The popularity of dermal fillers has grown rapidly in recent years because they offer the rejuvenative and enhancing aesthetic improvements previously only achievable with surgery, but at lower cost and with limited-to-no recovery time. According to data from the American Society for Aesthetic Plastic Surgery (ASAPS), more than 1.6 million dermal filler treatments were performed in 2011, making them the second most popular nonsurgical cosmetic procedure performed in the USA after neuromodulators; the latter procedure is frequently performed in concert with dermal filler injections.
As public awareness and acceptance of dermal fillers grows, so does the size of the market, with an estimated 160 products currently available worldwide from more than 50 companies. Their main indications are the filling of rhytides and folds, and correction of soft tissue loss due to disease or age. Increasingly, fillers are used for volume replacement and enhancement procedures, including cheek and chin augmentation, tear trough correction, nose reshaping, midfacial volumization, lip enhancement, hand rejuvenation, and the correction of facial asymmetry. As the indications and the number of procedures performed increase, the number of complications will likely also increase.
Understanding the different characteristics, capabilities, injection techniques, risks, and limitations of available fillers is essential for injectors to reduce the risk of complications, improve patient outcomes, and care for patients who have experienced adverse events. This requires expert familiarity with the properties and potential complications of a wide range of products, including those that are not available in the injector’s country of practice, as patients may present with adverse reactions to fillers that were injected abroad. Particularly important is how the incidence of local adverse events following treatment is related to the injection technique versus the chemical composition of the dermal filler. This review will provide physicians with a background to the etiology of filler-related complications, and structured and clear guidance on their treatment and avoidance.
In this article, we mainly focus on ArteFill or ArteColl and Sculptra. ArteFill or ArteColl consists of 80% bovine dermal collagen plus 20% 32-40um PMMA microspheres. The collagen vehicle is degraded within 1–3 months, leaving the microspheres encapsulated by a fine fibrous capsule. Sculptra aesthetic is an injectable implant containing microparticles of poly-L-lactic acid (PLLA), carboxymethylcellulose (USP), non-pyrogenic mannitol (USP) and sterile water for injection (USP).
Pic.1: Characteristics of Sculptra and ArteFill