J Skin Stem Cell. 2020 March; 7(1):e104559.
Published online 2020 June 10.
History of Dermal and Subdermal Injectable Fillers Before Collagen:
The Early Years
Omeed Memar 1, *
1Academic Dermatology and Skin Cancer Institute, Chicago, USA
*Corresponding author: Academic Dermatology and Skin Cancer Institute, Chicago, USA. Email: firstname.lastname@example.org
Received 2020 May 05; Revised 2020 May 28; Accepted 2020 June 05.
Dermal ﬁllers are a mainstay of aesthetic medicine. Currently, the most common ingredient in ﬁllers in hyaluronic acid (HA). How-
ever, there was an evolution of products that brought us to where we are today. We review the ﬁllers from fat to synthetic ﬁllers in
this review paper. We present notable ﬁgures in history who used such ﬁllers and key legislation on the use of such ﬁllers. The early
evolution of the use of volumization has been reviewed. This is an important milestone in the history of ﬁllers that is rather brief
in the present literature.
Keywords: Fat Transfer, Silicone Injection, Paraﬃnoma
This review aims to cover the data on soft tissue volu-
mizers before the advent of collagen.
2. Introduction, Discussion and Conclusion
Soft tissue augmentation dates back to the 19th cen-
tury, when Neuber (1) excised fat lobules from the arm
for facial scar, and concluded that larger grafts were less
predictable than smaller ones. Czerny (2) used fat from
a lipoma to introduce for breast reconstruction in 1895.
Lexer (3) studied fat survivability, and concluded that ex-
cised fat grafts should be handled with care in both ex-
cision and implantation in order to achieve good results.
By 1890s, the hypodermic syringe was being developed in
glass and silver (Figure 1) (4,5).
Lexer (6) presented successful volumization of the face
and breasts. By 1911, the hypodermic needle/syringe was
use to inject particles of excised fat for post-rhinoplasty ir-
regularities, with excellent results in the short term, and
signiﬁcant subsequent resorption (7). In 1912, the ﬁrst pho-
tographic evidence of fat transplantation using a hypoder-
mic needle/syringe for facial lipoatrophy was published
(8). In 1923, the ﬁrst histologic evidence of transplanted
fat that had engrafted was published, and therefore, fat
was not just a mass that would be converted to scar tis-
sue, but a true live tissue transplantation (9). In 1926, the
term cannula was introduced in the realm of fat transplan-
tation, when Miller (10) presented his technique of face
and neck scar correction with injection of fat through a
cannula. In 1931, facial lipoatrophy was treated success-
fully with fat grafting (11). Next, breast reconstruction with
fat grafting was reported in 1941, with one breast receiv-
ing a large fat graft and another receiving a combination
fat/fascia graft, with the fat/fascia graft having better vol-
ume retention (12). In 1950, Peer predicted that his tech-
nique yielded a 50% survivability of fat grafts (13). He ex-
amined histologic samples of transplanted fat to develop
the “cell survival theory,” concluding that fat viability was
correlated to graft volume (14).
In 1951, Gray et al. (15) performed dermis/fat grafts,
and reported complications, including cyst formation. In
1969, Sawhney et al. (16) reported animal studies of der-
mis/fat grafts done on pigs. Fat/dermis grafts measuring
1.5 ×1.5 cm were transplanted with dermis side down. At
one week, the grafts had a reduction of volume by 6.7%;
2 weeks, a 9% reduction of volume; 3 weeks a 20% reduc-
tion of volume; 4 weeks, a 33.3% reduction of volume vis-
a-vie the original transplant. All the fat was replaced with
ﬁbrous tissue, yet the volume was maintained in the 4-
week study. Ben-Hur and Neuman (17) determined that ep-
ithelial cells were causing cysts and hence the cyst forma-
tions reported by Gray et al. were most likely due to inad-
equate de-epithelialization (18). The game changes came
in 1975, when a father/son gynecologist team changed the
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Figure 1. Hypodermic needle: patent drawing of the device designed by Mitchell
and Gillespie, 1896.
way fat was harvested, and set in motion a technique that is
ever more popular today (17). The Fischer (18) used a blunt
metallic suction cannula and invented modern-day lipo-
suction. This allowed procurement of abundant viable fat
Concurrently, petroleum was discovered, from which
came mineral oil. Reﬁned mineral oil produced liquid
paraﬃn. Gersuny (20) published the ﬁrst medical use of
paraﬃn with a hypodermic needle/syringe in 1900 for cre-
ation of a testicular prosthesis in a man who had a bilateral
orchiectomy due to tuberculosis. From 1899 to 1914, paraf-
ﬁn was used for breast augmentation. The Derma Featu-
ral Company, incorporated in England, was focused on cos-
metic surgery, and a court case in 1908 describes the use of
hot paraﬃn injected into the nasal skin and molded to the
desired shape. Derma Featural’s largest account was a der-
matologist named John Humphrey Woodbury (Figure 2) in
New York, NY, who had established cosmetic surgery cen-
ters in New York, Boston, Philadelphia, Chicago, St. Louis,
and Washington, DC. However, he got tied up with many
law suits and committed suicide in 1909 (21). The most no-
table victim of paraﬃn injection was the beautiful Gladys
Marie Spencer-Churchill, Duchess of Marlborough (Figure
3). She tried to even a small nasal tip asymmetry with paraf-
ﬁn and had some injected into her jaw. The procedure
caused major deformities to the point that she became a
recluse. She died at the age of 96 in 1977 (22). By 1912, com-
plications of paraﬃn injection were reported, including,
draining persistent ﬁstulas, pulmonary embolism, ulcera-
tion, necrosis, breast amputation, and death (23,24).
Figure 2. John Humphrey Woodbury
Paraﬃn complications opened the door to a new
comer, “Cleopatra’s needle” (25), where liquid silicone was
used for breast augmentation. Liquid silicone was devel-
oped and used during world war II as insulation for elec-
trical transformers (26). This began in Japan, where stolen
Army stocks of industrial silicone were being injected into
the breasts of local prostitutes, creating a more Western
appearing contour. Dr. James Brown applied silicone to
2 J Skin Stem Cell. 2020; 7(1):e104559.
Figure 3. Portrait of Gladys Marie Spencer Churchill, Duchess of Marlborough; the
most notable victim of paraﬃnoma syndrome
soft tissue supplementation in 1947 (27). He further studied
the safety and complications, concluding that silicone is
biocompatible and a safe tissue enhancer (28). Dow Corn-
ing introduced a liquid silicone called MDX4-4011, which
was FDA approved for coating syringes, but started being
used in an unregulated manner for soft tissue augmenta-
tion. In 1964, Carol Doda became the face of silicone in-
jections, as she ﬂaunted her breasts in topless burlesques.
(Figure 4). Some even mixed diﬀerent oils, including olive
oil and paraﬃn to the silicone oil to develop their individ-
ualized mixtures (29). However, many complications be-
gan being reported (30), including granulomas, product
migration (31), granulomatous hepatitis, and death (32).
In 1975, Nevada became the ﬁrst state to outlaw the use
of injectable silicones. Currently, only two liquid forms
of silicone are FDA approved, and only for intra-ocular in-
jection to treat retinal detachment (33). Many have used
medical grade silicone oﬀ-label for soft-tissue augmenta-
tion and by using the droplet-technique. This technique
induced fewer complications. However, the illegal use of
non-medical grade liquid silicones in the hands of non-
medical or ill trained individuals has skyrocketed and re-
sulted in multiple deaths (34). The hunt for the ideal ﬁller
was now hotter than ever, since a market had been devel-
oped, which demanded easy and aﬀordable soft-tissue vo-
lumization. Collagen and a slew of other ﬁllers followed,
but the ideal ﬁller is still quite elusive.
Figure 4. Ticket to a show by Carol Doda
Authors’ Contribution: The author contributed all the
work in this manuscript.
Conﬂict of Interests: There are no conﬂicts of interest for
Funding/Support: No funding was needed for this work.
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