Article

Dermal Filler

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Abstract

Dermal filler is a non-surgical procedure to improve facial volume or the anatomy of other parts of the body. It is also a rejuvenate therapy to achieve a younger appearance. Besides that, the need of lipodystrophy therapy is increasing. There are several types of fillers with their superiorities and inferiorities; therefore, it is pretty difficult to determine and choose the ideal filler. Dermal fillers vary in duration of therapeutic effect, filler technique, filler origin, and their physical properties. To date, there is no perfect filler so far. An ideal filler must be non-allergenic, non-carcinogenic, non-teratogenic, as well as has achievable cost and long acting effect. In case that dermal filler is therapeutical indicated, good preparation of doctor and patient is essentially needed. Consultation and information have to cover the therapy indication, filler technique, filler limitation, side effects, outcome, cost, and informed consent. As the other cosmetic procedures, to achieve optimal satis-faction, the doctor must be able to provide effective communication to the patient before and after the dermal filler therapy.Keywords: dermal fillerAbstrak: Dermal filler adalah prosedur non-bedah untuk penambahan volume wajah atau anatomi tubuh lainnya. Prosedur ini juga merupakan salah satu terapi rejuvenasi yang bertujuan untuk tampilan lebih muda. Selain itu, kebutuhan untuk terapi lipodistrofi juga makin meningkat. Terdapat berbagai jenis filler dengan keunggulan dan kekurangaood prepnnya masing-masing, sehingga agak sulit menentukan atau memilih produk filler yang ideal. Dermal filler bervariasi dalam hal lamanya efek terapi yang diperoleh, cara pemberian, asal filler, dan sifat fisiknya. Sampai saat ini tidak ada produk filler yang sempurna. Untuk menjadi ideal, produk filler harus nonalergenik, nonkarsinogenik, nonteratogenik, harga terjangkau dan berefek terapi yang panjang. Saat dermal filler menjadi pilihan terapi atau tindakan, persiapan yang tepat baik dokter maupun pasien merupakan hal yang esensial. Konsultasi dan informasi harus meliputi ketepatan indikasi pemberian filler, tehnik pemberian, keterbatasan filler, efek samping, kemungkinan hasil akhir, biaya, dan informed consent. Sebagaimana prosedur kosmetik lainnya, untuk kepuasan bersama, dokter harus mampu dan bersedia memberikan komunikasi efektif kepada pasien sebelum dan sesudah terapi dermal filler.Kata kunci: dermal filler

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BACKGROUND Soft-tissue augmentation using calcium hydroxylapatite (CaHA) filler has been shown to be a safe and effective filler agent. A previous study utilizing electron microscopy demonstrated deposition of collagen around filler microspheres with minimal inflammatory response. OBJECTIVE The purpose of this study was to further characterize the expression of collagen in response to injected CaHA filler material using conventional, special, and immunohistochemical (IHC) staining. MATERIALS AND METHODS Five subjects with mild to moderate nasolabial rhytids underwent a single treatment with CaHA filler. Additionally, 0.1 to 0.2 mL of the filler material was injected subdermally into the postauricular area. Six months following the treatment, all subjects underwent biopsy of the treated postauricular area. Biopsies were analyzed using hematoxylin and eosin staining, special staining with picrosirius red (PSR), and IHC staining for collagen Types I and III. RESULTS All subjects completed the study with no complications. Biopsy specimens revealed increased deposition of collagen around the filler material, which was confirmed and further characterized using PSR and IHC staining. CONCLUSION Soft tissue augmentation with CaHA filler leads to long-term deposition of new collagen surrounding filler microspheres, which may contribute to the overall improvement in the appearance of treated rhytids.
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Injectable soft tissue augmentation materials available for use in the United States have proliferated during the past 5 years. In addition to bovine collagen and autologous fat, physicians can now choose between numerous other options, including hyaluronic acid derivatives, poly-L-lactic acid, injectable calcium hydroxylapatite, injectable liquid silicone, polymethylmethacrylate microspheres, and human collagen. While these materials are generally safe and versatile, each has specific features that inform its best use. The guidelines presented herein are not intended to delineate the standard of care but rather to present how most injectors commonly use these materials in patients. These guidelines are a consensus document produced by the ASDS Guidelines of Care Task Force in conjunction with recognized experts in the field who have volunteered their time. While efforts have been made to maintain accuracy and timeliness at the point of submission, these guidelines will no doubt evolve over time and should be considered in the context of the patients' individual needs.
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