|
|
http://www.injectablesafety.org/
 Botox®, although off label for many uses, is able to treat wrinkles by inhibiting release of acetylcholine which causes weakness of muscles that create wrinkles. Sequential treatments are necessary to maintain effect. It is most commonly used at the forehead, glabellar area (junction between the forehead and nose), the nasolabial crease (junction between the upper lip and cheek), the bunny lines (on the sides of the nose), the crow’s feet area (adjacent to the eyes), the dimpled chin, and neck bands. Beneficial effects are seen within 1 to 3 days and can last for 4 to 6 months.
Fat can be harvested from one area, prepared, and injected in other areas to treat deep wrinkles, depressions, skin folds, areas of fat atrophy, and thin lips. Some fat resorption occurs over the first year (30-70% in different reports) with fat injection and may lead to irregularities. Some fat stem cells are transplanted and can remain viable permanently.
Collagen for many years was the main option for soft tissue augmentation. Sources include cow (bovine) skin, pig (porcine) skin, and human skin and allergy testing is often necessary. Zyderm I® is 3.5% bovine collagen and is used for superficial wrinkles. Zyderm II® is 6.5% collagen and is used for medium wrinkles. Zyplast® is crosslinked with glutaraldehyde which makes it more resistant to breakdown, less immunogenic, and better for deep wrinkles and folds, as well as lip augmentation. Dermalogen® is a collagen matrix filler derived from cadaveric skin. Cosmoderm® and Cosmoplast® are collagen matrices harvested from neonatal foreskin. Autologen® is prepared from a patient’s own skin and processed prior to injection. Cymetra® is small particles of Alloderm®, which is a proprietary preparation of acellular cadaveric dermis. This product contains a dermal matrix in addition to collagen and promotes ingrowth of tissue. Fascian® is a particulate acellular fascial product harvested from the extremities of cadavers. It can be injected to correct wrinkles and grooves but is thick and difficult to inject. The effects of each of the above last 3-6 months.
Hyaluronic Acid as a dermal filler has become a huge component of cosmetic surgery and skin care. There are a variety of products which come from different sources or have different preparations, with some variability in durability (Restylane®, Perlane®, Juvederm®, Hylafor®, Reviderm Intra®, AcHyal®). Hyaluronic acid is a glycosaminoglycan which is a normal component of skin and the human body and is important in skin hydration. Its presence attracts water, thickening skin in the area of injection. Since it is a naturally occurring substance, an allergic reaction to hyaluronic acid is not possible although it is possible to have an allergic reaction to a preservative in a particular product. Hyaluronic acids are thin liquids which are easy to inject and are ready off the shelf. Hyaluronic acid products are frequently used for fine wrinkles, perioral creases, lips, and smile lines by injecting in the mid-dermis. Topical anesthetic or field blocks are frequently used, as this product is not pre-mixed with lidocaine.  
 Sculptra® is biocompatible poly-L-lactic acid, FDA approved for the restoration of atrophy associated with the loss of fat in HIV, but is frequently used for aesthetics. The effects are not immediate and are cumulative. Typically 3–4 treatments are needed about every 3-4 months to gradually increase the thickness of the skin and the face.
Radiesse®/Radiance® is a long-lasting (2-3 year) injectable filler made with calcium hydroxyapatite, a normal component of bone that stimulates new collagen growth. This is a biocompatible filler that does not require skin testing.
Silicone, an inert synthetic polymer of dimethysiloxanes comes in many different forms and viscosities and is permanent. Goretex® (Polytetrafluoroethylene: PTFE) causes no inflammatory response and is permanent.
Artecoll® and Arteplast® are combinations of bovine collagen and polymethylmethacrylate used for deeper wrinkles and soft tissue deficiencies. The bovine collagen requires skin testing and the polymethylmethacrylate is the permanent component of the product as it is too large for the immune system to remove. Due to the larger particles, its use is recommended for deeper wrinkles and grooves.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
