Flávio Dermal Fillers for Facial Harmony

1. Auflage 2020
ISBN: 978-1-64724-007-3
Verlag: Quintessence Publishing Co, Inc
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 176 Seiten

In our esthetics-obsessed culture, patients are becoming more aware and demanding of dermal filler treatments. Yet all too often we hear news stories of botched procedures or anesthesia gone wrong. This book walks you through how to incorporate dermal fillers into your clinical armamentarium, starting with the basic characteristics of the materials and advancing to the injection techniques and clinical indications for their use. The author includes such fine detail as whether to use a needle versus a cannula and why you must understand the precise tissue layers of the face in order to effectively deliver this nuanced treatment. In step with its sister volume, Botulinum Toxin for Facial Harmony, the book focuses on facial analysis as a crucial step in determining appropriate treatment, a philosophy that is carried through the entire book. An entire chapter is devoted to clinical cases illustrating the various facial regions and their appropriate filler applications, clearly demonstrating how to use the techniques presented to optimize esthetics and facial harmony. Supplemental material and videos are available via QR code for additional learning.

Altamiro Flávio, DDS, graduated from the Federal University of Goiás College of Dentistry in 1990 and went on to become a specialist in dental prostheses at the Federal University of Uberlândia in 1992. In 2010, he created a continuing education course called 'A Smile for Each Face,' which included topics such as facial analysis, digital planning, dental anatomy, direct and indirect veneers, restorations, botulinum toxin, facial fillers, and viscosupplementation. He continues to teach courses like this all over the world, and he also teaches the specialization course in restorative dentistry at the Brazilian Association of Dentistry in Goiás. Dr Flávio is an accredited member of the Brazilian Society of Aesthetic Dentistry and a founder of the Brazilian Society of Botulinum Toxin and Facial Implants. He maintains a private practice in Goiânia, Brazil.

Autoren/Hrsg.

Flávio, Altamiro

Leseproben

C H A P T E R 02 History, Classification, and Characteristics of Fillers History of Fillers The development of biocompatible and safe fillers required many years of study and research. Table 2-1 illustrates the historical evolution of fillers. With the development of local anesthesia and surgical techniques toward the end of the 19th century, more invasive cosmetic procedures became available, including soft tissue fillers. Fat was one of the first soft tissue fillers to be used after trauma and is still widely used today. However, autologous fat transplantation is considered a relatively major procedure, as it requires the transplantation of fat from another site, and its results may be variable. Prior to the introduction of autologous fat grafting, paraffin oil had been used for the restoration of volume and symmetry. However, its use was accompanied by a high incidence of inflammatory foreign body granulomatous nodules (paraffinomas), with consequent facial distortion and occasionally life-threatening pulmonary emboli. Hence, the use of paraffin oil was discontinued.3 Table 2-1 History of facial fillers YEAR FILLER DESCRIPTION 1863 Paraffin Used during and after the Civil War. Complications included migration, foreign body granuloma, and pulmonary embolism.1,2 1923 Autologous fat Used to fill volumes after trauma or to treat diseases such as lipoatrophy, scars, lipodystrophy (aging), and gluteal augmentation.1,2 1950 Silicone At first, the same silicone used to manufacture flexible catheters to correct urethral strictures was employed as a filler.1,2 1961 Liquid silicone Liquid injectable silicone used for breast augmentation and facial surgeries. It was banned by the US Food and Drug Administration (FDA).3 1962 Polydimethylsiloxane (PDMS) Pasty, noninjectable silicone for industrial use. Because it is an alloplastic material, it tends to be encapsulated.1,2 1981 Bovine collagen The first agent to be approved by the FDA for cosmetic injection. Because it caused allergies, an allergy test was necessary before injection into the patient. In addition, its effect was short.1,2 1989 Polymethyl methacrylate (PMMA) Nonresorbable and provides a permanent result.4 2003 Hyaluronic acid (HA) First HA dermal filler to be approved by the FDA (Restylane, Galderma).5 It is the most popular dermal filler.4 2003 Calcium hydroxyapatite (CaHA) Semisolid, cohesive subdermal product; its main component is the synthetic CaHA.6 2004 Poly-L-lactic acid (PLLA) Biodegradable and bioresorbable polymer used in areas of high loss of tissue volume; not suitable for filling individual wrinkles.7 In the mid-20th century, a shift was seen toward purified synthetic polymers in the form of injectable silicone. Although seemingly promising at first, the US Food and Drug Administration (FDA) eventually banned this material because of its similar complications of granuloma formation.8 However, microdroplet injection of limited amounts of silicone material is still used today as an off-label use for silicone that is FDA approved for ocular injections.9–11 Teflon, a synthetic polytetrafluoroethylene polymer, was next tested as a soft tissue filler, but it was quickly abandoned because of the resultant inflammatory reaction and the difficulty of injection.12 The first facial filler to receive FDA approval was bovine collagen, under the trade name Zyderm (Inamed, now Allergan), in 1981. The approval of Zyderm led to widespread research and development of other fillers, including alloplastic and implantable materials, as well as a renewed interest in and use of autologous fat.13 Despite this added research, bovine collagen remained the only FDA-approved filler until 2003, when the FDA approved the first hyaluronic acid (HA) dermal filler, under the trade name Restylane (Galderma), for temporary soft tissue augmentation.14 Since then, numerous fillers have received FDA approval in response to the growing popularity of minimally invasive facial rejuvenation procedures5 (Table 2-2 and Box 2-1). Further investigations and research have continued, and more long-lasting synthetic fillers have become available, including calcium hydroxyapatite (CaHA) and poly-L-lactic acid (PLLA).15 Table 2-2 Injectable fillers listed by date of FDA approval YEAR OF FDA APPROVAL TRADE NAME (MANUFACTURER) DESCRIPTION 1981 Zyderm 1 (Inamed/Allergan) Bovine collagen (35 mg/mL) 1983 Zyderm 2 (Inamed/Allergan) Bovine collagen (65 mg/mL) 1985 Zyplast (Inamed/Allergan) Bovine collagen (35-mg/mL collagen crosslinked with glutaraldehyde) 2003 Cosmoderm (Inamed/Allergan) Human collagen Cosmoplast (Inamed/Allergan) Human collagen Restylane (Galderma) HA 2004 Hylaform (Inamed/Allergan) Animal-derived HA Captique (Genzyme) Non–animal-derived HA Sculptra (Valeant) PLLA 2005 Cosmoderm 2 (Inamed/Allergan) Human collagen 2006 Juvéderm Ultra (Allergan) Non–animal-derived HA Juvéderm Ultra Plus (Allergan) Non–animal-derived HA Artefill (Suneva Medical) PMMA Radiesse (Merz) CaHA 2007 Perlane (Medicis) Non–animal-derived HA Elevess (Anika) Non–animal-derived HA 2008 Prevelle Silk (Mentor) Non–animal-derived HA Evolence (ColBar LifeScience) Porcine collagen 2009 Hydrelle (formerly Elevess) (Anika) Non–animal-derived HA Sculptra Aesthetic (Valeant) PLLA 2010 Juvéderm XC (Allergan) Non–animal-derived HA with lidocaine Restylane-L (Galderma) Non–animal-derived HA with lidocaine Perlane-L (Medicis) Non–animal-derived HA with lidocaine 2011 Belotero (Merz) Non–animal-derived HA LaViv (Fibrocell) Autologous fibroblasts 2013 Juvéderm Voluma-XC (Allergan) Non–animal-derived HA with lidocaine 2017 Juvéderm Vollure-XC (Allergan) Non–animal-derived HA Products in boldface are currently available. The FDA is aware that unapproved versions of Juvéderm, such as Juvéderm Ultra 2, 3, and 4, are being sold and distributed in the US, including by online retailers. (Data from Kontis.8) Box 2-1 FDA-approved indications for dermal fillers • Mid to deep dermis to treat facial wrinkles and folds • Perioral rhytids • Dorsum of the hands • Lips for lip augmentation • Contour deficiencies • Acne scars Classification of Fillers Dermal fillers can be classified according to their material properties, biodegradability, and duration of effect: Material properties • Autologous: Derived from the same individual (eg, autologous fibroblasts) • Heterologous: Derived from a different species (eg, bovine collagen) • Alloplastic: Nonbiologic material such as metal, ceramic, or plastic (eg, polymethyl methacrylate [PMMA]) Biodegradability • Biodegradable: Capable of being broken down, especially into innocuous products (eg, HA, PLLA) • Nonbiodegradable: Substance or chemical that cannot be changed to a natural state (eg, PMMA) Duration of effect • Temporary: Effective for less than 6 months (eg, collagen) • Long-lasting: Effective for 6 to 24 months (eg, HA [12–24 months], CaHA [18–24 months]) • Semipermanent: Effective for 2 to 5 years (eg, PLLA [2–3 years]) • Permanent: Nonfading results (eg, PMMA) HA is a...