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Fillers and Soft Tissue Augmentation

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European Handbook of Dermatological Treatments

Abstract

Fillers are widely used for soft tissue augmentation.

This chapter includes descriptions of ageing of the face, essential anatomy, types and choice of fillers, indications for their use, and methods of injection (full face and site specific) and reviews the prevention and treatment of filler complications.

Though the complication rate with most fillers is very low, it is usually preferable to begin by using an inert biodegradable soft tissue filler of temporary duration. HA is the filler for most indications and has the advantage of reversibility using hyaluronidase. Moreover, in due course, even untreated, most HA-related complications resolve spontaneously.

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Abbreviations

BDDE:

1,4 butane-diol-diglycidyl ether

CaHa:

Calcium hydroxylapatite

DIR:

Delayed inflammatory reaction

DTHG:

Delayed type hypersensitivity granuloma

FBG:

Foreign body granuloma

HA:

Hyaluronic acid

HBOT :

Hyperbaric oxygen therapy

ORL:

Orbital retaining ligament

PLLA:

Poly-l-lactic acid

PMMA:

Polymethylmethacrylate

SILS:

Serial intralesional steroid

SMAS :

Superficial musculoaponeurotic system

SMDS :

Serial microdroplet silicone

SOOF:

Sub-orbicularis oculi fat

TNF:

Tumour necrosis factor

References

  • American Society of Plastic Surgeons. www.plasticsurgery.org/news-and-resources/2012-plastic-surgery-statistics.html. 2012.

  • Andre P, Wechsler J, Revuz J. Facial lipoatrophy: report of five cases after injection of synthetic filler into naso-labial folds. J Cosmet Dermatol. 2002;1:120–3.

    Article  CAS  PubMed  Google Scholar 

  • Artzi O, Loizides C, Verner I, Landau M. Resistant and recurrent late reaction to hyaluronic acid-based gel. Dermatol Surg. 2016;42(1):31–7.

    Article  CAS  PubMed  Google Scholar 

  • Artzi O, Cohen JL, Dover JS, Suwanchinda A, Pavicic T, Landau M, et al. Delayed inflammatory reactions to hyaluronic acid fillers: a literature review and proposed treatment algorithm. Clin Cosmet Investig Dermatol. 2020;13:371–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Beleznay K, Carruthers JDA, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg. 2015;41(10):1097–117.

    Article  CAS  PubMed  Google Scholar 

  • Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthet Surg J. 2019;39(6):662–74.

    Article  PubMed  Google Scholar 

  • Carey W. The maxi injections of the face. In: Redaelli A, Braccini F, editors. Facial ageing medical, surgical and odontostomatological solutions for mid and inferior part of the face. 1st ed. Firenze: Officina Editoriale Oltrarno; 2012. p. 235–48.

    Google Scholar 

  • Christensen LH. Normal and pathologic reactions to soft tissue gel fillers. Dermatol Surg. 2007;33(Suppl 2):5168–72.

    Google Scholar 

  • Christensen LH. Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers. Dermatol Surg. 2009;35(Suppl 2):1612–9.

    Article  CAS  PubMed  Google Scholar 

  • Chung KL, Convery C, Ejikeme I, Ghanem AM. A systematic review of the literature of delayed inflammatory reactions after hyaluronic acid filler injection to estimate the incidence of delayed type hypersensitivity reaction. Aesthet Surg J. 2020;40(5):NP286–300.

    Article  PubMed  Google Scholar 

  • Coleman SR. Facial augmentation with structural fat grafting. Clin Plast Surg. 2006;33(4):567–77.

    Article  PubMed  Google Scholar 

  • Cotofona S, Gotkin Robert H, Frank K, Lachman N, Schenck T. Anatomy behind the facial overfilled syndrome: the transverse facial septum. Dermatol Surg. 2020;46(8):e16–22.

    Article  Google Scholar 

  • Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg. 2011;27(1):23–8.

    Article  CAS  PubMed  Google Scholar 

  • De Boulle K. Management of complications after implantation of fillers. J Cosmet Dermatol. 2004;3(1):2–15.

    Article  PubMed  Google Scholar 

  • De Maio M. MD Codes™: a methodological approach to facial aesthetic treatment with injectable hyaluronic acid fillers. Aesthet Plast Surg. 2021;45(2):690–709.

    Article  Google Scholar 

  • Duffy DM. Liquid silicone for soft tissue augmentation: histological, clinical, and molecular perspectives. Dermatol Surg. 2005;31(11 Pt 2):1530–51.

    Article  CAS  PubMed  Google Scholar 

  • Edsman K, Nord L, Ohrlund A, Larkner H, Kenne AH. Gel properties of hyaluronic acid dermal fillers. Dermatol Surg. 2012;38(7 Pt 2):1170–9.

    Article  CAS  PubMed  Google Scholar 

  • Fortune Business Insights. Global dermal filler market, 15 December, 2020.

    Google Scholar 

  • Fournier P. Microlipoextraction and microlipoinjection. In: 13th annual meeting of American Society of Dermatologic Surgery, California, 1986.

    Google Scholar 

  • Gleeson C, Lucas S, Langrish CJ, Barlow R. Acute fatal fat tissue embolism after autologous fat transfer in a patient with lupus profundus. Dermatol Surg. 2011;37(1):111–5.

    Article  CAS  PubMed  Google Scholar 

  • Glicenstein J. Les premiers « fillers », vaseline et paraffine. Du miracle à la catastrophe. Annales de Chirurgie Plastique Esthétique. 2007;52(2):157–61.

    Article  CAS  Google Scholar 

  • Goldie K, Peeters W, Alghoul M, Butterwick K, Casabona G, Yu Chao YY, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg. 2018;44:11S.

    Article  Google Scholar 

  • Grunebaum LD, Allemann IB, Dayan S, Mandy S, Baumann L. The risk of alar necrosis associated with dermal filler injection. Dermatol Surg. 2009;35:1635–40.

    Article  CAS  PubMed  Google Scholar 

  • Hall-Stoodley L, Stoodley P. Evolving concepts in biofilm infections. Cell Microbiol. 2009;11(7):1034–43.

    Article  CAS  PubMed  Google Scholar 

  • Hall-Stoodley L, et al. Bacterial biofilms: from the natural environment to infectious diseases. Nat Rev Microbiol. 2004;2:95–108.

    Article  CAS  PubMed  Google Scholar 

  • Ibrahim O, Overman J, Arndt K, Dover JS. Filler nodules: inflammatory or infectious? A review of biofilms and their implications on clinical practice. Dermatol Surg. 2018;44:53–60.

    Article  CAS  PubMed  Google Scholar 

  • Lambros V. The use of hyaluronidase to reverse the effects of hyaluronic acid filler. Plast Reconstr Surg. 2004;114(1):277.

    Article  PubMed  Google Scholar 

  • Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S. Blindness following cosmetic injections of the face. Plast Reconstr Surg. 2012;129(4):995–1012.

    Article  CAS  PubMed  Google Scholar 

  • Lemperle G, Gauthier-Hazan N. Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options. Plast Reconstr Surg. 2009;123(6):1864–73.

    Article  CAS  PubMed  Google Scholar 

  • Lemperle G, Morhenn V, Charrier U. Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthet Plast Surg. 2003;27(5):354–66.

    Article  Google Scholar 

  • Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58(1):80–8.

    Article  CAS  PubMed  Google Scholar 

  • Nusbaum AG, et al. Biofilms in dermatology. Skin Ther Lett. 2012;17:1–5.

    CAS  Google Scholar 

  • Orentriech DS, Orentriech N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg. 1995;21(6):543–9.

    Article  Google Scholar 

  • Park TH, Seo WS, Kim JK, Chang CH. Clinical experience with polymethylmethacrylate microsphere filler complications. Aesthet Plast Surg. 2012;36(2):421–6.

    Article  Google Scholar 

  • Pathmarajah P, Rowland Payne C. Paired ear creases of the helix (PECH). A possible physical sign. Cureus. 2017;9(11):e1884. https://doi.org/10.7759/cureus.1884.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ricardo AA, et al. Aesthetic, functional, surgical anatomy of the face. In: Redaelli A, Braccini F, editors. Facial ageing. 1st ed. Firenze: Officina Editoriale Oltrarno; 2012. p. 63–94.

    Google Scholar 

  • Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27.

    Article  CAS  PubMed  Google Scholar 

  • 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(5):1804–9.

    Article  CAS  PubMed  Google Scholar 

  • Rowland Payne CME. The Mona Lisa smile. J Eur Acad Dermatol Venereol. 2003;1(Suppl 3)

    Google Scholar 

  • Rowland Payne CME. The 1ml facelift. Oral presentation, section of plastic surgery. London: Royal Society of Medicine; 2015a.

    Google Scholar 

  • Rowland Payne CME. The ala nasi lift. Oral presentation at FACE, London, 2015b.

    Google Scholar 

  • Rowland Payne CME. Fillers for feet. Oral presentation, London 16th June 2017.

    Google Scholar 

  • Rowland Payne CME, Gout U. The aesthetic consultation. In: Andre P, Haneke E, Marini L, Rowland Payne CME, editors. Cosmetic medicine and surgery. Boca Raton: CRC Press/Taylor & Francis; 2016. p. 68–74.

    Google Scholar 

  • Rowland Payne CME, et al. From silica granuloma to scar sarcoidosis. Clin Exp Dermatol. 1983;8:171–5.

    Article  Google Scholar 

  • Rzany B, Cartier H, Kestemont P, Trevidic P, Sattler G, Kerrouche N, et al. Full-face rejuvenation using a range of hyaluronic acid fillers: efficacy, safety, and patient satisfaction over 6 months. Dermatol Surg. 2012;38(7 Pt 2):1153–61.

    Article  CAS  PubMed  Google Scholar 

  • Skoog T. Plastic surgery. Philadelphia: WB Saunders Company; 1974.

    Google Scholar 

  • Surek CK, Vargo J, Lamb J. Deep pyriform: anatomical clarifications and clinical implications. Plast Reconstr Surg. 2016;138(1):59–64.

    Article  CAS  PubMed  Google Scholar 

  • Talmor G, Trang A, Ahadiat O, Pakshover B, Wysong A. Anatomic danger zones of the head and neck. Dermatol Surg. 2020;46(12):1549–59.

    Article  CAS  PubMed  Google Scholar 

  • Turkmani M, De Boulle K, Philipp-Dormston W. Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness. Clin Cosmet Investig Dermatol. 2019;12:277–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Verner I. Lip augmentation techniques. In: Azib N, Charrier JB, Cornette DI, Garcia P, Gout U, Lemaire T, Noel X, Pavicic T, Padey H, Penna V, Surlemont Y, Trevidic P, Verner I, editors. Anatomy and lips enhancement. Monaco: Expert 2 Expert Publishing; 2012.

    Google Scholar 

  • Verner I. Diagnosis and management of delayed inflammatory reactions. In: Annual congress of the European Academy of Dermatovenereology, 2020.

    Google Scholar 

  • Verner I, Rowland Payne CME. Fillers and soft tissue augmentation. In: Shai A, Maibach HL, Baran R, editors. Handbook of cosmetic skin care. 2nd ed. London: Informa Healthcare; 2009. p. 193–200.

    Chapter  Google Scholar 

  • Vert M. Degradable and bioresorbable polymers in surgery and in pharmacology: beliefs and facts. J Mater Sci Mater Med. 2009;20(2):437–46.

    Article  CAS  PubMed  Google Scholar 

  • Wang F, Garza L, Kang S, Varani J, Orringer JS, Fisher GJ, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;143(2):155–63.

    Article  CAS  PubMed  Google Scholar 

  • Warren RJ, Aston S, Mendelson B. Face lift. Plast Reconstr Surg. 2011;1286(6):747e–64e.

    Article  Google Scholar 

Further Reading

  • Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J. Aging and the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129(1):263–73.

    Article  CAS  PubMed  Google Scholar 

  • Verner I. Radiofrequency. In: Andre P, Haneke E, Marini L, Rowland Payne CME, editors. Cosmetic medicine & surgery. Boca Raton: CRC Press/Taylor & Francis; 2016. p. 417–23.

    Google Scholar 

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Rowland Payne, C.M.E., Verner, I., Cotofana, S. (2023). Fillers and Soft Tissue Augmentation. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D'Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Cham. https://doi.org/10.1007/978-3-031-15130-9_118

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  • DOI: https://doi.org/10.1007/978-3-031-15130-9_118

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