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Ch. 6 - Radiesse
- Edited by Neil S. Sadick, Cornell University, New York
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- Book:
- Augmentation Fillers
- Published online:
- 26 February 2010
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- 18 January 2010, pp 43-52
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Summary
INTRODUCTION
Synthetic particulate-based materials are notable for their ability to provide a robust and durable implant and have long been used as bulking agents in a variety of surgical and nonsurgical settings. Radiesse® (BioForm Medical, Inc., San Mateo, CA) is an injectable filler material composed of synthetic calcium hydroxylapatite (CaHA) microspheres suspended in an aqueous carrier gel. Seventy percent of the composition of Radiesse is sodium carboxymethylcellulose carrier gel; the remaining 30 percent of the composition is CaHA microspheres. These uniform microspheres (25–45 microns) are identical in composition to the mineral portion of human bone and teeth.
CaHA has been used for over twenty years in various forms in plastic and reconstructive surgery, otology, otolaryngology, neurosurgery, orthopedic surgery, maxillofacial surgery, and dentistry. The excipients that comprise the aqueous gel carrier (i.e., cellulose, glycerin, and sterile water) are classified as “Generally Recognized as Safe” (21 CFR 182) by the Food and Drug Administration and have an extensive record of use in intramuscular injectable products such as Cortone®, Decadron®, and Dalalone®.
The components of CaHA occur naturally in the body and therefore are inherently biocompatible. Results from extensive in vitro and in vivo safety studies, including toxicology assessments, standardized biocompatibility testing, and a three-year animal study, demonstrate that injectable CaHA is biocompatible, nontoxic, nonirritating, and nonantigenic. Because CaHA contains no animal or human tissue derivatives, patient sensitivity testing is not required before use.
Ch. 8 - Augmentation Fillers in Cosmetic Dermatology: Silicone
- Edited by Neil S. Sadick, Cornell University, New York
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- Book:
- Augmentation Fillers
- Published online:
- 26 February 2010
- Print publication:
- 18 January 2010, pp 69-80
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Summary
INTRODUCTION
As the armamentarium of fillers for soft tissue augmentation expands, physicians and patients continue to seek those that approach criteria for the “ideal filler.” Regardless of treatment area, the ideal filler would demonstrate versatility, biocompatibility, consistency of results, a natural feel, an excellent safety profile, and a superb cost-to-benefit ratio. Furthermore, it would be easy to inject, have minimal side effects, and not require allergy testing. The ideal filler would also achieve some degree of longevity and, arguably, permanence.
Liquid injectable silicone (LIS) is the original permanent, synthetic soft tissue–augmenting filler that may be employed for a variety of cutaneous and subcutaneous atrophies. Used worldwide for at least forty years, it distinctively meets a majority of the criteria that would define the ideal filler, including versatility, reliability of results, a natural feel, and an excellent cost-to-benefit ratio. When LIS is appropriately administered with the microdroplet serial puncture technique, patients may obtain enduring correction of scars, rhytids, and depressions, as well as lasting augmentation of lips and other facial contour atrophies and deformities.
However, the “permanence” of LIS refers to the enduring nature of the product in vivo rather than a “permanent” cosmetic result. Although the progressive tissue volume loss of aging will continue to occur, the degree of correction due to placement of LIS will persist. For this reason, silicone and other permanent fillers are much less forgiving than temporary fillers, in that overcorrection or undesired augmentation will also persist. Hence, experience and precise technique are prerequisites to favorable patient outcomes.
Ch. 16 - Conclusion: Future Trends in Fillers
- Edited by Neil S. Sadick, Cornell University, New York
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- Book:
- Augmentation Fillers
- Published online:
- 26 February 2010
- Print publication:
- 18 January 2010, pp 149-152
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Summary
The present treatise has outlined the major advances in the development and utilization of fillers in the United States. Fillers are playing an ever-expanding role within this clinical setting. Combination programs employing toxins, fillers, light source, and radiofrequency technologies make up the backbone of noninvasive photorejuvenation programs. The therapeutic armentarium of fillers available in this country continues to evolve annually. There are six major trends in next-generation fillers that have evolved in this regard. A well-accepted and standardized classification schema of these agents has yet to be evolved.
LONGER ACTING FILLING AGENTS
There is definitely a trend toward longer acting fillers. In our busy world and for economic reasons, individuals would like to minimize the number of filler treatments that are necessary while still maintaining effect. The major question that is not universally accepted is what is that optimal duration of effect? Most physicians feel that an intermediate-acting filler with duration of twelve to eighteen months is optimal. This allows for longevity greater than older generation collagens and traditional hyaluronic acid derivatives; however, if there are adverse sequelae, it will resolve within a reasonable period of time, although one may expect as we move down the road that this timeline may continue to expand.
SITE-SPECIFIC FILLERS
Another major trend in fillers is specific capabilities. This means that they have clinical and physical characteristics that are uniquely beneficial for given anatomic areas. Examples of such site-specific areas are the lips and tear troughs, where lighter fillers with greater laminar flow characteristics would be more beneficial.