Skip to main content

Advertisement

SpringerLink
Log in

Injectable volumetric fillers and botulinum toxin in facial rejuvenation

  • Review
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

There has been an upsurge in the technology of injectable volumetric filler materials for soft tissue augmentation of the face in the past decade. This is a dynamic field that has provided plastic surgeons and dermatologists who treat the aging face with newer tools and techniques. Injectable volumetric fillers can be applied in a variety of combinations and can be added to the various surgical options in conjunction with surgery or as maintenance following surgery. In practice, there are essentially four classes of materials that may be considered gold standard for minimally invasive rejuvenation and beautification of the face: botulinum toxin A, autologous fat, derivatives of hyaluronic acid, and, to a limited extent, hydroxyapatite. These coincide with the philosophy of applying materials and devices associated with the least amount of risk. Long lasting, or permanent–nondegradable, nonextractable, and nonabsorbable fillers remain an unresolved controversial issue, as the longer lasting the device, the greater also is the likelihood for long-term or even irreversible complications. The current trend for nonsurgical minimally invasive procedures for beautifying the face will most probably continue to surge, in light of their affordability in the growing economies around the globe, the increasing demand for a youthful look, and the need for less downtime for these procedures. There will be a rising demand for more hi-tech (bio- or genetically engineered) safe fillers with higher purity and less immunogenicity that allow a short recuperation time in order to attain a product that will serve as an ideal injectable volumetric filler for soft tissue augmentation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Alster TS, West TB (2000) Human-derived and new synthetic injectable materials for soft-tissue augmentation: current status and role in cosmetic surgery. Plast Reconstr Surg 105(7):2515–2525 discussion 2526–2528. Review. doi:10.1097/00006534-200006000-00034

    Article  PubMed  CAS  Google Scholar 

  2. Andre P, Lowe NJ, Parc A, Clerici TH, Zimmermann U (2005) Adverse reactions to dermal fillers: a review of European experiences. J Cosmet Laser Ther 7(3–4):171–176 doi:10.1080/14764170500344393

    Article  PubMed  CAS  Google Scholar 

  3. Ashinoff R (2000) Overview: soft tissue augmentation. Clin Plast Surg 27:479–487 Review

    PubMed  CAS  Google Scholar 

  4. Beljaards RC, de Roos KP, Bruins FG (2005) NewFill for skin augmentation: a new filler or a failure. Dermatol Surg 31:772–776

    PubMed  CAS  Google Scholar 

  5. Bergeret-Galley C, Latouche X, Illouz YG (2001) The value of a new filler material in corrective and cosmetic surgery: DermaLive and DermaDeep. Aesthetic Plast Surg 25:249–255 doi:10.1007/s002660010131

    Article  PubMed  CAS  Google Scholar 

  6. Bigata X, Ribera M, Bielsa I, Ferrandiz C (2001) Adverse granulamatous reaction after cosmetic dermal silicone injection. Dermatol Surg 27:198–200 doi:10.1046/j.1524-4725.2001.00020.x

    Article  PubMed  CAS  Google Scholar 

  7. Blitzer A, Brin MF, Keen MS, Aviv JE (1993) Botulinum toxin for the treatment of hyperfunctional lines of the face. Arch Otolaryngol Head Neck Surg 119:1018–1022

    PubMed  CAS  Google Scholar 

  8. Butterwick KJ, Lack EA (2003) Facial volume restoration with the fat autograft muscle injection technique. Dermatol Surg 29:1019–1026 doi:10.1046/j.1524-4725.2003.29294.x

    Article  PubMed  Google Scholar 

  9. Carraway JH, Mellow CG (1990) Syringe aspiration and fat concentration: a simple technique of autologous fat injection. Ann Plast Surg 24:293–296 doi:10.1097/00000637-199003000-00018

    Article  PubMed  CAS  Google Scholar 

  10. Carruthers A, Carruthers J (2001) Botulinum toxin type A: history and current cosmetic use in the upper face. Semin Cutan Med Surg 20:71–84 doi:10.1053/sder.2001.25138

    Article  PubMed  CAS  Google Scholar 

  11. Carruthers JD, Carruthers JA (1992) Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol 18:17–21

    PubMed  CAS  Google Scholar 

  12. Carruthers J, Fagien S, Matarasso SL, Botox Consensus Group (2004) Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg 114(6)(Suppl):1S–22S doi:10.1097/01.PRS.0000144795.76040.D3

    Article  PubMed  Google Scholar 

  13. Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E (2005) Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 29:34–48 doi:10.1007/s00266-004-0113-6

    Article  PubMed  Google Scholar 

  14. Claoue BL, Rabineau P (2004) The polyalkylimide gel: experience with Bio-Alcamid™. Semin Cutan Med Surg 23:236–240 doi:10.1016/j.sder.2004.08.001

    Article  PubMed  Google Scholar 

  15. Coleman SR (2006) Facial augmentation with structural fat grafting. Clin Plast Surg 33:567–577 doi:10.1016/j.cps.2006.09.002

    Article  PubMed  Google Scholar 

  16. Coleman SR (1997) Facial recontouring with lipostructure. Clin Plast Surg 24:347–367

    PubMed  CAS  Google Scholar 

  17. Coleman SR (2001) Structural fat grafts: the ideal filler? Clin Plast Surg 28:111–119

    PubMed  CAS  Google Scholar 

  18. Coleman SR, Saboeiro AP (2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg 119:775–785 doi:10.1097/01.prs.0000252001.59162.c9

    Article  PubMed  CAS  Google Scholar 

  19. de Maio M (2004) the minimal approach: an innovation in facial cosmetic procedures. Aesthetic Plast Surg 28:295–300 doi:10.1007/s00266-004-0037-1

    Article  PubMed  Google Scholar 

  20. De Ugarte DA, Ashjian PH, Elbarbary A et al (2003) Future of fat as raw material for tissue regeneration. Ann Plast Surg 50:215–219 doi:10.1097/01.SAP.0000029661.38066.15

    Article  PubMed  Google Scholar 

  21. Duffy DM (1990) Silicone: a critical review. Adv Dermatol 5:93–107

    PubMed  CAS  Google Scholar 

  22. Duffy DM (2005) Liquid silicone for soft tissue augmentation. Dermatol Surg 31:1530–1541

    PubMed  CAS  Google Scholar 

  23. Duranti F, Salti G, Bovani B, Calandra M, Rosati ML (1998) Injectable hyaluronic acid gel for soft tissue augmentation. A clinical and histological study. Dermatol Surg 24:1317–1325 doi:10.1016/S1076-0512(98)00151-4

    Article  PubMed  CAS  Google Scholar 

  24. Ellenbogen R (1986) Free autogenous pearl fat grafts in the face: a preliminary report of a rediscovered technique. Ann Plast Surg 16:179–194 doi:10.1097/00000637-198603000-00001

    Article  PubMed  CAS  Google Scholar 

  25. Ersek RA (1991) Transplantation of purified autologous fat: a 3-year follow up is disappointing. Plast Reconstr Surg 87:219–227

    PubMed  CAS  Google Scholar 

  26. Ferreira MC, Salles AG, Giminez R, Soares MF (2004) Complications with the use of botulinum toxin type a in facial rejuvenation: report of 8 cases. Aesthetic Plast Surg 28:441–444 doi:10.1007/s00266-004-0031-7

    Article  PubMed  Google Scholar 

  27. Frankel AS, Kamer FM (1998) Chemical browlift. Arch Otolaryngol Head Neck Surg 124:321–323

    PubMed  CAS  Google Scholar 

  28. Ghislanzoni M, Bianchi F, Barbareschi M, Alessi E (2006) Cutaneous granulomatous reaction to injectable hyaluronic acid gel. Br J Dermatol 154:755–758

    PubMed  CAS  Google Scholar 

  29. Giovagnorio F, Drudi FM, Valentini C, Paonessa A (2004) Ultrasonography in follow-up of soft tissue augmentation of the face with synthetic materials: a pilot study. Acta Radiol 45:746–750 doi:10.1080/02841850410008207

    Article  PubMed  CAS  Google Scholar 

  30. Guerrerosantos J (2000) Long term outcome of sutologous fat transplantation in aesthetic facial recontouring. Clin Plast Surg 27:515–543

    PubMed  CAS  Google Scholar 

  31. Guyuron B, Huddleston SW (1994) Aesthetic indications for botulinum toxin injection. Plast Reconstr Surg 93:913–918

    Article  PubMed  CAS  Google Scholar 

  32. Guyuron B, Majzoub RK (2007) Facial augmentation with core fat graft: a preliminary report. Plast Reconstr Surg 120:295–302 doi:10.1097/01.prs.0000264399.40701.71

    Article  PubMed  CAS  Google Scholar 

  33. Kanchwala SK, Holloway L, Bucky LP (2005) Reliable soft tissue augmentation: a clinical comparison of injectable soft-tissue fillers for facial-volume augmentation. Ann Plast Surg 55:30–35 doi:10.1097/01.sap.0000168292.69753.73

    Article  PubMed  CAS  Google Scholar 

  34. Karim RB, Hage JJ, van Rozelaar L, Lange CA, Raaijmakers J (2006) Complications of polyalkylimide 4% injections (Bio-Alcamid™): a report of 18 cases. J Plast Reconstr Aesthet Surg 59:1409–1414 doi:10.1016/j.bjps.2006.01.049

    Article  PubMed  CAS  Google Scholar 

  35. Kaufman MR, Miller TA, Huang C et al (2007) Autologous fat transfer for facial recontouring: is there science behind the art. Plast Reconstr Surg 119:2287–2296 doi:10.1097/01.prs.0000260712.44089.e7

    Article  PubMed  CAS  Google Scholar 

  36. Klein AW (2001) Collagen substances. Facial Plast Surg Clin North Am 9:205–218, May

    PubMed  CAS  Google Scholar 

  37. Klein AW (2006) Soft tissue augmentation 2006: filler fantasy. Dermatol Ther 19:129–133 doi:10.1111/j.1529-8019.2006.00066.x

    Article  PubMed  Google Scholar 

  38. Klein AW, Elson ML (2000) The history of substances for soft tissue augmentation. Dermatol Surg 26:1096–1105 doi:10.1046/j.1524-4725.2000.00512.x

    Article  PubMed  CAS  Google Scholar 

  39. Krandendonk S, Obagi S (2007) Autologous fat transfer for periorbital rejuvenation: indications, technique, and complications. Dermatol Surg 33:572–578 doi:10.1111/j.1524-4725.2007.33116.x

    Article  CAS  Google Scholar 

  40. Kuran I, Tumerdem B (2005) A new simple method used to prepare fat for injection. Aesthetic Plast Surg 27:18–22 doi:10.1007/s00266-004-0059-8

    Article  Google Scholar 

  41. Lahiri A, Waters R (2007) Experience with Bio-Alcamid, a new soft tissue endoprosthesis. J Plast Reconstr Aesthet Surg 60:663–667 doi:10.1016/j.bjps.2006.07.010

    Article  PubMed  Google Scholar 

  42. Lai et al (2003) Surgical treatment of facial siliconoma involving the temporal area. Plast Reconstr Surg 155:553–558

    Google Scholar 

  43. Lemperle G, Morhenn V, Charrier U (2003) Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 27:354–366 doi:10.1007/s00266-003-3022-1

    Article  PubMed  Google Scholar 

  44. Locke MB, de Chalain T (2008) Current practice in autologous fat transplantation. Suggested clinical guidelines based on a review of recent literature. Ann Plast Surg 60:98–102

    Article  PubMed  CAS  Google Scholar 

  45. Lohuis PJ, Watts SJ, Vuyk HD (2001) Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 26:214–217 doi:10.1046/j.1365-2273.2001.00453.x

    Article  PubMed  CAS  Google Scholar 

  46. Lombardi et al (2004) Orofacial granulomas after injection of cosmetic fillers. Histopathologic and clinical study of 11 cases. J Oral Pathol Med 33:115–120 doi:10.1111/j.1600-0714.2004.00194.x

    Article  PubMed  CAS  Google Scholar 

  47. Lowe NJ, Maxwell CA, Patnaik R (2005) Adverse reactions to dermal fillers. Dermatol Surg 31(11 Pt 2):1616–1625. review

    PubMed  CAS  Google Scholar 

  48. Manna F, Dentini M, Desideri P et al (1999) Comparative chemical evaluation of two commercially available derivatives of hyaluronic acid (hylaform from rooster combs and restylane from streptococcus) used for soft tissue augmentation. J Eur Acad Dermatol Venereol 13:183–192

    PubMed  CAS  Google Scholar 

  49. Marmur ES, Phelps R, Goldberg DJ (2004) Clinical, histologic and electron microscopic findings after injection of a calcium hydroxylapatite filler. J Cosmet Laser Ther 6:223–226 doi:10.1080/147641704100003048

    Article  PubMed  Google Scholar 

  50. Matarasso SL (2007) Injectable collagens: lost but not forgotten-A review of products, indications, and injection techniques. Plast Reconstr Surg 120(6)(Supplement):17S–26S doi:10.1097/01.prs.0000248802.65041.ff

    Article  PubMed  CAS  Google Scholar 

  51. Matarasso SL, Carruthers JD, Jewell ML, the Restylane Consensus Group (2006) Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg 117(3)(Supplement):3S–34S doi:10.1097/01.prs.0000204759.76865.39

    Article  PubMed  Google Scholar 

  52. Missana MC, Laurent I, Barreau L, Balleyguier C (2007) Autologous fat transfer in reconstructive breast surgery: indications, technique and results. Eur J Surg Oncol 33:685–690 doi:10.1016/j.ejso.2006.12.002

    PubMed  CAS  Google Scholar 

  53. Mizuno H, Zuk PA, Zhu M et al (2002) Myogenic differentiation by human processed lipoaspirate cells. Plast Reconstr Surg 109:199–209 doi:10.1097/00006534-200201000-00030

    Article  PubMed  Google Scholar 

  54. Murillo WL (2004) Buttock augmentation: case study of fat injection monitored by magnetic resonance imaging. Plast Reconstr Surg 114:1606–1614 doi:10.1097/01.PRS.0000138760.29273.5D

    Article  PubMed  Google Scholar 

  55. Narins RS, Beer K (2006) Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 118(Suppl.):77S doi:10.1097/01.prs.0000234919.25096.67

    Article  PubMed  CAS  Google Scholar 

  56. Nelson L, Stewart KJ (2008) Plastic surgical options for HIV-associated lipodystrophy. J Plast Reconstr Aesthet Surg 61:359–365 doi:10.1016/j.bjps.2007.11.014

    Article  PubMed  CAS  Google Scholar 

  57. Nelson L, Stewart KJ (2008) Experience in the treatment of HIV-associated lipodystrophy. J Plast Reconstr Aesthet Surg 61:366–371 doi:10.1016/j.bjps.2007.10.031

    Article  PubMed  CAS  Google Scholar 

  58. Neuber F (1893) Fett transplantation. Chir Kong Verhandl Deutsch Ges Chir 22:66–68

    Google Scholar 

  59. Niechajev I, Sevcuk O (1994) Long term results of fat transplantation: clinical and histological studies. Plast Reconstr Surg 94:496–506 doi:10.1097/00006534-199409000-00012

    Article  PubMed  CAS  Google Scholar 

  60. Nordstrom RE, Wang J, Fan J (1997) “Spaghetti” fat grafting: a new technique. Plast Reconstr Surg 99:917–918

    PubMed  CAS  Google Scholar 

  61. Pacini S, Ruggiero M, Morucci G et al (2002) Bio-alcamid: a novelty for reconstructive and cosmetic surgery. Ital J Anat Embryol 107:209–214

    PubMed  Google Scholar 

  62. Pinsolle V, Chichery A, Grolleau JL, Chavoin JP (2008) Autologous fat injection in Poland’s syndrome. J Plast Reconstr Aesthet Surg 61:784–791

    Article  PubMed  CAS  Google Scholar 

  63. Pitaru S, Noff M, Blok L, Nir E, Pitaru S, Goldlust A, Savion N (2007) Long-term efficacy of a novel ribose—cross-linked collagen dermal filler: a histologic and histomorphometric study in an animal model. Dermatol Surg 33:1045–1054 doi:10.1111/j.1524-4725.2007.33218.x

    Article  PubMed  CAS  Google Scholar 

  64. Ramon Y, Fodor L, Ullmann Y (2007) Preliminary experiences with Bio-Alcamid in HIV facial lipoatrophy. Dermatology 214:151–154

    PubMed  Google Scholar 

  65. Raszewski R, Guyuron B, Lash RH, McMahon JT, Tuthill RJ (1990) A severe fibrotic reaction after cosmetic liquid silicone injection. A case report. J Craniomaxillofac Surg 18:225–228 doi:10.1016/S1010-5182(05)80417-2

    PubMed  CAS  Google Scholar 

  66. Rotunda AM, Narins RS (2006) Poly-L-lactic acid: a new dimension in soft tissue augmentation. Dermatol Ther 19:151–158 doi:10.1111/j.1529-8019.2006.00069.x

    Article  PubMed  Google Scholar 

  67. Sclafani AP, Romo T 3rd, Jacono AA, McCormick S, Cocker R, Parker A (2000) Evaluation of acellular dermal graft in sheet (AlloDerm) and injectable (micronized AlloDerm) forms for soft tissue augmentation. Clinical observations and histological analysis. Arch Facial Plast Surg 2:130–136 doi:10.1001/archfaci.2.2.130

    Article  PubMed  CAS  Google Scholar 

  68. Sclafani AP, McCornick SA, Cocker R (2002) Biophysical and microscopic analysis of homologous dermal and fascial materials for facial aesthetic and reconstructive uses. Arch Facial Plast Surg 4:164–171 doi:10.1001/archfaci.4.3.164

    Article  PubMed  Google Scholar 

  69. Shafir R, Amir A, Gur E (2000) Long-term complications of facial injections with Restylane (injectable hyaluronic acid). Plast Reconstr Surg 106:1215–1216 doi:10.1097/00006534-200010000-00048

    Article  PubMed  CAS  Google Scholar 

  70. Sidwell RU, Dhillon AP, Butlert PEM, Rustin MHA (2004) Localized granulamatous reaction to a semi-permanent hyaluronic acid and acrylic hydrogel cosmetic filler. Clin Exp Dermatol 29:630–632 doi:10.1111/j.1365-2230.2004.01625.x

    Article  PubMed  CAS  Google Scholar 

  71. Sklar JA, White SM (2004) Radiance FN: a new soft tissue filler. Dermatol Surg 30:764–768 doi:10.1111/j.1524-4725.2004.30214.x

    Article  PubMed  Google Scholar 

  72. Spear SL, Wilson HB, Lockwood MD (2005) Fat injection to correct contour deformities in the reconstructed breast. Plast Reconstr Surg 116:1300–1305 doi:10.1097/01.prs.0000181509.67319.cf

    Article  PubMed  CAS  Google Scholar 

  73. Terino EO (2001) Alloderm acellular dermal graft: applications in aesthetic soft-tissue augmentation. Clin Plast Surg 28:83–99. Review

    PubMed  CAS  Google Scholar 

  74. Tirakunwichcha S, Tulvatana W, Kulvichit K (2003) An unusual complication from esthetic injection of liquid silicone into the forehead. Am J Ophthalmol 136:944–945 doi:10.1016/S0002-9394(03)00465-3

    Article  PubMed  Google Scholar 

  75. Tzikas TL (2004) Lipografting: autologous fat grafting for total facial rejuvenation. Facial Plast Surg 20:135–143 doi:10.1055/s-2004-861754

    Article  PubMed  Google Scholar 

  76. Valdatta L, Thione A, Buoro M, Tuinder S (2001) A case of life-threatening sepsis after breast augmentation by fat injection. Aesthetic Plast Surg 25:347–349 doi:10.1007/s002660010147

    Article  PubMed  CAS  Google Scholar 

  77. Position VII Statement of IQUAM, the International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery, 15 July 2006, Regensburg, Germany. www.IQUAM.org

  78. Zheng DN, Li QF, Lei H, Zheng SW (2008) Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up. J Plast Reconstr Aesthet Surg 61:792–798

    Article  PubMed  Google Scholar 

  79. Zocchi ML, Zuliani F (2008) Bicompartmental breast lipostructuring. Aesthetic Plast Surg 32:313–328 doi:10.1007/s00266-007-9089-3

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel

    Moris Topaz

  2. The International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery (IQUAM), P.O. Box 2340, Ra’anana, 43665, Israel

    Moris Topaz

Authors
  1. Moris Topaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moris Topaz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Topaz, M. Injectable volumetric fillers and botulinum toxin in facial rejuvenation. Eur J Plast Surg 31, 281–291 (2008). https://doi.org/10.1007/s00238-008-0296-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-008-0296-1

Keywords

Search

Navigation