摘錄  顏面真皮填充劑 : 選擇適合的產品及技巧

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Facial Dermal Fillers: Selection of Appropriate Products and Techniques

Steven H. Dayan, MD; and Benjamin A. Bassichis, MD

Over the last decade, there has been a shift in the way aesthetic surgeons approach facial rejuvenation. With recognition of the value of volume enhancement in achieving a more youthful appearance, as well as the ease of office procedures offering minimal downtime and predictable results, there has been a concomitant explosion in the soft tissue filler market. Given the vast array of filler products currently available, the decision of which facial filler to use in specific situations can be complicated and confusing. A physician’s selection of facial filler(s) should be based on a solid understanding of the various filler products, appropriate patient selection, and the physician’s proficiency in injection techniques. We present a review of the most widely used fillers, offering guidance on patient selection and effective injection techniques. (Aesthetic Surg J 2008;28:335–347.)

Table 1. Facial fillers

 

Filler

Function

Uses

Pros

Cons

Comments

Collagen-based products (Cosmoderm and Cosmoplast)

人膠原蛋白

台灣未許可

Human-derived, bioengineered collagen injected to fill facial wrinkles

Anywhere; effective contouring agent (lips, fine etched lines)

Immediate results with no downtime; formulated with lidocaine for patient comfort

Limited longevity (lasts 3 months)

An FDA-approved collagen dermal filler that does not require a skin test

Hyaluronic acid (Restylane, Perlane, Juvederm, Captique)

玻尿酸類

台灣許可大部份

Non–animal-derived hyaluronic acid engineered to resist degradation for wrinkle filler and volume replacement

Volume and contouring (periorbital, nasolabial, lips, cheeks, etc.)

Results are immediate and last 6–18 months; reversible

May be visible or palpated if injected superficially; less effective for treating lipoatrophy or very large volume correction

Stimulates de novo collagen formation; FDA-approved for filling moderate to severe wrinkles around the nose and mouth; all other uses considered off-label; no risk of animal-based disease transmission

Calcium hydroxylapatite (Radiesse)

微晶瓷

台灣許可

Microspheres of calcium hydroxylapatite inducing production of collagen

Volume enhancer (nasolabial and cheeks)

Biocompatible and ultimately biodegradable; long-lasting (12 months and maybe beyond) ; moldable

Clumping, lumping, and nodules can appear when injected into the lips

Do NOT use Radiesse in the lips; FDA-approved for facial lipoatrophy and moderate-to-severe wrinkles around the mouth

Poly-L-lactic acid (Sculptra and New Fill)

台灣未許可

Synthetic material is injected into the face, causing body to produce its own collagen

Volume enhancer (nasolabial, cheeks, and temples)

Long-lasting (18–24 months)

Results not immediate, may require multiple treatments; skin nodules and granulomatous reactions possible

In a clinical study of Sculptra, the treatment results lasted for up to2 years after the first treatment session; FDA-approved for facial lipoatrophy

Fat transfer

自體脂肪移植

Fat cells are harvested from one part of the body and injected into the face to replenish

Volume augmentation (cheeks, periorbital, and temple); not used for finer contouring volume

Most natural filler; fat can be stored for touch-up

For volume replacement, less effective at finer contouring; duration is unpredictable: 6 months–10 yrs

“Predictably unpredictable”

Silicone (Silikon 1000 and Adaptosil 5000)

台灣及世界均不許可

Highly refined silicone oil is injected using microdroplet technique

Volume replacement and contouring

Permanent

Cannot be removed after being injected

Beware of black market non-medical silicone; off-label cosmetic use

Polymethylmethacrylate (PMMA; Artecoll and Artefill)

台灣曾許可

但使用者不多

PMMA microspheres surrounded by collagen

FDA-approved for nasolabial folds, deep wrinkles

Permanent

Numerous injections needed for volume; allergic reactions possible; requires 3 months for full effects; sometimes visible under skin

Because of the bovine collagen component, allergy skin testing is required; PMMA does not break down

FDA, U.S. Food and Drug Administration.

Adaptosil 5000 is manufactured by Bausch Lomb (Rochester, NY). Artecoll is manufactured by Artes (San Diego, CA). Captique, Cosmoderm, Cosmoplast, Hylaform, and Juvederm are manufactured by Allegan, Inc (Irvine, CA). New Fill is manufactured by Ashford Aesthetics (Brussels, Belgium). Perlane is manufactured by QMed (Eatontown, NJ). Radiesse is manufactured by Bioform Medical (San Mateo, CA). Restylane is manufactured by Medicis (Scottsdale, AZ). Sculptra is manufactured by Sanofi-Aventis (Bridgewater, NJ). Silikon 1000 is manufactured by Alcon (Fort Worth, TX). Zyplast is manufactured by Inamed Aesthetics (Santa Barbara, CA).

 

 

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