Table of Fillers

Abstract

The landscape of available substances for soft tissue augmentation is constantly evolving, with new products appearing on the market, and others going out of production. The most commonly used fillers are those based on hyaluronic acid. They are perhaps the most versatile group of products, with uses from the most superficial injection sites through deeper facial contouring. They are unique in that their effects can be reversed through injection of hyaluronidase. Calcium hydroxylapatite is another frequently used product. Its increased viscosity and durability make it a good choice for general contour improvement and treatment of heavier folds; however, this lends it less appropriate for superficial injection or in delicate areas such as the eyelids and lips.

The landscape of available substances for soft tissue augmentation is constantly evolving, with new products appearing on the market, and others going out of production. The most commonly used fillers are those based on hyaluronic acid. They are perhaps the most versatile group of products, with uses from the most superficial injection sites through deeper facial contouring. They are unique in that their effects can be reversed through injection of hyaluronidase. Calcium hydroxylapatite is another frequently used product. Its increased viscosity and durability makes it a good choice for general contour improvement and treatment of heavier folds; however, this lends it less appropriate for superficial injection or in delicate areas such as the eyelids and lips. Although most fillers likely have some biostimulatory properties, Poly-l-lactic acid is a unique filler substance in that it relies almost exclusively on its ability to stimulate native collagen production rather than direct expansion of tissues by the product itself. It has proven very useful for larger zone contouring, but less useful for thin-skinned areas such as the vermillion lips and eyelids. Less commonly used are the permanent or semipermanent products such as polymethyl methacrylate, liquid injectable silicone, and implantable devices.

The locations and manner in which fillers are used has experienced a renaissance. In addition to direct augmentation of the nasolabial folds, marionette lines, and lips, the role for fillers has continuously expanded. A greater appreciation of the changes to the aging face that occur at multiple depths including the bone, cartilage, muscle, fat, and skin has led to injection techniques that create a more global and natural correction than merely injecting into the dermis underlying a specific rhytid or fold. Correction of age-related changes to the deep tissues can be achieved via injection in the cheeks, jawline, and temporal fossae. Similarly, a role for fillers has been appreciated in anatomic sites not initially considered to be within the scope of these products, such as the tear troughs, brows, prejowl sulci, ear lobes, and for nasal contouring. It is common to use multiple products at different depths and locations to achieve a more complete correction. Other recent additions to injection technique are the use of blunt-tipped microcannulae and the mixing of local anesthetic with fillers (Table 142.1).

Table 142.1 Table of fillers