Zusammenfassung
Hintergrund
Füllmaterialien (Filler) dienen der Volumenaugmentation und Faltenunterspritzung im Gesicht. Es handelt sich um eine große und heterogene Gruppe von Stoffen, deren Klassifikation, therapeutische Anwendung und häufigste Komplikationen beschrieben werden.
Methode
Die aktuelle Literatur sowie Beispiele aus dem eigenen klinischen Alltag werden zusammengefasst.
Ergebnisse
Im Hinblick auf die klinische Verwendung und die Behandlung von Komplikationen ist eine Unterteilung nach der biologischen Abbaubarkeit in nichtpermanente, teilweise permanente und permanente Filler sinnvoll. Nichtpermanente Filler wie Hyaluronsäure und Kollagen werden im Gewebe nach einigen Monaten vollständig abgebaut. Teilweise permanente Filler sind biologisch abbaubar, induzieren aber länger anhaltende sekundäre Effekte. Permanente Filler sind durch körpereigene Prozesse nicht degradierbar und sollten heutzutage wegen des Risikos langanhaltender Nebenwirkungen nicht mehr eingesetzt werden. Die häufigsten Nebenwirkungen nach Fillerinjektionen sind Farbveränderungen, Schwellungen und Formveränderungen im Sinn einer Unter- oder Überkorrektur. Klinisch sichtbare Knoten nach Injektion können durch Materialakkumulation, Granulombildung oder Infektionen bedingt sein.
Schlussfolgerungen
Das Wissen um Nutzen und Risiken der kommerziell erhältlichen Substanzen ist für den sicheren klinischen Gebrauch unabdingbar. Frühzeitiges Erkennen und adäquates Behandeln von Komplikationen sind wichtig, um schwerwiegende Nebenwirkungen zu vermeiden und ein kosmetisch optimales Ergebnis zu erzielen.
Abstract
Background
A variety of fillers is commonly used for tissue augmentation as well as skin rejuvenation, and consist of a large heterogeneous group of biomaterials. The objective was to provide an overview and classification of the most commonly injected filler materials and filler-related complications including therapy.
Method
A summary of the current literature and common associated side effects is provided from a personal clinical perspective.
Results
According to degradability, filler materials can be classified as temporary (degradable), semi-permanent, and permanent (nondegradable). Temporary fillers such as hyaluronic acid and collagen are completely degraded by the surrounding tissue within several months. Semi-permanent fillers are degradable, but may induce longer-lasting secondary effects. Permanent fillers such as silicone and mineral oil derivatives are not biodegradable and have been increasingly abandoned because of severe and irreversible side effects. The most common filler-related adverse events include pigmentation changes, edema and post-injection deformations. Visible or palpable nodules can be due to filler accumulation, formation of granuloma, or infection.
Conclusions
Substantial knowledge of the chemical and clinical features of the injected materials is indispensable for safe and efficient application. Early recognition of filler-related adverse effects is important to avoid severe complications and to achieve optimal results.
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M. Heppt, D. Hartmann, M. Reinholz, G. Feller-Heppt und T. Ruzicka geben an, dass kein Interessenkonflikt besteht. G.G. Gauglitz erhielt Vortragshonorare und/oder ist im Advisory Board von Merz Pharmaceuticals, Sinclair Pharma, Lumenis, Candela, Asclepion.
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Heppt, M., Hartmann, D., Reinholz, M. et al. Filler und ihre Nebenwirkungen. HNO 63, 472–480 (2015). https://doi.org/10.1007/s00106-015-0030-9
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DOI: https://doi.org/10.1007/s00106-015-0030-9