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Author: Vanessa Ngan, Staff Writer, 2002.
Dermal fillers and other implants are used for facial augmentation. They can be chosen for reconstructive or cosmetic purposes. It has become increasingly popular for the ‘normal’ everyday person to seek dermal fillers to fill in acne scars and facial lines or to enhance a specific facial area. Dermal fillers are injected just below the skin surface. Other materials are implanted in the subcutaneous area to restore or replace fat.
Over the years, many filling agents have been developed. However, the search is still on for the ideal facial implant material. The ideal product should have the following properties:
Dermal fillers and facial implants can be used in reconstructions for areas that may have been scarred or altered by trauma. This may be done in conjunction with minor or major plastic surgery. The other increasing use of dermal fillers is in cosmetic surgery where patients seek these treatments to improve their appearance.
They are mainly used for the removal or improvement of scars caused by acne, correction of facial (wrinkle) lines, and enhancement or filling in of certain specific facial features such as the lips or chin.
|Facial lines and features that can be corrected using dermal fillers|
There are numerous substances that add bulk to tissue. Each has its place and specific uses in facial augmentation. See individual implant types for specific details regarding use. The list below includes some older products that are no longer in general use.
|Implant type||Product names|
|Collagen||Zyderm™, Zyplast™, Alloderm™, CosmoDerm™, CosmoPlast™|
|Hyaluronic acid||Hylaform™, Restylane™, Captique™, Perlane™, Juvederm™, Prevelle™, Puragen™, Elevess™|
|Hydroxyapatite||Hydroxyapatite (HA), Coralline Hydroxyapatite (CH), Radiesse™|
|Silicone||Popular manufacturers include Implantech, Allied Biomedical, Advanced Bio-Technologies, Inamed Aesthetics|
|Expanded polytetrafluoroethylene (ePTFE)||Gore-Tex™, SoftForm™|
|Polymethyl-methacrylate (PMMA)||Artecoll™, MetaCrill™, Artefill™|
|Hydrophilic polyacrylamide||Hydrogel™, HPG™, Argiform™, Bioformacryl™, DermaLive™, Aquamid™|
Of the implant types described above, the following are injectable augmentation products:
These products provide facial augmentation with less downtime. Collagen and hyaluronic acid provide only a temporary solution as they are reabsorbed into the body over time (3–12 months); top-up treatments are necessary to maintain the desired correction. PMMA and hydrophilic polyacrylamide gel are recent additions of injectable augmentation products and give more long-lasting results (months to years).
All dermal fillers and facial implants currently used have some side effects that preclude them from being the ideal agent. Some of the side effects and complications that may occur include:
See individual implant types for specific problems.
Proper knowledge of facial anatomy, training in injection technique and supervision of new injectors will reduce the risks.
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