. Lomax and E. S . Vesell Ed., Karger, 1991). Adrenoceptor agonists such as clonidine have been primarily used orally, though a patch formulation is known. The a-2 agonists are known to mediate vasoconstriction both in the core and periphery of a patient. In particular a-2 adrenoceptor agonists are known to cause vasoconstriction of peripheral arterioles, in response to stimulation due to cold or stress.

The most preferred compound is (5-Bromo-quinoxalin-6-yl)- (4, 5-dihydro-IH-imidazol-2-yl)- amine (commonly referred to as brimonidine) and pharmaceutically acceptable salts thereof, particularly the tartrate salt. Other compounds of the invention include , tetra- hydrozaline, , , epinephrine, norepinephrine, and and their pharmaceutically acceptable salts. A number of patents describe the use of brimonidine for treating ophthalmic conditions and eye diseases. In Canadian patent CA2326690, there is described the use of topical ophthalmic preparations for use only in the eyes, to treat eye diseases.

In one embodiment, the compounds of the invention are administrated to a patient in need thereof topically. Therefore, in the context of the instant invention the compounds are delivered to the affected area of the skin in a pharmaceutically acceptable topical carrier. A s used herein, a pharmaceutically acceptable topical carrier is any pharmaceutically acceptable formulation that can be applied to the skin surface for topical, dermal, intradermal, or transdermal delivery of a pharmaceutical or medicament. The combination of a pharmaceutically acceptable topical carrier and a compound of the invention is termed a topical formulation or topical composition of the invention.

Topical formulations of the invention are prepared by mixing a compound of the invention with a topical carrier according to well-known methods in the art, for example, methods provided by standard reference texts such as, REMINGTON: THE SCIENCE AND PRACTICE O F PHARMACY 1577-1591 ,1672-1673, 866-885 (Alfonso R . Gennaro ed. 19th ed. 1995); Ghosh, T. K.; et al. TRANSDERMAL AND TOPICAL DRUG DELIVERY SYSTEMS (1997), both of which are hereby incorporated herein by reference.

The topical carriers useful for topical delivery of compounds of the invention can be any carrier known in the art for topically administering pharmaceuticals, for example, but not limited to, pharmaceutically acceptable solvents, such as a polyalcohol or water; emulsions (either oil-in- water or water-in-oil emulsions), such as creams or lotions; micro emulsions; ; ointments; liposomes; powders; and aqueous solutions or suspensions.

In a preferred embodiment, the topical carrier used to deliver a compound of the invention is an emulsion, , or ointment. Emulsions, such as creams and lotions are suitable topical formulations for use in the invention. An emulsion is a dispersed system comprising at least two immiscible phases, one phase dispersed in the other as droplets ranging in diameter from 0.1 mu m to 100 mu m . An emulsifying agent is typically included to improve stability. When water is the dispersed phase and an oil is the dispersion medium, the emulsion is termed a water-in-oil emulsion. When an oil is dispersed as droplets throughout the aqueous phase as droplets, the emulsion is termed an oil-in-water emulsion. Emulsions, such as creams and lotions that can be used as topical carriers and their preparation are disclosed in REMINGTON: THE SCIENCE AND PRACTICE OF PHARMACY 282-291 (Alfonso R. Gennaro ed. 19th ed. 1995, hereby incorporated herein by reference.

In another embodiment, the topical carrier used to deliver a compound of the invention is a gel, for example, a two-phase gel or a single-phase gel. Gels are semisolid systems consisting of suspensions of small inorganic particles or large organic molecules interpenetrated by a liquid. When the gel mass comprises a network of small discrete inorganic particles, it is classified as a two-phase gel. Single-phase gels consist of organic macromolecules distributed uniformly throughout a liquid such that no apparent boundaries exist between the dispersed macromolecules and the liquid. Suitable gels for use in the invention are disclosed in REMINGTON: THE SCIENCE AND

PRACTICE OF PHARMACY 1517-1518 (Alfonso R . Gennaro ed. 19th ed. 1995), hereby incorporated herein by reference. Other suitable gels for use with the invention are disclosed in U.S. Pat. No. 6,387,383 (issued May 14, 2002); U.S. Pat. No. 6,517,847 (issued Feb. 11, 2003); and U.S. Pat. No. 6,468,989 (issued Oct. 22, 2002), each of which patents is hereby incorporated herein by reference.

In another embodiment, the topical carrier used to deliver a compound of the invention is an ointment. Ointments are oleaginous semisolids that contain little if any water. Preferably, the ointment is hydrocarbon based, such as a wax, petrolatum, or gelled mineral oil.

Suitable ointments for use in the invention are well known in the art and are disclosed in REMINGTON: THE SCIENCE AND PRACTICE OF PHARMACY 1585-1591 (Alfonso R . Gennaro ed. 19th ed. 1995), hereby incorporated herein by reference.

In another embodiment, the topical carrier used in the topical formulations of the invention is an aqueous solution or suspension, preferably, an aqueous solution.

Well-known solutions and suspensions are suitable topical carriers for use in the invention. Suitable aqueous topical formulations for use in the invention are disclosed in REMINGTON: THE SCIENCE AND PRACTICE OF PHARMACY 1563-1576 (Alfonso R. Gennaro ed. 19th ed. 1995), hereby incorporated herein by reference. Other suitable aqueous topical carrier systems are disclosed in U.S. Pat. No. 5,424,078 (issued Jun. 13, 1995); U.S. Pat. No. 5,736,165 (issued Apr. 7, 1998); U.S. Pat. No. 6,194,415 (issued Feb. 27, 2001); U.S. Pat. No. 6,248,741 (issued Jun. 19, 2001); U.S. Pat. No. 6,465,464 (issued Oct. 15, 2002), all of which patents are hereby incorporated herein by reference.

The topical formulations of the invention can comprise pharmaceutically acceptable excipients such as those listed in REMINGTON: THE SCIENCE AND PRACTICE OF PHARMACY 866- 885(Alfonso R. Gennaro ed. 19th ed. 1995; Ghosh, T. K.; et al. TRANSDERMAL AND TOPICAL DRUG DELIVERY SYSTEMS (1997), hereby incorporated herein by reference, including, but not limited to, protectives, adsorbents, demulcents, emollients, preservatives, , moisturizers, buffering agents, solubilizing agents, skin-penetration agents, and surfactants.

Pharmaceutical Additives

The topical formulations of the invention can include pharmaceuticals or their pharmaceutically acceptable salts, for example, but not limited to, topical and other anti-inflammatory agents, such as , diflorasone, amcinonide, fluocinolone, , , prednisone, and ; local anesthetics and analgesics, such as camphor, menthol, lidocaine, and dibucaine, and pramoxine; , such as , chloroxylenol, triacetin, sulconazole, nystatin, undecylenic acid, tolnaftate, miconizole, , oxiconazole, griseofulvin, econazole, ketoconozole, and amphotericin B; antibiotics and anti-infectives, such as , erythromycin, clindamycin, gentamicin, polymyxin, bacitracin, and silver sulfadiazine; and antiseptics, such as iodine, povidine-iodine, benzalkonium chloride, benzoic acid, chlorhexidine, nitrofurazine, benzoyl peroxide, hydrogen peroxide, hexachlorophene, phenol, , and cetylpyridinium chloride.

Dosages and dosing frequency will be determined by a trained medical professional depending on the activity of the compound of the invention, the characteristics of the particular topical formulation, and the identity and severity of the dermatologic disorder treated or prevented.

In general, a compound of the invention is present in a formulation of the invention in an amount of from about 0.001 % to about 10 %of the total weight of the formulation, preferably, of from about 0.05 % to about 5%, more preferably, of from about 0.1 % to about 2 %of the total weight of the formulation.

Another aspect of the invention is an article of manufacture that comprises a topical formulation of the invention in a suitable container with labelling and instructions for use. The container can be a dropper or tube with a suitable small orifice size, for instance the topical formulations of the invention can be filled and packaged into a plastic squeeze bottle or tube; or a small-size bottle, a phial or a vial.

Preferably, instructions are packaged with the formulations of the invention, for example, a pamphlet or package label. The labeling instructions explain how to administer topical formulations of the invention, in an amount and for a period of time sufficient to treat the patient. Preferably, the label includes the dosage and administration instructions, the formulation's composition, the clinical pharmacology, drug resistance, pharmacokinetics, absorption, bioavailability, and contraindications.

Fillers can be any product known by the skilled artisan and the preferred compounds are molecules such as Hyaluronic acid, collagen, dextran sulphate, elastine, polyurethane gels, poly- L-lactic acid or calcium hydroxyapatite or silicone or mixture thereof. The most preferred are compounds resorbable such as hyaluronic acid cross-linked or linear.

Hyaluronic acid or hyaluronate is a non-sulfated distributed widely throughout connective, epithelial, and neural tissues. It is one of the chief components of the , contributes significantly to proliferation and migration. It plays an important role in skin hydration and skin elasticity. The level of hyaluronic acid decreases with ageing in quantity and quality, inducing skin drying which becomes wrinkled. Hyaluronic acid is highly soluble in water and forms solutions with high viscosity levels. Therefore, it is widely used as pharmaceutical product.The safety of this compound is considered to be very safe since no immunogenicity reaction has been observed. Few minor adverse events have been noticed.

Therefore and advantageously, the filler is hyaluronic acid or a pharmaceutically acceptable salt or derivative thereof, particularly the sodium or potassium salt. Hyaluronic acid can be used under different forms: salts thereof, derivatives thereof such as esters or amides, in a linear form or cross-linked. In particular, the molecular weight, typically comprised between 500 kDa and 5 000 kDa, and the degree of cross-linking depends on the application, especially on the depth of the to be filled.

According to the instant invention, the term "pharmaceutically acceptable salt (s) ", as used herein, means those salts of compounds of the invention that are safe and effective for topical use in mammals and that possess the desired biological activity. Pharmaceutically acceptable salts include salts of acidic or basic groups present in compounds of the invention. Pharmaceutically acceptable acid addition salts include, but are not limited to, hydrochloride, hydrobromide, hydroiodide, , sulfate, bisulfate, phosphate, acid phosphate, isonicotinate, acetate, lactate, salicylate, citrate, tartrate, pantothenate, bitartrate, ascorbate, succinate, maleat, gentisinate, fumarate, gluconate, glucaronate, saccharate, formate, benzoate, glutamate, methanesulfonate, ethanesulfonate, benzensulfonate, p-toluenesulfonate and pamoate (i. e., 1, 1'- methylene-bis- (2-hydroxy-3-naphthoate) ) salts. Certain compounds of the invention can form pharmaceutically acceptable salts with various amino . Suitable base salts include, but are not limited to, aluminum, calcium, , magnesium, potassium, sodium, zinc, and diethanolamine salts. For a review on pharmaceutically acceptable salts see BERGE ET AL., 66 J. PHARM. Sci. 1-19 (1977), incorporated herein by reference.

By "pharmaceutically acceptable topical formulation" it is meant in the context of the invention any formulation which is pharmaceutically acceptable for topical delivery of the compounds of the invention. According to the invention, a topical formulation will comprise at least a compound of the invention. The choice of topical formulation will depend on several factors, including the nature of the symptoms to be treated or prevented, the physiochemical characteristics of the particular compound of the invention and of other excipients present, their stability in the formulation, available manufacturing equipment, and cost constraints. As used herein, a "therapeutically effective amount of a compound of the invention" means the minimum amount of the compound that is effective to obtain the desired effect in the context of the invention. As used herein, the term "subject" or "patient " are used equivalent^ and means any animal, preferably a mammal, more preferably, a human to which will be or has been administered compounds or formulations of the invention. The term 'mammals used herein, encompasses any mammal.

Figures are photographs of skin treatment with brimonidine (including both treated (Z4) and non- treated area in the same picture (Z3) taken immediately and 2 - 5 and 10 minutes after the dermabrasion.

EXAMPLES:

The following examples are provided for illustrative purposes only and are not to be construed as limiting the invention's scope in any manner.

Example 1 : A aqueous solution topical formulation of the invention comprises (5-Bromo-quinoxalin-6- yl)- (4, 5-dihydro-IH-imidazol-2-yl)-amine-L-tartrate, (brimonidinetartrate) (0.15 wt. %); benzalkonium chloride (0.005 wt. %) as a preservative; and the inactive ingredients: boric acid; calcium chloride; magnesium chloride; potassium chloride; purified water; sodium borate; sodium carboxymethylcellulose; sodium chloride; with hydrochloric acid and/or sodium hydroxide to adjust the pH to 5.6 to 6.6. The osmolality is in the range of 250-350 mOsmol/Kg.

Example 2 : A possible gel formulation of the invention is described in the Table below.

The ingredients are mixed together and aqueous sodium hydroxide is slowly added to the mixture until a pH of about 7 is reached and the gel is formed. Example 3: In vivo dermabrasion assays in minipig minizone model using a BURANE XL laser and skin interaction with Brimonidine gel.

The objectives of this study were to assess the local dermal effect of single dermal application of Brimonidine Gel placebo or 1% applied on delimited abraded mini-zone (2.8 cm2 and different dermabraded skin conditions) in the Gόttingen® minipig.

In the present work, the σ2A-adrenoceptor (Brimonidine) which is a well-known potent vasoconstrictor * in the porcine species is evaluated with regards to different skin dermabrasion conditions in order to evaluate the cutaneous reactions and particularly the redness / bleeding kinetics modifications.

One female Gόttingen® minipig (naϊve), between 4 and 8 months old, received Dermal (topical) application of Brimonidine Gel at 1% on delimited mini-zones (2.8 cm2, using a ringflost®).

On day -1 : each zone is clipped free from hair. On the clipped area (dorsum, avoiding the spinal column and the intra-scapular area), 4 minizones (2 on either side) is delimited using ringflost ® and surrounded with an indelible pen.

On day 1: The animal is anesthetized (Zoletil®) before dermabrasion. Each minizone is disinfected with chlorexidine. The experimental conditions used for each zone is set as follows:

Head O Z 1: 6.5j/cm2, 6 passes O Z3: 10j/cm2, 6 passes Left O Z2: Brimonidine gel 1% + 6.5j/cm2, 6 passes O Z4: Brimonidine gel 1% + 10j/cm2, 6 passes Right

The Brimonidine gel 1% is gently applied 5 minutes prior to the dermabrasion procedure.

The cutaneous reaction is evaluated immediately, and 2 - 5 and 10 minutes after the dermabrasion procedure. The skin is examined to evaluate the degree of erythema, , desquamation, scab formation and any other lesions. Cutaneous reaction is evaluated according to the grading scale describe in "OCDE Guideline No. 404. Acute dermal irritation/corrosion". If feasible, cutaneous reactions evaluation will be performed by the same persons during the whole study.

The duration of treatment was one day. Thereafter each zone is covered with Tegaderm® dressings until complete healing process.

Potographs (including both treated and non-treated area in the same picture) will be taken immediately and 2 - 5 and 10 minutes after the dermabrasion procedure. These assays showed that only superficial damage is induced by the Erbium laser in these conditions: depth was limited to the . All dermabrasion procedures are performed under anesthesia (Zoletil®).

Painkiller ( 1 ml_ per animal, Finadyne®) is used after the 20 minutes dermal evaluation completion. The Laser used is Erbium Yag, 2940 nm BURANE XL from Wavelight aesthetics (Quantel) As demonstrated by comparative analysis in the pictures between Z3 & Z4, the vasoconstrictor effect of Brimonidine being visually more evident starting from 5 min post-dermabrasion until 14 min and beyond since the half-life of brimonidine is 4 hours. This effect was clearly visible, starting from the peripheral area (erythematic halo) and expanding until the heart of the circular area. As conclusion, this example shows that Brimonidine is capable of decreasing cutaneous reactions during aesthetic or surgery procedures and particularly of alleviating bruising or bleeding reactions.

(*) : Anna Wikberg-Matsson and UIf Simonsen, "Potent o2A-Adrenoceptor-Mediated Vasoconstriction by Brimonidine in Porcine Ciliary Arteries", Investig. Ophth. and Visual Science. 2001; 42:2049-2055 Claims

1. A combination or association of a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine with fillers and preferably with hyaluronic acid.

2. Use in an individual in need, of a quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers intended for decreasing of alleviating cutaneous reactions.

3. Use according to claim 2 wherein, of a quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers are intended to be applied to the skin simultaneously or one after the other, in any order, or in a sequential order .

4. Use according to claim 2 or 3 wherein the skin application of a quantity of adrenergic receptor agonist α- 1 or α-2, in combination or association with fillers is within a time interval of less than 1 hour, preferably less than 30 minutes, preferably less than 15 minutes, more preferably less than 5 minutes.

5. Use according to claims 2 to 4, wherein adrenergic receptor agonist α- 1 or α-2 is brimonidine combination or association with filler(s).

6. Use according to claims 2 or 5, wherein filler(s) in combination or association with adrenergic receptor agonist α- 1 or α-2 and preferably brimonidine, is hyaluronic acid.

7. Use according to anyone of claims 2 to 6 , wherein cutaneous reactions are selected from the following: bruising, bleeding, ecchymosis, erythema, oedema, necrosis, ulceration, swelling and/or inflammation.

8. A kit of part combining a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine with fillers and preferably with hyaluronic acid.

9. A kit of part according to claim 8, wherein the quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine is in a form of a topical composition or formulation. 10. A method for diminishing or decreasing or avoid bruising and, to a lesser extent, bleeding and particularly in aesthetic procedures, including dermal fillers and preferably hyaluronic acid,

Botulinum toxin and laser resurfacing, by providing to an individual in need thereof a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine.

11. A method for alleviating or decreasing cutaneous reactions and particularly in aesthetic procedures, including injection of dermal fillers and preferably hyaluronic acid, Botulinum toxin and laser resurfacing, by providing to an individual in need thereof a quantity of adrenergic receptor agonist α- 1 or α-2, and preferably product known as brimonidine.

12. A method according to claim 8, wherein cutaneous reactions are selected from the list of reactions: ecchymosis, bruising, bleeding, erythema, oedema, necrosis, ulceration, swelling and/or inflammation.