International Academy of Cosmetic Dermatology
SOFT TISSUE AUGMENTATION
Three permanent fillers are commonly used worldwide: silicone, polymehtylmethacrylate (PMMA), and polyacrylamide. Although permanent results are achieved with single to a few sessions, permanent fillers can induce granulomatous reactions during a lifetime. Delayed reactions can occur, when the body is under pro-inflammatory conditions; i.e. when fighting infections or after administration of interferon. The more superficial the filler is placed, the higher is its potential to produce undesirable granulomas. When applying silicone, the microdroplet technique should be used.
Poly-L-lactic acid and hydroxyapatite are longer lasting resorbable fillers (18 months or longer). Their main action is the induction of neo-collagenesis through a continuous low-grade inflammatory response.
Hyaluronic acid and collagen are typical short duration fillers (less than 8 months duration). Recent technological advances have yielded longer lasting hyaluronic acid and collagen products that are more suitable for augmentation procedures.
While age related volumetric loss is pronounced in the subcutaneous tissue, it also occurs in the dermis. This results in deep nasolabial folds and a concave appearance of the malar, bucal, and perioral areas. It is also pronounced in the lips and temporal areas. Augmenting these areas can restore a more youthful appearance. When combined with a surgical facelift in older patients, it offers a more natural look.
The following table lists some fillers available for augmentation. N.B. prices are estimates and vary according to the filler used and the physician. The number of sessions over a ten year period is highly variable and depends upon the amount of product used per session, technique, and product specificities; i.e. degree of hyaluronic acid or collagen cross-linkage, centrifugation of fat, etc.
Davi de Lacerda, MD