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Facial Plast Surg 2012; 28(01): 08-20
DOI: 10.1055/s-0032-1305786
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Injectable Fillers for Volume Replacement in the Aging Face

Timothy M. Greco
1   Division of Facial Plastics and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
2   Eastern Cosmetic Surgery Institute, Bala Cynwyd, Pennsylvania
,
Marcelo B. Antunes
1   Division of Facial Plastics and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Seth A. Yellin
3   Division of Facial Plastic Surgery, Emory Healthcare; Emory Facial Center; and Department of Otolaryngology–Head and Neck Surgery, Emory University, Atlanta, Georgia
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Publikationsdatum:
14. März 2012 (online)

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Abstract

In recent years, there has been a better understanding of the aging process. In addition to changes occurring in the skin envelope, significant changes occur in the subcutaneous fat and craniofacial skeleton. This has led to a paradigm shift in the therapeutic approach to facial rejuvenation. Along with soft tissue repositioning, volumizing the aging face has been found to optimize the result and achieve a more natural appearance. Early in the aging process, when there has not been a significant change to the face requiring surgical intervention, fillers alone can provide minimally invasive facial rejuvenation through volumizing. Multiple injectable soft tissue fillers and biostimulators are currently available to provide facial volume such as hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, polymethyl methacrylate, and silicone. A discussion of the morphological changes seen in the aging face, the properties of these products, and key technical concepts will be highlighted to permit optimum results when performing facial volumizing of the upper, middle, and lower thirds of the face. These fillers can act as a dress rehearsal for these patients considering structural fat grafting.

Keywords

aging face - volume loss - hyaluronic acid - calcium hydroxylapatite - poly-l-lactic acid
 

  • References

  • 1 Pessa JE. An algorithm of facial aging: verification of Lambros's theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg 2000; 106: 479-488 ; discussion 489–490
    CrossrefPubMedGoogle Scholar
  • 2 Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007; 119: 2219-2227 ; discussion 2228–2231
    CrossrefPubMedGoogle Scholar
  • 3 Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2008; 121: 1804-1809
    CrossrefPubMedGoogle Scholar
  • 4 Lapière CM. The ageing dermis: the main cause for the appearance of “old” skin. Br J Dermatol 1990; 122 (Suppl 35) 5-11
    PubMedGoogle Scholar
  • 5 Greco TM, Elenitsas R. Localization and histological characterization of injected hyaluronic acid in excised nasolabial fold tissue. J Drugs Dermatol 2010; 9: 399-404
    PubMedGoogle Scholar
  • 6 Lober CW, Fenske NA. Cutaneous aging: effect of intrinsic changes on surgical considerations. South Med J 1991; 84: 1444-1446
    CrossrefPubMedGoogle Scholar
  • 7 Hill WR, Montgomery H. Regional changes and changes caused by age in the normal skin. J Invest Dermatol 1940; 3: 231-245
    CrossrefPubMedGoogle Scholar
  • 8 Montagna W, Carlisle K. Structural changes in ageing skin. Br J Dermatol 1990; 122 (Suppl 35) 61-70
    PubMedGoogle Scholar
  • 9 Bolognia JL. Dermatologic and cosmetic concerns of the older woman. Clin Geriatr Med 1993; 9: 209-229
    PubMedGoogle Scholar
  • 10 Gilchrest BA. Skin aging and photoaging: an overview. J Am Acad Dermatol 1989; 21 (3 Pt 2) 610-613
    CrossrefPubMedGoogle Scholar
  • 11 Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989; 83: 11-16
    CrossrefPubMedGoogle Scholar
  • 12 Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 1992; 89: 441-449 ; discussion 450–451
    CrossrefPubMedGoogle Scholar
  • 13 Laurent TC. Biochemistry of hyaluronan. Acta Otolaryngol Suppl 1987; 442: 7-24
    PubMedGoogle Scholar
  • 14 John HE, Price RD. Perspectives in the selection of hyaluronic acid fillers for facial wrinkles and aging skin. Patient Prefer Adherence 2009; 3: 225-230
    PubMedGoogle Scholar
  • 15 Longas MO, Russell CS, He XY. Evidence for structural changes in dermatan sulfate and hyaluronic acid with aging. Carbohydr Res 1987; 159: 127-136
    CrossrefPubMedGoogle Scholar
  • 16 DeVore DP, Hughes E, Scott JB. Effectiveness of injectable filler materials for smoothing wrinkle lines and depressed scars. Med Prog Technol 1994; 20: 243-250
    PubMedGoogle Scholar
  • 17 Tezel A, Fredrickson GH. The science of hyaluronic acid dermal fillers. J Cosmet Laser Ther 2008; 10: 35-42
    Google Scholar
  • 18 Restylane® (Package Insert). Scottsdale, AZ: Medicis Aesthetics Holdings, Inc.; 2010
    Google Scholar
  • 19 JuveDerm® Ultra (package insert). Paris, France: Corneal; 2010
    Google Scholar
  • 20 JuveDerm® Ultra Plus (package insert). Paris, France: Corneal; 2010
    Google Scholar
  • 21 Perlane® (Package Insert). Scottsdale, AZ: Medicis Aesthetics Holdings, Inc.; 2010
    Google Scholar
  • 22 Carruthers J, Carruthers A. A prospective, randomized, parallel group study analyzing the effect of BTX-A (Botox) and nonanimal sourced hyaluronic acid (NASHA, Restylane) in combination compared with NASHA (Restylane) alone in severe glabellar rhytides in adult female subjects: treatment of severe glabellar rhytides with a hyaluronic acid derivative compared with the derivative and BTX-A. Dermatol Surg 2003; 29: 802-809
    CrossrefPubMedGoogle Scholar
  • 23 Rohrich RJ, Ghavami A, Crosby MA. The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: review and technical considerations. Plast Reconstr Surg 2007; 120: 41-54
    CrossrefPubMedGoogle Scholar
  • 24 Friedman PM, Mafong EA, Kauvar AN, Geronemus RG. Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation. Dermatol Surg 2002; 28: 491-494
    CrossrefPubMedGoogle Scholar
  • 25 Fernández-Aceñero MJ, Zamora E, Borbujo J. Granulomatous foreign body reaction against hyaluronic acid: report of a case after lip augmentation. Dermatol Surg 2003; 29: 1225-1226
    CrossrefPubMedGoogle Scholar
  • 26 Lambros V. The use of hyaluronidase to reverse the effects of hyaluronic acid filler. Plast Reconstr Surg 2004; 114: 277
    PubMedGoogle Scholar
  • 27 Marmur ES, Phelps R, Goldberg DJ. Clinical, histologic and electron microscopic findings after injection of a calcium hydroxylapatite filler. J Cosmet Laser Ther 2004; 6: 223-226
    CrossrefPubMedGoogle Scholar
  • 28 LeGeros RZ. Biodegradation and bioresorption of calcium phosphate ceramics. Clin Mater 1993; 14: 65-88
    CrossrefPubMedGoogle Scholar
  • 29 Lemperle G, Morhenn V, Charrier U. Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 2003; 27: 354-366 ; discussion 367
    CrossrefPubMedGoogle Scholar
  • 30 Misiek DJ, Kent JN, Carr RF. Soft tissue responses to hydroxylapatite particles of different shapes. J Oral Maxillofac Surg 1984; 42: 150-160
    CrossrefPubMedGoogle Scholar
  • 31 Moers-Carpi MM, Tufet JO. Calcium hydroxylapatite versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month, multicenter, prospective, randomized, controlled, split-face trial. Dermatol Surg 2008; 34: 210-215
    CrossrefPubMedGoogle Scholar
  • 32 Moers-Carpi M, Vogt S, Santos BM, Planas J, Vallve SR, Howell DJ. A multicenter, randomized trial comparing calcium hydroxylapatite to two hyaluronic acids for treatment of nasolabial folds. Dermatol Surg 2007; 33 (Suppl 2) S144-S151
    CrossrefPubMedGoogle Scholar
  • 33 Felderman LI. RadiesseTM for facial rejuvenation. Cosmetic Dermatol 2005; 18: 823-826
    PubMedGoogle Scholar
  • 34 Jacovella PF, Peiretti CB, Cunille D, Salzamendi M, Schechtel SA. Long-lasting results with hydroxylapatite (Radiesse) facial filler. Plast Reconstr Surg 2006; 118 (3, Suppl) 15S-21S
    PubMedGoogle Scholar
  • 35 Radiance FP. Facial Plast Surg 2004; 20: 165-169
    Artikel in Thieme ConnectPubMed
  • 36 Gogolewski S, Jovanovic M, Perren SM, Dillon JG, Hughes MK. Tissue response and in vivo degradation of selected polyhydroxyacids: polylactides (PLA), poly(3-hydroxybutyrate) (PHB), and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB/VA). J Biomed Mater Res 1993; 27: 1135-1148
    CrossrefPubMedGoogle Scholar
  • 37 Sculptra® (Package Insert). Bridgewater, NJ: Sanofi-Aventis U.S., LLC; 2010
    Google Scholar
  • 38 Moyle GJ, Brown S, Lysakova L, Barton SE. Long-term safety and efficacy of poly-L-lactic acid in the treatment of HIV-related facial lipoatrophy. HIV Med 2006; 7: 181-185
    CrossrefPubMedGoogle Scholar
  • 39 Lam SM, Azizzadeh B, Graivier M. Injectable poly-L-lactic acid (Sculptra): technical considerations in soft-tissue contouring. Plast Reconstr Surg 2006; 118 (3, Suppl) 55S-63S
    CrossrefPubMedGoogle Scholar
  • 40 Lowe NJ. Optimizing poly-L-lactic acid use. J Cosmet Laser Ther 2008; 10: 43-46
    CrossrefPubMedGoogle Scholar
  • 41 Lacombe V. Sculptra: a stimulatory filler. Facial Plast Surg 2009; 25: 95-99
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 42 Mest DR, Humble GM. Duration of correction for human immunodeficiency virus-associated lipoatrophy after retreatment with injectable poly-L-lactic acid. Aesthetic Plast Surg 2009; 33: 654-656
    CrossrefPubMedGoogle Scholar
  • 43 Lowe NJ. Optimizing poly-L-lactic acid use. J Cosmet Laser Ther 2008; 10: 43-46
    CrossrefPubMedGoogle Scholar
  • 44 Borelli C, Kunte C, Weisenseel P, Thoma-Greber E, Korting HC, Konz B. Deep subcutaneous application of poly-L-lactic acid as a filler for facial lipoatrophy in HIV-infected patients. Skin Pharmacol Physiol 2005; 18: 273-278
    CrossrefPubMedGoogle Scholar
  • 45 Haneke E. Polymethyl methacrylate microspheres in collagen. Semin Cutan Med Surg 2004; 23: 227-232
    CrossrefPubMedGoogle Scholar
  • 46 Lemperle G, Romano JJ, Busso M. Soft tissue augmentation with artecoll: 10-year history, indications, techniques, and complications. Dermatol Surg 2003; 29: 573-587 ; discussion 587
    CrossrefPubMedGoogle Scholar
  • 47 Hilinski JM, Cohen SR. Soft tissue augmentation with ArteFill. Facial Plast Surg 2009; 25: 114-119
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 48 Hoffmann C, Schuller-Petrovic S, Soyer HP, Kerl H. Adverse reactions after cosmetic lip augmentation with permanent biologically inert implant materials. J Am Acad Dermatol 1999; 40: 100-102
    CrossrefPubMedGoogle Scholar
  • 49 Rudolph CM, Soyer HP, Schuller-Petrovic S, Kerl H. Foreign body granulomas due to injectable aesthetic microimplants. Am J Surg Pathol 1999; 23: 113-117
    CrossrefPubMedGoogle Scholar
  • 50 Jones DH, Carruthers A, Orentreich D , et al. Highly purified 1000-cSt silicone oil for treatment of human immunodeficiency virus-associated facial lipoatrophy: an open pilot trial. Dermatol Surg 2004; 30: 1279-1286
    CrossrefPubMedGoogle Scholar
  • 51 Chasan PE. The history of injectable silicone fluids for soft-tissue augmentation. Plast Reconstr Surg 2007; 120: 2034-2040 ; discussion 2041–2043
    CrossrefPubMedGoogle Scholar
  • 52 Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 2006; 118 (3, Suppl) 77S-84S
    CrossrefPubMedGoogle Scholar
  • 53 Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006; 118 (3, Suppl) 108S-120S
    CrossrefPubMedGoogle Scholar
  • 54 Pessa JE, Zadoo VP, Yuan C , et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg 1999; 103: 635-644
    CrossrefPubMedGoogle Scholar
  • 55 Shaw Jr RB, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 2007; 119: 675-681 ; discussion 682–683
    Google Scholar
  • 56 Niamtu III J. Accurate and anatomic midface filler injection by using cheek implants as an injection template. Dermatol Surg 2008; 34: 93-95 ; discussion 96
    PubMedGoogle Scholar
  • 57 Levy PM. The “Nefertiti lift”: a new technique for specific re-contouring of the jawline. J Cosmet Laser Ther 2007; 9: 249-252
    CrossrefPubMedGoogle Scholar