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| AUGMENTATION TECHNIQUES | OPINION said to promote fibrovascular ingrowth,


which may help to prevent infection. Medpor is available in preformed


shapes, or it can be fashioned to an individual patientÕs needs. It is used by cosmetic surgeons for chin augmentation, and also in a number of medical situations, including the correction of craniofacial defects, reconstruction of the orbit following enucleation, repair of orbital wall fractures, correction of nasal deformities, and reconstruction of the outer ear following trauma. It is reportedly associated with a low rate of complications. A further type of polymer-based


product is EthiconÕs Mersilene mesh, a non-absorbable polyester fibre sheet originally introduced in the 1950s for the repair of abdominal hernias. It is claimed to have excellent tensile strength, durability and host tolerance and, because of good tissue ingrowth, remains immobile and is essentially undetectable by palpation. Its most important advantage is said to be the natural appearance that it provides.


Dermal fillers A third group of materials used for facial implants comprises a diverse group of natural products including hyaluronic acid and hydroxylapatite. Hyaluronic acid is a naturally occurring glycosaminoglycan found in all living organisms, particularly in soft connective tissue and in the fluid surrounding the


eye, as well as some cartilage and joint fluids, and in skin tissue. It is a jelly-like substance that also has a lubricating function. Injected into the skin, it can be used as a dermal filler to improve the skinÕs contour by softening facial lines and to reduce depressions in the skin owing to scars or injury. Hyaluronic acid was by far the most widely used filler material in the US in 2011 (Figure 1). The number of commercially available


hyaluronic acid products is quite large, and includes: ■ Genzyme BiosurgeryÕs Hylaform/ Hylaform Plus and Captique


■ Restylane and Perlane (Q-Med, A Galderma Division)


■ AllerganÕs Juv• derm Ultra/Ultra Plus ■ MentorÕs Prevelle Silk ■ Anika TherapeuticsÕ Hydrelle (previously known as Elevess)


■ Merz AestheticsÕ Boletero ■ Tedec-Meiji FarmaÕs AcHyal, which is not yet approved in the US. All hyaluronic acid preparations may


cause mild side-effects such as localised reddening or inflammation. Compared with many of the other


Figure 1 Numbers of soft tissue filler procedures in the US in 2011.


Number of procedures in 2011 Hyaluronic acid 1 303 656


Hydroxylapatite 286 179 Collagen 72 300 Adipose tissue 68 410


Poly-L-lactic acid 143 777 PMMA microspheres 16 836 Source: American Society of Plastic Surgeons


Reference


American Society of Plastic Surgeons, Plastic Surgery Statistics Report. 2011. http://tinyurl.com/ ccmqpmv (accessed 21 May 2012)


prime-journal.com | June 2012 ❚


materials already mentioned, hydroxyapatite (strictly speaking, calcium hydroxylapatite) is fairly heavy. Hydroxylapatite occurs naturally in bone, although the material used for cosmetic and restorative procedures is actually obtained from a marine coral. It is porous in nature, allowing for bony and fibrous ingrowth, essentially replacing lost


volume and acting as a temporary scaffold for the bodyÕs own collagen to regenerate. It has been used in its solid form, whereby solid implants are anchored to the existing bone using rigid fixation, or as a suspension of microspheres in a water-based gel as a dermal filler. The leading product of this type is Merz AestheticsÕ Radiesse. A particular use of hydroxylapatite is


the treatment of facial lipodystrophy, a side-effect of antiretroviral drugs used to treat HIV-positive patients. Treatment of HIV-associated facial lipoatrophy is also a particular application for a final type of facial dermal filler, in this case based on a synthetic polymer known as poly-L-lactic acid, although it is also used to treat the signs of ageing. The polymer has been used in the surgical setting for many years. The leading poly-L-lactic acid currently in use is SanofiÕs Sculptra, which is marketed in many countries.


Conclusions Early attempts at facial remodelling depended largely on procedures that involved tightening the skin ® the classic


Ô face liftÕ ® or removing tissue. As both available products and surgical procedures improved, the emphasis shifted towards the replacement of tissue lost as a result of ageing using a range of restorative materials. This approach also suits modern lifestyles, as such procedures are usually done on an outpatient basis and patients can even return to normal activities the same day. This trend towards convenience and rapid results is nowhere more apparent than in the use of AllerganÕs Botox (onabotulinumtoxinA), which is in some respects the ultimate facial remodelling tool. Given the popularity of such procedures, it would seem that the outlook for facial remodelling products is good.


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