The search for the perfect injectable has come a long way since the first FDA-approved filler for cosmetic injection into the face was purified bovine collagen in 1981. Patients today demand a filling material that is durable, affordable, biocompatible and natural-looking. To understand the future of facial augmentation, it's important to look to the past for valuable lessons and cautionary tales to make progress a success. The proliferation of hyaluronic acid fillers is understandable in the context of the above materials, as is the caution used with permanent fillers. Skepticism remains with autologous fat transfer, as the procedure has not yet been refined so that results can be reliably reproduced from one doctor to another.
Silicone, a permanent liquid filler, remains controversial and fillers such as calcium hydroxylapatite not only improve the appearance of volume loss, but can also induce collagen formation. As the physician's filler arsenal increases, so does the desire to advance the actual injection techniques themselves. The end result has been an improvement in facial filler technology and results. Microcannulas are an alternative to the traditional needle and, depending on the injector's preference, can be used to insert the filler.
In the 19th century, the first cases of soft tissue augmentation with dermal fillers included autologous fat extracted from the arms to correct depressed facial defects and scarring in a patient with tuberculous osteitis, as well as injecting paraffin into the scrotum as a testicular prosthesis in a patient with advanced tuberculosis. Now, many dermal fillers have lidocaine mixed in during manufacture and can help reduce the discomfort experienced by some patients. The first known injectable agent was paraffin, but its use as a dermal filler was discontinued after complications including embolization, migration (i.e., movement into surrounding tissue) and granuloma formation were reported. Fillers are products that are injected into soft tissues and are classified as resorbable or non-resorbable (permanent).
Since celebrities also admit (and almost celebrate), having had lip fillers and other cosmetic procedures, the culture around these treatments has changed to become more common and accepted. Acquisition Aesthetics strives to bring together experts in facial rejuvenation and non-surgical treatments to provide the highest level of training in facial aesthetics. While prior fillers were limited, those used today are comprised of a wide range of substances including collagen, hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and synthetic or artificial polymers (Table). With this, as expected, one of the most popular, effective and requested treatments today is that of lip fillers.
Cadaver-derived fillers and implants will not be discussed, since these materials are expensive, not all of them are approved by the U. S. Food and Drug Administration (FDA), and are more commonly used in burn victims than cosmetic patients. Although fillers have become a popular choice among cosmetic patients, clinical experience has shown that fillers should be used with caution, as complications can occur.
