- Basic administration
- Outpatient (minimal recuperation)
- Large amount available
- Easy storage
Soft tissue fillers have been used for more than a century to improve contours, soften rhtytides, blunt depressed scars, and enhance lips. The history of soft tissue augmentation dates back to 1893, when Neuber first attempted to use autologous fat transfer for tissue augmentation. He utilized blocks of free fat harvested from the arms to reconstruct depressed facial defects. In 1899 Gersvny injected paraffin into the scrotum as a testicular prosthesis for a patient with advanced tuberculosis.
Injectable collagen products are temporary dermal fillers that are used to improve and reduce cutaneous defects that are the result of soft tissue loss or scarring. They are solely approved by the United States FDA for the glabrous skin of the nasolabial fold (NLF) and vermilion border of the lip.
The desire to restore the focal loss of facial volume that occurs with age has driven the development of numerous filler substances. Before embarking on a treatment plan with a patient seeking cosmetic improvement of the signs of aging, the physician must have a thorough understanding of the realistic capabilities of the available filler substances and a systematic approach to assessing facial esthetics.
The aging changes seen in the lower third of the face affect the lips, chin, lower cheeks, and neck. Changes result from a combination of chronic ultraviolet light damage to the skin, loss of subcutaneous fat, changes due to the muscles of facial expression, gravitational changes from loss of elasticity of the tissue, and remodeling of the underlying bony and cartilaginous structures.
Physicians should approach a patient seeking cosmetic improvement of the signs of aging from an anatomic standpoint. To appreciate facial symmetry and balance, one commonly used practice is to divide the face horizontally into thirds. The upper third ranges from the trichion to the glabella, the middle third from the glabella to the subnasale, and the lower third from the subnasale to the menton. Filler substances are mainly applicable, either alone or in combination with other treatment modalities, to the lower two-thirds of the face.
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Over the past few decades, there has been an increase in sun exposure through increased leisure time and outdoor activities. Years of people trying to acquire the ‘healthy tan’ have produced high rates of prematurely aged skin. Cumulative sun exposure is the greatest factor in aging skin, and is responsible for a large portion of the unwanted esthetic effects, including many of the wrinkles which may be treated with filler substances. Glogau has developed a systematic classification of patient photoaging types. Depending upon the degree of sun exposure, these generalizations apply at different ages and to different degrees in patients with more pigmented skin.
The face ages in response to a number of factors, which may appear to varying degrees between individuals. Sun exposure and smoking tend to accelerate the following changes:
The word aesthetic is derived from the Greek word aisthe-sis, which means having a sense or love of that which is beautiful. The attractive, idealized face tends to exhibit several general characteristics, with slightly different proportions and shapes between women and men. While there are exceptions to every rule, these trends tend to be universally perceived across different cultures and across the ages. The idealized female face tends to exhibit:
It cannot be overemphasized that the approach to facial aesthetics should be a comprehensive one. No one type of procedure will achieve facial harmony in all aesthetic subjects. Fillers are merely one instrument to achieve this goal. Combining fillers with other modalities will often optimize results.