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The History of Injectable Facial Fillers
Abstract
In an attempt to maintain a youthful appearance or to reconstruct facial deformities, physicians have greeted new technologies with excitement. In the late 1800 s, shortly after the invention of the syringe, chemical agents were used for facial augmentation. Unfortunately, history has taught us that new technologies must be used with care, because complications can occur, sometimes many years after initial treatment. The first injectable filling agent was paraffin, whose use was abandoned after complications of migration, embolization, and granuloma formation were described. More recently, silicone use was banned by the U.S. Food and Drug Administration (FDA) because of similar complications. In 1981, bovine collagen was the first agent to be approved by the FDA for cosmetic injection. Since its approval, dozens of injectable filling agents have been developed, and many are already FDA approved for cosmetic use. This article will review the highlights of the evolution of facial filling agents.
... The most used injectable prosthetic is composed of hyaluronic acid [7]. The history of lip filler dates back to the early 1900s, at which point it was composed of a waxy liquid known as paraffin [8]. Since then, the 1960s introduced silicone as an agent to augment lips, similar ...
... This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. to its role in breast augmentation [8]. During the 1980s, there was a transition in the aesthetic medicine community to using collagen as a lip-filling agent [8]. ...
... to its role in breast augmentation [8]. During the 1980s, there was a transition in the aesthetic medicine community to using collagen as a lip-filling agent [8]. However, collagen is derived from animals, so allergy testing and additional safety measures are required for individual patients [8]. ...
Background
The lip augmentation market is projected to reach a value of 11.6 billion USD by 2030. Hyaluronic acid (HA) fillers are the most common type due to biocompatibility and reversibility. However, there has been an increase in alternative procedures, such as the “lip flip,” involving the injection of botulinum neurotoxin A (BoNT‐A) into the superior orbicularis oris muscle.
Aims
The purpose of this study is to review the current literature and evaluate the general public interest in dermal lip fillers compared to supralabial BoNT‐A injections over the past decade.
Methods
The Google Trends database was used to collect relative monthly search volume for the terms “lip filler” and “lip flip” over a decade‐long period (January 1, 2014–January 1, 2024). Google Trends data is automatically normalized with a value of 100 indicating maximal search volume and 1 indicating minimal search volume.
Results
Search volume for lip filler and lip flip increased similarly from 2014 to 2024. Lip filler was consistently more searched and had an average 75% increase in relative search volume per month. Meanwhile, “lip flip” had, on average, a 33% increase in search volume per month.
Conclusions
Although lip filler was more frequently inquired about than “lip flip,” the latter increased in popularity over time, reaffirming its popularity as a potential alternative to lip filler. Superior obicularis oris BoNT‐A injections are rising in popularity and may be a valuable option for patients seeking cosmesis with hesitation toward dermal fillers.
... Paraffin, created from beech wood tar, is the first described cosmetic facial filler. 5 Although the concept of reversing age-related facial volume loss was sound, complications and side effects were so negative in the public eye that historians attributed paraffin injections to slowing advancements in the cosmetic field for the first half of the 20th century. Silicone liquid injection was popularized in the 1960s. ...
... However, it was banned for use as a cosmetic injectable by the Food and Drug Administration (FDA) in 1979 due to foreign body granuloma reaction, migration, fistula formation, and even death. 5 Today, injectable silicone is available for treatment of retinal detachment, but is considered illegal for cosmetic use in some states. 5 Despite setbacks with some filler materials, newer and safer products are now currently available. ...
... 5 Today, injectable silicone is available for treatment of retinal detachment, but is considered illegal for cosmetic use in some states. 5 Despite setbacks with some filler materials, newer and safer products are now currently available. ...
Objective
The aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications.
Data Sources
Clinical experience and scientific papers.
Conclusions
Reversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.
... Collagen: Bovine collagen was the first agent approved by the FDA for cosmetic injection, known commercially as Zyderm or Zyplast (7). Since this approval in 1981, it continues to see use today as both a stand-alone and adjunct temporary filler (7). ...
... Collagen: Bovine collagen was the first agent approved by the FDA for cosmetic injection, known commercially as Zyderm or Zyplast (7). Since this approval in 1981, it continues to see use today as both a stand-alone and adjunct temporary filler (7). Cosmoderm and Cosmoplast, human bioengineered collagen formulations, received FDA approval for cosmetic injection in 2003 (3). ...
Facial proportion changes and volume loss are commonly experienced corporeal changes, whether due to the natural process of senescence or as a side effect of systemic illness. Because these physical transformations are inevitably experienced by most people, treatments that assist in the maintenance or restoration of a youthful, yet natural appearance have long been a subject of great interest in the medical field. Thanks to the relative ease and low the aging process, facial and lip filling treatments have developed into a point of focus in the world of aesthetic medicine achieved with a multitude of injectable products, including temporary and permanent fillers. With an ever-increasing number of materials at their disposal, providers in the co important choices to make when advocating biomaterials to their patients based on desired aesthetic outcomes. This review aims to meticulously discuss different aspects of the most commonly employed biomaterials in the cosmetic fa treatments for which each material is best suited. The specific biomaterials addressed in this review include: (PLLA), calcium hydroxyapatite (CaHA), polymethyl methacrylate (PMMA), and autologous fat grafting (AFG). For each biomaterial discussed, the review provides information on how they became commonly used in aesthetic medicine, specific injection techniqu properties, and optimal situational applications for each biomaterial in the setting of elective patient cosmetic augmentation.
... Since then, several materials have been used for the development of injectable formulations. Some of them were abandoned because of the development of mediumsevere adverse reactions (e.g., paraffin: embolization, granuloma formation, migration; silicone: granuloma formation; teflon: inflammatory reaction) [15,64]. Among them, autologous fat is still used as filler for its biocompatibility, availability and low cost. ...
... This paved the way for research into and development of biomaterials-based injectable formulations. However, the risk of immunogenic and hypersensitivity reactions soon decreased the popularity of animal-derived collagen fillers [64]. Moreover, the fear that the protein extracted from some animal tissues can be a vector for prion infections precluded their use. ...
Soft tissues diseases significantly affect patients quality of life and usually require targeted, costly and sometimes constant interventions. With the average lifetime increase, a proportional increase of age-related soft tissues diseases has been witnessed. Due to this, the last two decades have seen a tremendous demand for minimally invasive one-step resolutive procedures. Intensive scientific and industrial research has led to the recognition of injectable formulations as a new advantageous approach in the management of complex diseases that are challenging to treat with conventional strategies. Among them, collagen-based products are revealed to be one of the most promising among bioactive biomaterials-based formulations. Collagen is the most abundant structural protein of vertebrate connective tissues and, because of its structural and non-structural role, is one of the most widely used multifunctional biomaterials in the health-related sectors, including medical care and cosmetics. Indeed, collagen-based formulations are historically considered as the “gold standard” and from 1981 have been paving the way for the development of a new generation of fillers. A huge number of collagen-based injectable products have been approved worldwide for clinical use and have routinely been introduced in many clinical settings for both aesthetic and regenerative surgery. In this context, this review article aims to be an update on the clinical outcomes of approved collagen-based injectables for both aesthetic and regenerative medicine of the last 20 years with an in-depth focus on their safety and effectiveness for the treatment of diseases of the integumental, gastrointestinal, musculoskeletal, and urogenital apparatus.
... Practice of esthetic medicine has a long history but recent introduction of various types of medical productsespecially injectable fillers-and their approval by authorized regulatory agencies, has flourished this field. 1,2 Hyaluronic acid (HA)-based fillers are main choices in esthetic field that have been widely used for years. They are safe, biocompatible, and can be easily resolved by hyaluronidase. ...
... They are safe, biocompatible, and can be easily resolved by hyaluronidase. 1,[3][4][5] Polycaprolactone (PCL)-based fillers are a new generation that have been introduced in 2000 s. 2,6 This group of fillers are collagen stimulators and have shown acceptable safety and satisfactory immediate and long-term results in limited available studies. 2,6,7 PCLs are biodegradable and have been well-received because of the perception and claims of their long-lasting effects but their main drawback is that they do not respond to hyaluronidase and may need invasive removal procedures. ...
A 60‐year‐old woman underwent polycaprolactone‐based filler injection in her midface. Four months later, she developed progressive swelling of midface after a self‐limiting viral gastroenteritis. The diagnosis was “delayed‐onset immune‐mediated nodule formation triggered by a virus.” Ultrasonography enabled us to efficiently treat her with a tailored intralesional corticosteroid injection method. Evidence supports the safety of polycaprolactone (PCL)‐based fillers. However, we have faced PCL‐related delayed‐onset nodules triggered by viruses. Such nodules can be efficiently treated by ultrasound‐assisted intralesional corticosteroid injection.
... The invention of the syringe in the mid-1800s was followed quickly by attempts to inject substances beneath the skin that could augment and shape bodies (Kontis & Rivkin, 2009). Surgeons discovered how to alter the shape of noses without scarring by operating from the inside to reduce bumps, hooks and 'angular prominence'. ...
... Paraffin, while ultimately withdrawn, spurred the search for a substance that could successfully and safely be used to sculpt features. Kontis and Rivkin (2009) recount the history of the different fillers used across the 20th and 21st centuries. 'Fat transfer'-where fat is harvested from one part of the body to augment another-emerged contemporaneously to paraffin. ...
Science, aesthetics, the body, and the concerns they attach to, such as gender, ‘race’, class, age and consumer culture, are key objects of sociological investigation. These discourses have been reignited in recent years by changes in the availability, accessibility and affordability of medicalised cosmetic procedures. The most popular of these procedures are non‐surgical ‘tweakments’ to the shape and/or appearance of the face, usually through use of ‘injectables’ such as Botox and dermal fillers. This shift in focus from surgical procedures to minimally invasive injections has led more practitioners to join the market of potential providers and a wider variety of consumers to seek them out. This has been accompanied by panic about the risks to bodies and aesthetic standards if stewardship of beauty should fall into the wrong hands. We trace the history of medicalised cosmetic practices and academic discourses on the body, particularly how cosmetic practices are understood to produce the body as gendered and racialised. We then suggest future approaches for exploring the sociological significance of new cosmetic practices. We encourage researchers to explore how imaginaries of (un)desirable bodies shape debates about appropriate use of non‐surgical cosmetic procedures, alongside investigation of the situated intersections of identity that are inscribed on bodies.
... Over the past two decades, dermal fillers have gained widespread popularity as nonsurgical cosmetic treatments globally, even supplanting surgical procedures in some cases. Common types of dermal fillers include calcium hydroxyapatite, polylactic acid, polymethyl methacrylate, and hyaluronic acid [1]. ...
... This paper presents 5 cases of patients with deviated noses who underwent correction using HA fillers, highlighting the techniques used and the outcomes achieved. [7][8][9][10] ...
Background
Nonsurgical correction of a deviated nose using hyaluronic acid (HA) fillers offers a minimally invasive alternative to traditional rhinoplasty. This study presents a series of cases demonstrating the efficacy of HA fillers in achieving improved nasal symmetry and alignment.
Methods
Five female patients, aged 23 to 44, with varying degrees of nasal deviation, were treated with HA fillers. The filler was strategically injected into the deep subcutaneous or supraperiosteal planes to correct the nasal contour.
Results
All patients showed significant improvement in nasal alignment and symmetry. The corrections were maintained during follow-up, and patients reported high satisfaction with minimal complications. HA fillers effectively camouflaged nasal deviations, providing a straighter appearance without invasive surgery.
Conclusion
HA fillers offer a viable, nonsurgical option for correcting mild to moderate nasal deviations, providing satisfactory esthetic results with reduced downtime. However, limitations exist in addressing structural issues like septal deviation, and the results are temporary, necessitating periodic retreatment.
Evidence-based Level
Level IV.
... Paraffin and other oils can cause granulomas, sterile abscesses, necrosis, embolization, and lymphangitis. Despite the major adverse events, it has survived the illegal criminal injections in the penis and muscles (1)(2)(3). ...
Dermal fillers first gained interest in the late 19th century, but their safety and efficacy were inadequate. But the development of fillers continued and is going on. Temporary fillers like cross-linked hyaluronic acid are widely used nowadays. Biostimulatory semi-permanent fillers like poly-L-lactic acid and calcium hydroxylapatite offer an increase in longevity with excellent safety. Newer developments are the hybrid fillers that often combines a temporary and a semi-permanent filler type to obtain better rheological qualities for a natural look. With the development of products on the market, our understanding of fillers has moved from substitution of lost volume to stimulation of autologous cells, such as fibroblasts, endothelial cells, and adipocytes. An improved understanding of tissue regeneration will support the design of a new filler type for specific interaction with the host tissue.
... The use of cosmetic fillers has been reported since 1893 [1], but an increase of injectable procedures was registered worldwide from 2017 to 2021 according to the latest global survey of International Society of Aesthetic Plastic Surgery [2]. Injections of calcium hydroxyapatite accounted for 290 095 procedures and hyaluronic acid for more than 5 million in 2021, representing an increase of 73.3% and 60.1%, respectively [2]. ...
Background
Cosmetic injections are increasing, as their complications, which can be misdiagnosed as neoplastic lesions. This study aimed to detail clinical, pathological, histochemical, and immunohistochemical features of adverse reactions to cosmetic fillers in the oral and maxillofacial region.
Methods
Samples were retrieved from five pathology laboratories. Hematoxylin–eosin (H&E), Alcian Blue, Sirius Red, and Toluidine blue stains were performed, as well as immunohistochemistry for CD68, CD3, and CD20. H&E was evaluated under polarization. Descriptive statistics were performed.
Results
Twenty‐three cases were included. Polymethyl‐methacrylate was the most common material. Most reactions affected women, lips and were asymptomatic, with a variable time of evolution, presenting as nodules. Materials had different shape and size on H&E. Giant cells were commonly found, except in silicone and hyaluronic acid. Foreign‐body granuloma was frequent in polymethyl‐methacrylate. Calcium hydroxyapatite and poly‐L‐lactic acid were refractile under polarized light. Hyaluronic acid and polyacrylamide hydrogel were metachromatic by Toluidine blue. Alcian blue was positive in all cases of hyaluronic acid. Mast cells were detected in all materials, except hyaluronic acid and polyacrylamide hydrogel. Eosinophils were rarer than mast cells. Numerous CD68‐positive cells were seen in all cases. All cases had CD3‐positive cells, with variable amounts. CD20 was scant or negative in most cases.
Conclusions
An evident macrophage reaction is observed in all aesthetic fillers, frequently associated with giant cell formation. Despite similarities, there are specific features of each material and the host response that assist the correct histopathological diagnosis. Immunohistochemistry for CD68 and Toluidine blue stain are useful in doubtful cases.
... The following are several basic injection techniques that should be mastered for efficient filler treatments. [16][17][18] The advancements in filler injection techniques have significantly enhanced the capability to achieve natural and balanced facial rejuvenation. Each technique, whether retrograde, linear threading, serial puncture, or the more complex dual plane injection, has its unique benefits and applications. ...
This narrative review explores the various injection techniques utilized in facial filler procedures, emphasizing their applications, benefits, and potential complications. The increasing demand for total facial contouring and rejuvenation has led to a rise in the use of volumizing fillers and the integration of these procedures with other treatments such as toxins, threads, lasers, radiofrequency, and ultrasound. Achieving satisfactory results necessitates a comprehensive understanding of facial anatomy and the effects of aging on skin tissue. Key injection techniques discussed include retrograde and anterograde injections, linear and serial threading, serial puncture, fanning, cross-hatching, bolus, towering, sandwich, tenting, and specialized methods like fern leaf and duck walk injections. Each technique offers unique advantages, such as the retrograde technique’s ability to minimize vascular complications and the dual plane technique’s effectiveness in achieving optimal volumization and contouring by layering different types of fillers at varying depths. The dual-plane injection technique, in particular, is highlighted for its ability to provide natural and lasting results by combining firm fillers in deep layers with softer fillers superficially, minimizing surface irregularities and filler migration. The review also underscores the importance of preprocedure planning, including the marking of injection points to ensure precision, especially in patients with facial asymmetry. This comprehensive review aims to equip practitioners with the knowledge to select and master appropriate injection techniques, tailored to the specific needs of different facial areas, thereby enhancing treatment outcomes and patient satisfaction while minimizing risks.
... These treatments aim to provide balance, facial symmetry, mitigate signs of aging, and improve patients' self-perception of their image [2]. While traditional surgical procedures often have higher morbidity and are typically irreversible and more costly, orofacial esthetic procedures are less invasive and more affordable [3,4]. This spectrum of procedures includes the application of botulinum toxin, hyaluronic acid fillers, suspension threads, the use of deoxycholic acid for submental fat reduction, and, most recently, collagen biostimulators-the latest generation of fillers, such as calcium hydroxyapatite, polycaprolactone, and poly-Llactic acid [5]. ...
Objective: The aim of this study was to systematically review the safety and effectiveness of the injectable biostimulators dermal fillers calcium hydroxyapatite (CaHA) and polycaprolactone (PCL) in facial esthetic procedures. Materials and Methods: Comprehensive electronic searches were executed across six academic databases. The primary outcome focused on safety by examining studies that reported the incidence of adverse events (AEs). The secondary outcome gauged the satisfaction of the patients and injectors by validated esthetic scales. To evaluate biases, the Joanna Briggs Institute Checklist tools were employed. Results: We included a total of 79 studies. In the quantitative assessment of the CaHA, out of 5032 injected patients, 21.8% manifested early AEs, 0.85% experienced delayed reactions, and 0.27% had severe complications. Within the PCL group, consisting of 1119 patients, 83.3% exhibited early AEs, 5.6% had delayed reactions, and none had serious complications. Regarding esthetic satisfaction outcome, both products presented favorable results, but a limited number of studies assessed these data. In the studies evaluated qualitatively, a broad array of AEs were cataloged. Conclusions: The occurrence of serious AEs associated with CaHA and PCL fillers is relatively low. Both CaHA and PCL fillers exhibit favorable safety profiles, with most AEs being transient in nature.
... Crosslinked HA has a higher mechanical stability and a significantly increased in-vivo degradation time (20,21). The most frequently used crosslinkers are divinyl sulfone and 1.4-butanediol diglycidyl ether (BDDE) (2,(22)(23)(24). Since unbound crosslinkers can lead to adverse toxic reactions after injection, thorough purification of the crosslinked HA is an essential step in production of HAFs. ...
Background/aim:
To overcome the natural visual consequences of the physiological aging process, the use of biodegradable fillers made of hyaluronic acid or sodium carboxymethyl cellulose is increasingly popular in modern esthetic medicine. Clinicians can choose from a wide range of fillers with variable compositions and rheological properties, and therefore with different application areas and injection depths. The aim of this study was to analyze and compare the most commonly used fillers for facial augmentation regarding their in vitro biocompatibility and to find potential correlations to their rheological properties.
Materials and methods:
In the present study, direct and indirect in vitro cytotoxicity analysis according to DIN EN ISO 10993-5 were performed on 39 different filler materials for facial augmentation.
Results:
All fillers analyzed in this study overall showed satisfactory results in the direct and indirect cytocompatibility tests. While no material was outside the threshold values in the 2,3-bis-(2-methoxy-4-nitro-5-sulphenyl)-(2H)-tetrazolium-5-carboxanilide (XTT) cell viability and bromodeoxyuridine (BrdU) cell proliferation assays or in the live-dead staining, only 7 out of the 39 fillers reached the required values in the lactate dehydrogenase assay.
Conclusion:
All biodegradable fillers examined in this study were found to be sufficiently cytocompatible. Although the qualitative analysis of the test results showed differences between the fillers, no concrete correlation between test performance and composition or manufacturer of the fillers was found. Future efforts are required to provide clinicians with even better support in choosing the right filler for optimal outcome and patient satisfaction.
... From 2003 to 2008, more than a dozen filling agents were FDA approved, including Juvederm, Radiesse, Restylane, and Sculptra. 21 By 2008, these products had been popularized through direct- to-consumer advertising and makeover television shows. 22 For the average American, injectables were a more affordable aesthetic intervention than surgical procedures. ...
Historically, demand for plastic surgery has been associated with the performance of the US economy. This study evaluates the relationship between economic performance indicators and the popularity and profitability of aesthetic surgery from 2006 to 2022, considering several recessions and the rise of social media. The data were collected from the Aesthetic Society's (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report from 2006 to 2022. Procedures analyzed included the most performed cosmetic surgeries, as well as neuromodulator injections and dermal fillers. Pearson correlation tests were used to analyze the strength of association between 8 financial indicators and case volumes and expenditures for each procedure. From 2006 to 2020, ASPS data demonstrated gross domestic product (GDP) per capita year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data were positively correlated with the YOY change of theNational Association of Securities Dealers Automated Quotations (NASDAQ), Standard and Poor's 500, and Dow Jones in 12 of the 24 variables (50%). This was followed by GDP YOY change, with positive correlations to 11 variables (45.8%). YOY changes of consumer-level finances and inflation indicators were less frequently associated among both datasets.In conclusion, our study shows that aesthetic plastic surgery procedures and expenditures correlate with GDP. Although aesthetic surgery demand may be difficult to anticipate, this study elucidates several factors plastic surgeons may use as a bellwether for their practices.
Level of Evidence: 5
... Ancient Egyptians carried out skull elongation, reconstructions of the nose, ears and mouth were performed in the 6 th century B.C. in India, and descriptions of drooping eyelids and gynecomastia procedures are present in the Turkish literature of the 11 th century [8]. In the 19 th century, facelifts were carried out with a solution of arsenic and lead, and the invention of the syringe allowed the injection of substances beneath the skin for aesthetic purposes, using a series of not-ideal injectables, such as paraffin [9]. The 20 th century saw an increase in the popularity of invasive surgery, made da Prato et al. ...
This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor−patient relationship.
... This was followed by the use of other injectable liquids including vegetable oil, mineral oil, lanolin, beeswax, and silicone, all of which were abandoned due to complications ranging from granulomatous foreign-body infections, emboli-associated phenomena, and severe disfigurement. 1 periosteum/perichondrium. 2 The skin of the nose is thicker at the nasion, thinner over the rhinion, and thicker at the nasal tip. ...
Interest in liquid, or nonsurgical rhinoplasty, has increased in demand as patients pursue less invasive techniques to achieve their aesthetic goals. Improved filler technology and refinement in injection techniques have made liquid rhinoplasty a reasonable choice for well‐selected patients in both primary and revision rhinoplasty cases. This article reviews nasal anatomy, injection techniques, selected applications, and safety measures pertinent to performing nonsurgical rhinoplasty.
... The first injectable wrinkle fillers date back to 1980-1981, when bovine collagen was employed, following their approval by the American Food and Drug Administration as cosmetic drugs [1]. Given that natural Hyaluronic Acid (HA) undergoes extremely rapid turn-over within the skin, commercially available HAs needed to be cross-linked using different manufacturing techniques, resulting in products that still widely vary in formulation and cross-linking degree. ...
Introduction: The principal author was given the opportunity to assess new hyaluronic acid filler, first before its European Commission labeling during clinical investigations in France, and then after its European Commission labeling in his clinical practice in Geneva, Switzerland. This hyaluronic acid gel benefits from the world’s first patented OxiFree™ technology. This article sought to present preliminary safety and efficacy data from the first private patient series treated in Geneva with this cross-linked hyaluronic acid gel, called MaiLi. Material and methods: Like most of its competitors, MaiLi is available in various variants, including gel for filling fine wrinkles, for deeper wrinkles, folds, and for lip enhancement, in addition to gels for volumizing indications. This cohort study encompassed patients from the authors’ private esthetic clientele in Geneva, Switzerland. Depending on the indications, the injections were performed according to previously described techniques, ranging from the “blanching technique” to deeper injections. Results: Between January and November 2021, overall 45 patients aged 56 years on average were injected MaiLi gels, according to the areas they wished to be treated, with a follow-up period ranging from a few days to 12 months. Based on our current dataset, we confirm that MaiLi fillers have proven very safe, causing no unexpected undesirable effects. The gel’s hold over time related to its remarkable projection capacity was excellent, resulting in quite natural outcomes and a perfect integration into the tissues. These beneficial effects were still evident at 1-year follow-up. Conclusion: The MaiLi hyaluronic acid fillers proved to be well tolerated and safe, with long-lasting effects. Remarkable properties revealed in this follow-up were their projection capacity and suppleness, as well as their ease of use and longevity, resulting in full patient satisfaction. No relevant undesirable effects were observed. There were no edematous reactions following the injections, nor were there any lymphatic circulation disorders.
... Over the ensuing century, the post-paraffin evolution of cosmetic injectables progressed through other suboptimal alloplastic compounds-most notably liquid silicone in the 1950s-prior to eventually settling on the use of homologous biocompatible materials like collagen (1980s) and hyaluronan (2000s) [15][16][17]. These agents, though of limited longevity, offered an unmatched safety profile and a low incidence of adverse reactions or complications. ...
Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
The accidental introduction of hyaluronic acid into blood vessels during injection may result in vascular embolism. Such blockages may obstruct blood flow to specific areas, leading to tissue ischemia, hypoxia, and potentially severe complications such as skin and tissue necrosis. This report presents the case of a 35-year-old woman who experienced an embolism following a nasolabial hyaluronic acid injection, which was successfully treated with intravascular hyaluronidase injection guided by ultrasound techniques. Utilizing ultrasound technology, the embolized vessel was precisely located, allowing for the effective administration of intravascular hyaluronidase injection for dissolution. Ultrasonography aids clinicians in enhancing their understanding of patients with embolic conditions by accurately determining the extent and severity of vascular embolization, thereby enabling more precise treatment strategies.
Aim
The authors sought to analyze lip dimensions of Vogue magazine cover models in order to quantify trends in lip dimensions over time. As a secondary objective, the authors aimed to characterize the relationship of these lip dimensions to trends in plastic surgery.
Methods
Three hundred seventy-four Vogue covers from January 1980 to September 2023 were analyzed, excluding covers with multiple people, profile views, and poor image quality. Two researchers measured upper lip, lower lip, and upper lip peak thicknesses, chin length, face length, and interpupillary distance. Ratios of upper to total lip thickness, upper to lower lip thickness, total lip thickness to face length, total lip thickness to chin length, and total lip thickness to interpupillary distance were compared between decades using ordinary 1-way analysis of variance with Tukey multiple comparisons. These ratios were also compared before and after 2004, a year in which the number of Food and Drug Administration–approved injectables increased dramatically, and May 2015, when Google searches for “lip filler” peaked, using 2-tailed unpaired t tests.
Results
Upper to total lip thickness ratio increased over time with significant differences between 1980s and all other decades (1980s vs 1990s, 2000s, 2010s, and 2020s [0.3654 vs 0.3870 ( P = 0.0159), 0.4018 ( P ≤ 0.0001), 0.4024 ( P ≤ 0.0001), and 0.4289 ( P = 0.0011)] with a suggestive upward trend. Similarly, upper to lower lip thickness ratio increased over time [0.5852 vs 0.6479 ( P = 0.0096), 0.6804 ( P ≤0.0001), 0.6837 ( P ≤ 0.0001), and 0.7571 ( P = 0.0015)]. There were significant increases in upper to total and upper to lower lip thickness ratios from pre- to post-2004 and suggestive increases from pre to post-May 2015 time periods.
Conclusions
The authors conclude that upper lip dimensions of Vogue cover models seem to be increasing relative to total lip dimensions over time and mirror trends in plastic surgery.
Facial rejuvenation has become an important subject of psychosocial wellbeing in this era of fashion and beauty. Injectables offer an excellent non-surgical method of facial rejuvenation. Among which, botulinum toxin and soft tissue fillers are one of the most common and favorite tools for non-surgical rejuvenation.
A new injectable dermal filler with rapid collagen regeneration is developed.
The injection of facial fillers and botulinum toxin are the minimally invasive anti-aging procedures most frequently used in doctors’ offices. As with any other injectable procedure, complications are likely to occur even in experienced hands; however, we need to identify them early and handle them appropriately. The purpose of this chapter is to outline the fundamentals of minimally invasive facial rejuvenation procedures.
Atualmente a Odontologia contemporânea está buscando a harmonização estética tanto na área de boca, sorriso e dentes como na face, visando melhorar a auto-estima e a auto-imagem dos pacientes. O nariz é um componente muito relevante na estética facial, pois faz parte de um dos 4 segmentos do rosto humano. Cada um deles tem papel importante num padrão de beleza proporcional. Este estudo tem como objetivo apresentar um relato de caso clínico que utiliza o ácido hialurônico de alta reticulação (PerfecthaSubskin®) para preencher e modelar o complexo nasal com a finalidade de aperfeiçoamento estético. Uma paciente do sexo feminino, com 22 anos de idade foi atendida em Clínica Odontológica de Especialização em Harmonização facial do Instituto Educacional das Américas com queixas de que seu nariz tinha características infantis e isso a incomodava profundamente. Durante a consulta, a paciente foi informada do plano de tratamento, do registro da sua documentação fotográfica, e detalhes sobre o seu procedimento terapêutico em si, em seguida preenchendo o Termo de Consentimento Livre e Esclarecido. Concluiu-se que, pelas observações da conduta e dos procedimentos realizados na paciente, que a rinomodelação demostrou ser um procedimento conservador, com um pós-operatório de leve edema e poucos relatos de dores além de obter resultados estéticos excelentes o que a leva a ser alternativa plausível para aqueles pacientes que desejam melhorar a estética em área de nariz, mas que não desejam se submeter a uma rinoplastia.
Assisted reproductive technologies are key to solving the problems of aging and organ defects. Collagen is compatible with living tissues and has many different chemical properties; it has great potential for use in reproductive medicine and the engineering of reproductive tissues. It is a natural substance that has been used a lot in science and medicine. Collagen is a substance that can be obtained from many different animals. It can be made naturally or created using scientific methods. Using pure collagen has some drawbacks regarding its physical and chemical characteristics. Because of this, when collagen is processed in various ways, it can better meet the specific needs as a material for repairing tissues. In simpler terms, collagen can be used to help regenerate bones, cartilage, and skin. It can also be used in cardiovascular repair and other areas. There are different ways to process collagen, such as cross-linking it, making it more structured, adding minerals to it, or using it as a carrier for other substances. All of these methods help advance the field of tissue engineering. This review summarizes and discusses the current progress of collagen-based materials for reproductive medicine.
Facial aesthetic procedures have become increasingly popular and complex, making knowledge of facial anatomy crucial for achieving desired outcomes without complications. Some of the most common procedures include blepharoplasty, bichectomy, face-lifts, facial implants, thread lifting, and fillers. Blepharoplasty and bichectomy are surgical procedures that respectively aim to restore youthful contours to the periorbita and create a slimmer lower face by removing Bichat fat from the maxillofacial region. Facial implants are used for aesthetic augmentation of the skeletal structure and restoration of facial contour by using biomaterials or autogenous bone grafts. Face-lift surgeries involve incisions and removal of excess skin, and thread lifts involve less invasive procedures performed by inserting threads beneath the skin, with the aim to lift the skin and thus reduce wrinkles and sagging. Fillers improve wrinkles and loss of facial volume, with biologic types made from animal, human, or bacterial sources (such as hyaluronic acid), while synthetic fillers include substances such as paraffin, silicone, calcium hydroxyapatite, polymethylmethacrylate microspheres, polyacrylamide hydrogel, hydroxyethyl-ethyl methacrylate, and poly-l-lactic acid. Synthetic fillers can be classified as rapidly resorbable (<12 months), slowly resorbable (<24 months), or permanent. Imaging modalities such as US, CT, and MRI can help identify and analyze each type of facial aesthetic procedure or filler, as well as their possible complications such as foreign-body granuloma, noninflammatory nodule, late intermittent persistent edema, filler migration, infection, or complications after removal of the buccal fat pad. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center The online slide presentation from the RSNA Annual Meeting is available for this article.
The history of cosmetics is reviewed with technologies unfolding less invasive options and more functional solutions involving neutraceutical supplementation with natural resources. Minimally invasive options are documented as is the adaptation of therapy to the Covid-19 pandemic. This chapter dives into the positive and negative implications of aesthetic procedures and how minimally invasive tactics could help advance all procedures focusing on the sake of performance, safety, and longevity.
Breast deformities caused by silicone injections affect aesthetic results and cause irreversible complications in patients. In the treatment, it is necessary to entirely remove silicone particles and infiltrated and fibrous breast tissues. The maximal preservation of healthy breast tissues is also critical. This report presents a case of severe breast deformities as complications 20 years after silicone injections at an unreputable aesthetic center. During the surgery, the authors separately removed fluid (silicone) masses and reconstructed mammary glandular tissues. Breast reconstruction was performed by the anchor breast lift along with the functional preservation of the nipple-areola complex and the superomedial pedicle. The surgery entirely addressed complications after injecting a large amount of silicone. 6 months postoperatively, the surgical outcomes were satisfactory. The surgical excision should be done to remove silicone-infiltrated tissues as much as possible before the reconstructive surgery. The combination of radical surgical excision and reconstructive surgery using the anchor breast lift as a single-stage procedure brought good aesthetic results.
Soft tissue fillers have gained tremendous popularity as a minimally invasive intervention for restoring volume loss and facial symmetry due to chronological aging, disease, and trauma [1]. The use of filler for facial reconstruction dates back the 1830s when the first injectable agent, paraffin was introduced followed by autologous fat in the 1890s. It was not until 1981, when Zyderm®, a bovine collagen filler, became the first Food and Drug Administration (FDA) approved agent for soft tissue reconstruction [2, 3]. Since then, various agents have been developed. In 2003, the FDA approved Restylane®, a product made from hyaluronic acid (HA). Shortly after, the market for dermal fillers experienced rapid growth with over 2.5 million injectable procedures performed in the United States in 2019 alone [4].
Many dermal fillers are classified as biostimulatory, meaning they stimulate the dermis to create new collagen, elastin, and other components of the extracellular matrix. Normal wound healing is also a biostimulatory process. It can be one of tissue replacement with scar formation, or one of true regenerative healing with functional restoration of the tissue. Dermal fillers can stimulate both types of healing, but to different degrees. This paper reviews this mechanism, exploring why some fillers seem to favour replacement, and some true regeneration. The patient's and the filler's propensity for late inflammatory reactions and their relationship to the biostimulatory characteristics of the product are examined as well.
Dermal filler injections are one of the most popular cosmetic procedures in the United States. Of the many options available, hyaluronic acid (HA) dermal fillers like Juvederm or Restylane are often used. Despite their use and popularity, adverse events are known to occur from these procedures. Although most outcomes may be mild and resolve over time, rare instances of severe complications cannot be ignored, as these effects may be irreversible. Healthcare practitioners and patients must be aware of these risks, as these cosmetic procedures can affect the patient's quality of life. The aim of this study was to evaluate the incidence of adverse events (AEs) reported from the use of hyaluronic acid dermal fillers in the facial region. A systemized search of randomized controlled trials was conducted using Cochrane Central, Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Web of Science databases. After screening for eligibility and conducting a critical appraisal of the articles, 19 studies were retained for the final review. The meta-analysis results included different side effects by facial location, i.e., nasolabial fold (NLF) vs. other (midface, perioral line, and lip region). The midface includes the anteromedial cheek region, the zygomaticomalar region, and the submalar region. The adverse events were swelling, pain, erythema, bruising, lumps and bumps, firmness, tenderness, itching, and skin discoloration. A significant difference was found in the proportion of individuals experiencing swelling, lumps or bumps, and firmness at the nasolabial fold site versus the midface, perioral line, and lip region. There was no significant difference in the proportion of individuals experiencing pain, erythema, bruising, tenderness, itching, or skin discoloration at the nasolabial fold site versus the other sites. The study highlights the prevalence of common AEs that can result from HA dermal fillers like Juvederm or Restylane, thus emphasizing the importance of healthcare professionals explaining the risk and benefits to patients.
Introduction
Dermal fillers are an efficacious option for treating age‐related volume deficiency, as well as scars and wrinkles. Additionally, they are useful for facial sculpting and contouring, and to augment anatomical structures such as the lips.
Discussion
The start of the search for an ideal dermal filler can be traced back to the late 1800s. Characteristics of this ideal filler product include nontoxic, nonmigratory, noncarcinogenic, easily applied, noninfectious, painless, and long‐lasting. It would also have predictable and consistent results, feel natural, and require no patient downtime. Over the past century and a half, numerous products have been used or developed in an attempt to achieve a filler possessing these characteristics. However, only in the past few decades have safe, injectable filler products approved by the US Food and Drug Administration (FDA), been developed. Herein, we discuss the various injectable agents used in the past, as well as the most commonly used agents of present day.
Conclusion
Reflecting upon the history of dermal filler development serves as an important reminder to proceed with caution, as serious complications may occur with their use. Importantly, no single filler is ideal for all patients or indications, therefore optimal treatment requires awareness of the properties and characteristics of each available product, and discretionary use by providers.
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
Contouring injection is one of the most popular procedures in cosmetology, and its popularity is steadily increasing. Various available fillers allow successful correction of aesthetic defects and age-related changes considering individual characteristics of patients. Delayed inflammatory reactions are a rare undesirable phenomenon and often lead to diagnostic difficulties, especially after previous cosmetic procedures. Non-certified fillers complicate the situation. Many of these fillers are permanent that directly affects therapeutic strategy and prognosis. Therefore, every cosmetologist, dermatologist and plastic surgeon should be aware of the properties, characteristics and behavior in tissues of various fillers. The first part of review is devoted to classification of fillers and description of permanent microimplants.
Purpose:
Exogenous silicone has been reported to migrate to anatomic sights far from an initial injection or implantation site; this phenomenon has been rarely described in the ocular adnexa, especially in the eyelids. We document 3 additional cases of distant migration of silicone implanted elsewhere in the body to the eyelids and review the prior literature on this uncommon event.
Methods:
A retrospective chart review of 3 patients was conducted along with analysis of diagnostic histopathology. A comprehensive review of the literature regarding dissemination or migration of silicone to the eyelids in patients with either silicone breast implants or silicone facial filler use was performed.
Results:
Cases of silicone migrating to the eyelids from silicone breast implants and silicone-based facial filler are outlined in Tables 1 and 2, respectively. There are 4 total reports of women with silicone breast implants, including the 2 described here, with evidence of migration of silicone to the eyelid. Similarly, 5 cases of silicone-based facial filler with resultant migration of filler to the eyelids were identified, including 2 of the cases presented in this report (1 patient had both silicone breast implants and silicone facial filler).
Conclusion:
Silicone is chemically inert, but is known to travel throughout the body, causing a resultant foreign body response in tissue that can adversely affect even the eyelids. Silicone has a relatively characteristic histologic appearance and diagnosis of silicone granuloma highlights the importance of obtaining a thorough clinical history, particularly regarding prior cosmetic injections or breast enhancement surgery. Foreign material/foreign body granuloma is important to consider in patients with deep eyelid nodules of unclear etiology.
There has been a noticeable increase in the number of patients who present to oral and maxillofacial surgery (OMFS) departments for treatment of post-operative complications of dermal fillers and botulinum toxin. These complications are more likely when the treatments are performed by untrained persons or self-administered by patients. Occasionally, these adverse outcomes cannot be avoided, even when products are administered by medically trained professionals. This review includes two cases and discusses some of the key issues surrounding these products so that patients can be informed of the benefits and risks with these types of non-surgical aesthetic procedures and, where possible, reduce the risk of complications occurring.
CPD/Clinical Relevance: Appropriate knowledge of facial anatomy and different types of dermal fillers is necessary to reduce the risk of complications associated with injection of these products.
Hintergrund: Injektionen gehören zum Arsenal aller medizinischen Disziplinen. Neben der gemeinsamen Grundlage gibt es aber auch für jedes Fach spezifische Aspekte, die hier mit Blick auf die HNO-Heilkunde in ihrer historischen Entwicklung dargestellt werden sollen. Intravenöse Injektionen: Die ersten Versuche mit intravenösen Injektionen wurden in Deutschland 1642 von einem Jagdgehilfen eines Edelmannes in der Oberlausitz an Hunden durchgeführt. Es folgten 1656 ähnliche Experimente in Oxford/England durch den Astronomen, Mathematiker und Architekten Christopher Wren und eine Gruppe von Wissenschaftlern um den Physiker Robert Boyle. Hier standen die neuen Erkenntnisse über den Blutkreislauf durch William Harvey (1628) im Vordergrund des Interesses. Die ersten Monographien über die Anwendung intravenöser Infusionen an Menschen erschienen in Deutschland: „Chirurgia infusoria” (Major 1664), „Clysmatica Nova” (Elsholtz 1667). Als Instrumente dienten Tierblasen oder Klistierspritzen. Wegen schwerer Zwischenfälle und zweifelhaften Nutzens kamen die Infusionen bald wieder außer Gebrauch. Nachdem es Köhler in Deutschland 1776 gelungen war, bei einem Menschen einen verschluckten Fremdkörper durch eine intravenöse Infusion mit Brechweinstein zu entfernen, blieb dies bis zur ersten endoskopischen Entfernung eines Ösophagusfremdkörpers durch Killian 1900 die wichtigste Indikation für diese Technik. Die kalibrierte Spritze nach Pravaz: Der französische Chirurg Ch.-G. Pravaz in Lyon entwickelte 1853 eine kleine Injektionsspritze aus Metall, deren Kolben durch ein Schraubengewinde vorwärtsbewegt wurde und so eine genaue Dosierung ermöglichte. Eine fein angeschliffene Nadel mit Trokar konnte direkt in das Blutgefäß eingestochen werden, so daß keine Venae sectio erforderlich war. Pravaz verwendete seine Spritze, um durch Injektion von Ferrum sesquichloratum arterielle Aneurysmen zu veröden. Die Pravazsche Spritze gab den Anstoß zur Entwicklung zahlreicher kalibrierter Spritzenmodelle aus Glas (Luer) oder Metall und Glas (Record). Subkutane Injektionen und Lokalanästhesie: Die kalibrierten Spritzen wurden zunächst hauptsächlich in der Quecksilbertherapie der Syphilis eingesetzt. In der HNO-Heilkunde fanden sie ihre spezielle Anwendung in der Lokalanästhesie, die Carl Ludwig Schleich 1892 eingeführt hatte. Paraffin-Injektionen: Um 1900 waren Injektionen von flüssigem Paraffin zur Auffüllung von Gewebsdefekten aufgekommen (Gersuny in Wien, Delangre in Tournai). Dies wurde rasch für Indikationen in der HNO-Heilkunde übernommen (Stein 1901). Dazu wurden neue Techniken, Spritzen, Paraffine von verschiedenem Schmelzpunkt und verschiedener Härte, entwickelt. Um die Mitte dieses Jahrhunderts wurden die Paraffininjektionen wegen zahlreicher schwerer Komplikationen wieder verlassen, und es wurden neue Substanzen eingesetzt, wie Teflon, Silikon und Kollagen. Diese Entwicklung der Injektionen wird mit zahlreichen anekdotischen Details, wörtlichen Zitaten und Abbildungen ausführlich dargestellt.
Background: Injections are part of the arsenal of all medical disciplines. In addition to this common ground, each specialty has its own particular aspects; the historical development of these are presented here with respect to otorhinolaryngology. Intravenous injections: The first experiments with intravenous injections were carried out in 1642 by a gentleman's hunting servant in eastern Germany. Similar experiments were done in 1656 by Christopher Wren, the astronomer, mathematician, and architect in Oxford, England, and a group of scientists around the physicist Robert Boyle. These experiments were prompted by new knowledge about blood circulation provided by William Harvey in 1628. The first books on the applications of intravenous infusions in humans were published in Germany by Major 1664 (Chirurgia Infusoria) and Elsholtz 1667 (Clysmatica Nova). Bladders of animals or enema syringes were used as instruments. Because of lethal accidents the infusions soon fell from favour. Köhler in Germany in 1776 eliminated a large bolus impacted in a patient's esophagus by an intravenous infusion of tartar emetic thus inducing violent vomiting. After this crucial experiment, foreign bodies in the esophagus were the most important indication for applying intravenous injections until Killian introduced extraction by esophagoscopy in 1990. Calibrated syringes after Pravaz: The French surgeon C. Pravaz in Lyon in 1853 invented a small syringe, the piston of which could be driven by a screw thus allowing exact dosage. A sharp needle with a pointed trocar could be introduced into the vessel making a dissection unnessessary. Pravaz used his syringe for obliteration of arterial aneurysms by injection of ferric sesquichlorate. Pravaz's syringe initiated the invention of a great number of various calibrated syringes made of glass or metal combined with glass. Subcutaneous injection and local anaesthesia: The calibrated syringes were commonly used in the treatment of syphilis by mercurialization. In otorhinolaryngology, they had and still have their primary application in local anaesthesia, which was introduced by Carl Ludwig Schleich in Berlin in 1892. Paraffin-injections: Around 1900 the injection of liquid paraffin for closing defects in subcutaneous tissues came into use (Gersuny in Vienna, Delangre in Tournai). This technique was immediately applied to rhinological indications such as a saddle nose (Stein 1901). This gave rise to the invention of special syringes and modifications of paraffin with different hardnesses and melting points. Around the middle of this century, paraffin was abandoned for this application because of serious complications, and new substances were introduced such like teflon, silicone and collagen. The historical development of these techniques of injections is described in details with many literature citations and figures.
The liquid form of silicone, called dimethicone (dimethylpolysiloxane), has been used extensively in some countries during the past 4 decades for soft tissue augmentation. Although considered biologically inert, this material has been reported as potentially inducing, after tissue injection, a granulomatous inflammatory response of variable severity. Interestingly, a remarkable paucity of reports exists about the development of complications after injections of liquid silicone into the facial tissues, especially considering its high frequency of use. The purpose of this article is to describe the clinical and microscopic features of 7 cases of silicone-induced granulomas that developed after injection of the facial tissues for cosmetic purposes and to discuss the differential diagnosis and management of this condition.
Injection of foreign materials, such as paraffin oil, is an old and obsolete procedure. The authors describe previous uses for this procedure that had been used since the 19th century and the treatment of patients affected by such a disease.
Silicone has a long and colorful history in cosmetic medicine. We are once again seeing a resurgence of its use as a soft tissue filler. This article is a review of the historical past of silicone use and its appropriate off-label uses today in cosmetic medicine.
To remain experts in skin care and treatment, every dermatologist must be aware of the evolving role of soft tissue fillers in dermatology. Patients with facial scarring, lipodystrophy, contour abnormalities, and age- and sun-induced rhytids can be successfully treated. A literature review, industry recommendations, and the authors' experience serve to highlight fillers most appropriate for each patient's complaint. Newer agents, including the hyaluronic acids and human collagens, and long-lasting materials, such as polymethlymethracrylate and calcium hydroxlyapatite, are reviewed. This discussion of the specific risks, indications, and technical pearls for the various fillers will allow clinicians to accurately advise or treat patients.
As society continues to seek the most opportune means to preserve youthful looks, an interest in filling substances has been reawakened. This is partly because the upper third of the face can now be successfully treated as a result of the development and recent US FDA approval of botulinum toxin (Botox®). Patients seeking cosmetic improvement need no longer resort to invasive procedures that require down-time for the upper third of the face, and they are consequently seeking similar results for the lower two-thirds of the face. Filling agents have filled this void. This article discusses current techniques for soft tissue augmentation, including fat transfer and bovine collagen injections, which enable doctors to provide their patients with highly satisfactory results using minimally invasive procedures.
Included in this review are an overview of the history of soft tissue augmentation and a brief prospectus of where this field of dermatology is headed in the future. Many of the currently available fillers are listed with a description of their most popular uses, possible adverse effects, manufacturers, and countries of use. Information regarding injection techniques and results from the most recent studies help to make this paper a useful source of information for experienced and novice injectors alike.
In 1899, Robert Gersuny, an austrian surgeon from Vienna, injected a mineral oil (vaseline) to correct the absence of a testicle in a patient who was castrated for tuberculous epididymitis. The immediate success of the operation encouraged him to use vaseline as filler for soft tissue defects. The principle of the technique consisted in the injection of a product that becomes semi liquid by heating but it solidifies when it gets colder. It remains stable and inert in the human body. Eckstein used paraffin instead because the melting temperature is too high (65 degrees ) to soften after the injection. The technique provoked enthusiasm. It was used for the cure of palatal and urinary fistulae, hernia but mainly in cosmetic indications: filling of face wrinkles, cheeks, front and breast augmentation as well as the penis and especially nasal defects. Although serious complications were reported, it remained popular for the first 20 years of the 20th century. Unfortunately even with initial good results, secondary or late severe complications appeared due to the dispersion of paraffin. There was formation of nodules, the paraffinomas that were very difficult to remove. The sequelae of paraffin injections were observed for several years.
Nowadays, patients are demanding not only enhancement to their dental (micro) esthetics, but also their overall facial (macro) esthetics. Soft tissue augmentation via dermal filling agents may be used to correct facial defects such as wrinkles caused by age, gravity, and trauma; thin lips; asymmetrical facial appearances; buccal fold depressions; and others. This article will review the pathogenesis of facial wrinkles, history, techniques, materials, complications, and clinical controversies regarding dermal fillers for soft tissue augmentation.
Facial soft-tissue augmentation by injection has become increasingly popular as a minimally invasive option for patients seeking cosmetic facial enhancement. Surgical rejuvenation procedures of the face often relate to a less than comprehensive solution to many of the changes that occur with age. Indeed, the surgical "lift," while providing the opportunity for soft-tissue repositioning, often fails to provide volumetric restoration to the face that is lost with aging. Appreciating the necessity of replacing depleted soft tissue has allowed for a more comprehensive approach to total facial rejuvenation. Hundreds of filling agents are available worldwide, and the enormity of options has led to confusion about which agents work best, where, and why. The vast array of available soft-tissue filling agents can be distilled into two simple categories: nonpermanent and permanent. In this article, the authors mostly limit their discussion, consistent with the mission of this supplement, to the evolution of nonpermanent filling agents, providing a rationale for their emergence and their individual use.
The debate over the legitimacy of silicone as a safe tool for soft-tissue augmentation has spanned well over half a century. Proponents concede that injections of questionable purity and/or of massive quantities have produced unfavorable outcomes. They assert that in experienced hands with "injectable-grade" silicone, there are very few problems. Despite these claims, the literature is replete with disastrous outcomes following silicone fluid injection, often many years after the initial treatment.
An extensive review of the English-language literature was conducted using MEDLINE.
A comprehensive review of injectable silicones was completed, revealing the origins, misuses, early clinical trials, and support for and against the injection of silicone fluids for the augmentation of soft tissues.
A better understanding of the history of injectable silicone fluids for soft-tissue augmentation can give insight into the pitfalls and complications surrounding its use. There has been an evolution in the technique and type of products used for soft-tissue augmentation. In its current use, silicone oil for permanent soft-tissue augmentation could be a very powerful tool. There is some literature that supports the use of a small amount of purified, high-viscosity silicone oil; however, there has not been a single longitudinal study to date with appropriate follow-up data. The unanswered question remains: Are the risks worth the potential benefits of silicone oil as a permanent filler?