Thursday, April 7, 2011

Things to know before you get Dermal Fillers

Kim Kardashian attending Maxim's 10th Annual Hot 100 Celebration,
Santa Monica, CA on May 13, 2009 -
photo by Glenn Francis of

A smooth healthy skin is an indicator of good general health and one of the most attractive traits in the opposite sex. The inevitability of facial aging carries with it the formation of Rhytides (Wrinkles).

Dermal fillers have had a tremendous impact on cosmetic plastic surgery over the past decade and continues to rise in frequency.

In 2008, almost 1.6 million procedures with dermal fillers were performed in the United States. This is equivalent to almost a three fold increase since the year 20001

5 Common Uses of Dermal Fillers:

  • Crow's Feet wrinkles around the eyes
  • Prominent naso-labial folds
  • Lip Augmentation
  • Tear trough Deformity "eyebags"
  • Correction of Depressed Acne Scars
  • Hand Rejuvenation

What are the types of dermal fillers?

Hyaluronic Acid (HA)
There are currently several FDA approved products for injectable dermal fillers. The most commonly used filler is Hyaluronic Acid (HA)
HA is found naturally in human connective tissue as part of the living tissue matrix. It is synthesized and used for correction of moderate to severe facial wrinkles and folds.
Examples of commercially available HA brands are Juvederm, Restalyne, Captique, Perlane, and Hylaform.
Early studies showed superior results of HA over collagen compounds. These presentations are non-animal stabilized HA and have less potential for having an allergic reaction, with the exception of Hylaform which does confer immunogenicity (potential for allergy).
Another advantage to the use of using (HA) is that since it binds to water, tissues undergo more distension, possibly leading to more native collagen formation 2 This, in theory translates into a longer lasting effect in terms of Wrinkle correction.
Particle concentration and the duration of these substances in the injected tissues varies from one brand to the next.

Calcium hydroxylapatite (CaHA)
This is the mineral component normally found in teeth and bone.
Radiesse is a suspension of 30% CaHA microspheres.
This substance has been found to persist in tissues for 2 to 7 years. It was FDA approved in 2006 for a variety of conditions including soft tissue wrinkles and folds, but allows for versatility in its use.
Other uses include correction of lipoatrophy seen in HIV patients, correction of dental interosseus defects and laryngeal augmentation.
CaHA is degraded over time, and has not been shown to create a granulomatous foreign body reaction 3,4,5
The clinical effect lasts approximately 12 months

Poly-L Lactic Acid
Poly - Lactic PLA (Sculptra)Acid is a synthetic material first made in 1954 . It has a wide variety of applications in the field of surgery. When used as a dermal filler, it persists in the tissues for 9 months. However it is substituted by collagen ingrowth (neocollagenosis) thus allowing for persistent filling of the Rhytid (Wrinkle). It has been used with success in treating HIV related lipoatrophy of the cheeks(Sunken cheek appearence). It has been shown to have a three fold increase in dermal thickness in this population, improving the longevity of the beneficial effects. The clinical benefits last approximately 2 years.

Polymethylmethacrylate beads coated in collagen

Polymethylmethacrylate (PMMA) is a widely used material chemically similar to plexy glass. It is a non-degradable and permanent filler. The commercial name for this filler is Artefill, and it is composed of 20% PMMA with bovine collagen . The bovine collagen surrounds the PMMA microspheres and is ultimately substituted by native collagen. Artefill was FDA approved in 2007 for the treatment of Rhytides. Since it has bovine collagen, it may result in an allergic reaction. Skin sensitivity testing is usually done prior to its application. When applied skillfully, this filler has a very pleasing appearance clinically. Since PMMA cannot be metabolized or Phagocytized (Cellular removal of foreign body) the beneficial effects are permanent and often only show as the patient ages.

One of the potential disadvantages of this filler is that once it is injected, the result is final even if the final appearance is undesirable. In addition to that, it may induce a local reaction and form indurated areas known as granulomas.

Granulomas often require surgical excision, either directly of via liposuction.

*Always consult your ABPS board certified or board eligible plastic surgeon prior to undergoing any cosmetic procedure*

Rafael G. Magana MD


1.American Society of Plastic Surgeons. 2009 report of the 2008 Statistics: National Clearinghouse of Plastic Surgery Statistics. Available at :

2. Wang F. Garza LA, Kang S. Varani J. Orringer JS. Fisher GJ. Voorhees JJ: in vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 2007; 143:156-163

3. Plastic Surgery, Indications and Practice. Chapter 105

4.Lemperle G, Morhenn V, Charrier U: Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 2003; 27:354.

5. Probeck H, Rothstein S: Histologic observation of soft tissue responses to imported multifaceted particles and discs of hydroxylapatite. J Oral Maxillofac Surg 1989; 42:143.

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