DOI: 10.1097/01.prs.0000248787.57587.d1
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PMID: 18090337
Issn Print: 0032-1052
Publication Date: 2007/11/01
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Excerpt
Despite many years of utilizing a variety of agents to fill facial defects, it has only been in the last decade that the salient issues have become clarified regarding what constitutes successful treatment. The indications for injectable filler agents have largely evolved through a better understanding of facial aging, specifically the soft-tissue deflation typically noted between youth and middle age. The limitations of surgical procedures to correct soft-tissue atrophy, as well as the possibility of postponing surgical procedures by early intervention with injectable fillers, have made these agents indispensable in improving the appearance of the aging face. With greater experience and scientific investigation, we now have a clearer understanding of both the short- and long-term effects of these agents. With the improvement in products and techniques, the results with fillers have become more consistent, thereby increasing patient and physician satisfaction.
Just over 25 years ago, we had a relatively modest appreciation of the value of soft-tissue augmentation as a complement to attempts at facial rejuvenation and far underestimated patients' ultimate acceptance of office-based treatments that had temporary results. In an age of lifestyles that demand minimal recovery after such treatments, the absorbable and biodegradable injectable agents have taken the lead in aesthetic procedures worldwide. Initially, a relative few embraced the use of injectable bovine collagens, Zyderm and Zyplast (distributed by Allergan Aesthetics, Inc., Irvine, Calif.), which were essentially the only materials available (they had no real competition in the marketplace). Compositionally, these agents were fibrillar extractions (fragments) of pepsin-solubilized, atelopeptide bovine collagen in a phosphate-buffered saline containing 0.3% lidocaine. It was with these agents, too, that the concept of cross-linking was introduced as an attempt to make varieties of these products more resistant to biodegradation (Zyplast) and carried through to even the newer products available today. Because these were the first agents introduced in the United States, they were utilized for a growing list of facial aesthetic applications, including the treatment of facial lines, shallow furrows, and scars, with volume augmentation applications essentially limited to lip enhancement. The ease of injectability and the ability to achieve satisfactory results (one of the few phenomena that shared the premise of horseshoes, where “close” was good enough) escalated their popularity, as patients became aware of and sought facial treatments that potentially had dramatic effects and could be performed during a brief visit to the doctor. The promise of “collagen replacement therapy” was appealing to all; yet the reality was that what actually occurred with treatments had little resemblance to it. Results typically lasted in the range of several months, although poor injection techniques and protocols often led to even shorter durations of effects. It was mostly concerns with allergenicity, however, and not lack of persistence that initially led to the pursuit of improved biocompatible materials that could serve as dermal bulking agents. The historical importance of collagen substances and the appreciation of newer and improved varieties looking ahead are just a few of the reasons that these agents are discussed in this supplement.
