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Chap. 30 - FILLERS: HOW WE DO IT
- from PART THREE - FILLERS AND NEUROTOXINS
- Edited by Sorin Eremia, University of California, Los Angeles, School of Medicine
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- Book:
- Office-Based Cosmetic Procedures and Techniques
- Published online:
- 06 July 2010
- Print publication:
- 08 February 2010, pp 129-132
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Summary
Injectable fillers have become an integral part of nonsurgical enhancement of the face and body. A wide variety of fillers are currently available in the United States, and even more are available worldwide. In the last few years, there has been an explosion in the use of injectable fillers. Due to the specific nature of each filler material, each one has different applications, advantages, and disadvantages. In this chapter, we will be discussing all of the available fillers and the various techniques we employ during treatment of the face and body.
MATERIALS AND MECHANISMS OF ACTION
The mechanism of action that all injectable fillers share is the augmentation of an existing area to a desired target volume. There are permanent and semipermanent fillers. In the nonpermanent group are short-acting, intermediate, and long-acting fillers, depending on the length of duration of the product.
The collagen-based fillers include bovine collagen (Zyplast, Zyderm) and recombinant human collagen (Cosmoplast, Cosmoderm), which are in the short-acting category. The older bovine collagen fillers require a skin test prior to use, whereas the newer human collagen fillers do not. Collagen-based fillers are injected into the dermis, in the superficial and deep planes, depending on which one is being used. These fillers are manufactured with lidocaine, making the injections easier to tolerate. Collagen-based fillers can be used anywhere on the face but are most commonly used in the perioral area, especially the nasolabial folds and lips. Collagen-based fillers are injected through a 30-gauge needle.
Chap. 34 - BOTOX: HOW WE DO IT
- from PART THREE - FILLERS AND NEUROTOXINS
- Edited by Sorin Eremia, University of California, Los Angeles, School of Medicine
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- Book:
- Office-Based Cosmetic Procedures and Techniques
- Published online:
- 06 July 2010
- Print publication:
- 08 February 2010, pp 151-156
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Summary
Botulinum toxin is a powerful medication that has been used to treat various conditions in humans for several decades. In the last few years, there has been an explosion in the use of this drug for cosmetic purposes. Millions have benefited from the therapeutic effects of botulinum toxin, with very few patients experiencing adverse effects. In this chapter, we will discuss the various techniques and therapeutic uses of botulinum toxin in the field of cosmetic dermatology.
MECHANISMS OF ACTION
The mechanism of action of botulinum toxin (BTX) has been well established (Sakaguchi 1983; Carruthers and Carruthers 1992; Keen et al. 1994; Hambleton 1992). Protein interactions at the neuromuscular junction prevent the release of acetylcholine. There are seven known antigenically distinct serotypes of BTX (A–G). The most widely used and studied is botulinum toxin type A (BTX-A). This protein irreversibly binds and cleaves the SNAP-25 protein. There are currently two available preparations of BTX-A on the U.S. market: Botox and Dysport. Botulinum toxin type B (BTX-B) binds to synaptobrevin. BTX-B is available commercially as Myobloc. The temporary nature of therapeutic BTX therapy is due to axonal sprouting at the motor end plate of the neuromuscular junction as well as the development of extrajunctional acetylcholine receptors (de Paiva et al. 1999). This occurs over several months after BTX therapy.
COSMETIC USE
Cosmetic BTX treatments have become one of the most common nonsurgical procedures performed by dermatologists and plastic surgeons.
Ch. 1 - Application of 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 1-4
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Summary
INTRODUCTION
In the last five years, there has been an increased demand in the number of fillers available in the market. This corresponds with the increased demand for less-invasive procedures among consumers. The result is a wide array of choices for the patient and injector to address almost any type of problem. In this chapter, we outline the various applications of fillers throughout the body.
BACKGROUND
The ideal injectable filler remains elusive to this day. The properties we look for in an ideal injectable filler include safety, ease of use, consistency of results, and longevity of results.
Liquid silicone was the first filler available to treat contour defects, scars, and rhytids of the face. It was widely used for two decades until concerns about long-term safety caused it to fall out of favor. Several years ago, a new liquid silicone product was cleared by the FDA and has been used in an “off-label” fashion for cosmetic enhancement of the face. Liquid silicone is a permanent filler.
Bovine collagen was the second available injectable filler and was widely used with a very low incidence of complications. Allergy testing of the skin was necessary with Zyderm and Zyplast. These products lasted for a few months after injection, requiring frequent administration. Over the years, collagen-based products have evolved. Cosmoderm and Cosmoplast (human collagen) eliminated the need for skin testing. Evolence (porcine collagen) is cross-linked, giving it a longer-lasting quality, and it does not require skin testing.
Autologous fat transfer techniques were introduced around the same time as bovine collagen.