PRIME PRoMotIon |
hyaluronic acid fillers
Aref Alsoufi discusses a retrospective analysis of 108 cases of patients receiving a hyaluronic acid filler for long-lasting volume restoration on the face
to ageing or results of facial reconstructive surgery. There is a loss of connective and subcutaneous tissue during the normal ageing process. With ageing, the skin loses some of elasticity, becomes thinner, dry, wrinkled, and changes to the face appear. Over the last few years, the focus in the field of aesthetic medicine
A
ESTHETIC DEMANDS FOR VOLUME restoration on the face and body have increased for a number of reasons. Surface deformities can be congenital (e.g. cleft lip) or caused by endogenous defects (e.g. pectus excavatum), or owing
controversial, owing to the appearance of granulomas as a side-effect of treatment. The use of HA is now the gold standard. However, in
applications and clinical evaluations, the author found that the approximate effective duration with first and second generation HAs was only 3–4 months, even considering with the range ‘new’ HAs that have been developed in the past few years.
Hyaluronic acid HA is a high molecular weight glycosaminoglycan composed of disaccharide repeats
of has gradually shifted to
minimally-invasive procedures, often because more and more patients are refusing to take prolonged absences from work. For the correction of surface deformities, botulinum toxin A, chemical peels, laser therapies, fat implantation and soft tissue fillers can be used. Minimally-invasive volume restoration of the face through long-lasting resorbable fillers is now more attractive and important for the patient. In the course of the ageing process, the treatment
AREF ALSOUFI, MD, Plastic Surgeon, Frankfurt, Germany
62 ❚
stages that are necessary for each specific individual need can be applied without creating an irrevocable outcome for the patient, which may happen when invasive surgical procedures are used. It is necessary for the treating physician to master all new minimally- invasive techniques in order to provide patients with optimal advice tailored to their specific needs. The ideal filler materials should be well tolerated by the body and comprise ingredients that are not toxic or antigenic. The injection of the filler should be simple and safe; patients should experience minimal side-effects and minimal downtime. In response to patients’ demands for safe and effective filler materials for the correction of wrinkles and volume restoration, a range of products has been developed. Soft tissue fillers are typically classified according to their longevity of effect: temporary, long-lasting, semi- permanent and permanent. A variety of soft tissue fillers for facial volume augmentation are available worldwide. Fillers such as collagen and hyaluronic acid (HA) are biodegradable and are therefore temporary. The use of permanent fillers such as polyacrylates has become increasingly
October 2011 |
prime-journal.com
N-acetylglucosamine and glucuronic acid. Owing to its viscoelastic properties, it is a component of soft connective tissues, including skin, synovial fluid, and vitreous humour. HA is extremely hygroscopic, meaning that it binds water in skin, influencing skin volume and compressibility. Previously, HA was commonly extracted from rooster comb or human umbilical cord, but is now manufactured in large quantities by a process of bacterial fermentation.
Cross-linked hyaluronic acid The half-life of HA in tissue ranges from 0.5 days to a few days. HA must be modified to prolong its half-life time in vivo. HA can be modified through cross-linking reagent of polymer chains to hydrogel compounds. HA gel is able to hold large volumes of water. The cross-linking of HA results in prolongation of residence time in tissue by up to 18 months; the cross-linking procedure does not reduce its biocompatibility. Cross-linked HA (Varioderm) comprises HA produced
by biofermatentation. The use of Varioderm ensures the absence of immunologically active proteins and biologically active animal components (e.g. viruses). A skin test is not required prior to injection. The highly concentrated and cross-linked HA (Varioderm Subdermal), which has a significantly higher viscosity compared with the initial HA solution, is subsequently made into particles and stabilised to facilitate the filling of the syringes without the need of any dilution. This is described as a Monophasic Particle Technology (MPT). When injected properly, this HA has proven to be
effective for a significantly longer period of time (12– 18 months after a single injection). The only disadvantage
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