Permanent fillers (Part IV of IV)

Perhaps no other product in the field of cosmetic surgery has as marred and misunderstood history as silicone. Since 1965 the FDA has maintained that no physicians are to use injectable silicone for cosmetic surgery purposes. Long used without official sanction, the FDA in 1997 granted the use of liquid silicone for the treatment of detached retinas. AdatoSil 5000 and Silikon 1000 are the only two injectable silicones approved on the market for intraocular injections. . Despite its disapproval, a survey by the American Academy of Cosmetic Surgery of 2000 cosmetic surgeons discovered that silicone injections was the ninth most popular procedure in cosmetic surgery in the mid 1990s. There were nearly 60,000 injections reported in the United States in 1990. After the initial use of injectable silicone during World War II for breast augmentation, silicone had been led down a defaming path from a lack of good common sense, impurity of materials, and ignorance of guidelines between and after injections. Silicone is permanent, minimally antigenic, non-carcinogenic filler. It is technique sensitive and should not be performed by a novice. Although there are complications inherent in the injection of this material, with good patient selection and proper technique these risks are no greater than the other materials spoken of. As an off label manner silicone can successfully be injected to treat the glabellar, marionette, and nasolabial folds, tear troughs, flexible acne scars, lips, genial and malar regions, and post rhinoplasty deformities. Because of its permanence, it should probably be delivered after the resorption of a pleasing trial with temporary filler. Overcorrection should be avoided and the patient should be forewarned to return for multiple visitations and supplementation injections at 1 to 2 month intervals. Injections too superficial will result in beading.

ArteColl is a permanent implant popular in Canada and Europe and recently introduced in the United States as ArteFill. Polymethylmethacrylate microspheres comprise this filler along with lidocaine in a collagen suspension. Upon injection the body resorbs the collagen in the suspension, as the body encapsulates the PMM with connective tissue. This process terminates in 8-12 weeks. At this time only 25% of the volume remains. Patients should be informed of the need for multiple treatments at a minimum of two-month intervals. It has excellent results thus far in highly mobile areas. Allergy testing is required for this product due to the sensitivity to bovine collagen in it.

Aquamid is polyacrylamide hydrogel and is used for facial volume augmentation in Australia, Europe, South America and the Middle East as of August 2006, has received approval by the FDA to begin clinical trials. A 2.5% hydrophilic polyacrylamide and 97.5% water together forms a transparent gel substance that is permanent filler for tissue augmentation. Although still a neophyte on the market, Aquamid has proved to yield very high (>90%) patient satisfaction and minimal, minor side effects.