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Advanta Lip Implant (before)
(after)
Soft tissue augmentation is accomplished by various implantable
substances that add bulk to tissue. There has been a great evolution of
new products. Augmentation is either by injectable substances or by
various implantable materials. Each offers advantages and disadvantages
and the choice of the material to use will depend on the perceived defect to be
repaired, the desired result, possible complications, duration of effect, cost
and recovery issues.
GORTEX, SOFTFORM, ADVANTA
These fall into the implantable filler category. These are brand names for various forms of woven Teflon. The
differences in these products has to do with density, softness and shape.. Teflon is available in many forms:
as a paste which used to be commonly used to correct defects of the vocal cords, as a thin
fabric used in clothing, as sheets, strands, or tubes used in implants, or as a
mesh used in hernia repair. It has been used as an implantable substance
in man for over 25 years in applications such as arterial grafts. It has
been used to correct cosmetic deformities and to add bulk to tissues for over 15
years. Our bodies do not usually recognize Teflon as a foreign substance,
so reactions to it are rare. In facial plastic surgery, it is used most
often to fill defects such as deep creases. It does not absorb, so the
correction should be permanent. Insertion is a minor surgical procedure done
under local anesthesia. Often there is a stitch or two that has to be
removed a week later. Advanta is a 3rd generation material in this class
and is the first artificial lip enhancement implant that has less than a 10%
extrusion rate. (See the pictures above).
 
COLLAGEN and other INJECTABLES
Collagen injectables such a Zyderm and Cosmoderm are no longer used in my
practice. Newer products offer easier introduction, longer life (of the
implant) and less allergic potential. Radiesse, a new injectable filler has been approved by the FDA for
some soft tissue augmentation procedures. It is a paste of calcium
hydroxyapatite, a material found in bone and teeth. It has been used in
Europe for several years to enhance lips and fill deep facial creasing and its
effects last for several years. Allergy testing is not required. Use
for cosmetic purposes is considered "off label", but it has been proven safe in
other areas and has been used in one form or the other for decades. Its most
common use in my practice is to fill soft tissue defects of the cheeks and to
fill in nasolabial lines. Lip enhancement is no longer done with this
filler because of inconsistent result. It takes a couple of years for
Radiesse to absorb completely although the visible effect rarely lasts more than
a year.
Restylane, Perlane, & Juvenate The products consist of stabilized hyaluronic acid.
which is a natural component of our soft tissue. The hyaluronic
acid in these products is derived from non animal sources and recombined for
increased stability and extended tissue life. Juvenate differs from
Restylane in that it is stabilized chemically with more cross links. It
requires less volume of injection to get the same result and theoretically
should last longer. Compared to Zyderm, Restylane's augmentation effect lasts 2 to3 times as long (8 to 9 months
on the average in one study and 6.4 months in another). It is used to
augment lips (improve contour and fullness), correct "smokers" lines
of the upper lip, fill in deep nasolabial folds, erase smile lines, fill in the
oral commissure (marionette lines), and erase worry lines from the
forehead. The advantage of these products over collagen products such as zyderm is an extended
effect and not needing a pre treatment skin test as allergic reactions have not
been a problem. Another advantage is that it is not permanent.
Aesthetic values change over a period of time (I remember doing lip reductions
in the 70's). Styles change and permanent enhancement may not be for you. The disadvantage is a longer period of swelling and
redness (sometimes up to one week instead of one day) and the need for local
anesthesia block prior to the injection of the implant material when used in the
lips. Restylane is for superficial lines. Perlane, made by the same
manufacturer is for deeper lines. Visit their website
at Q med for more detailed information:
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Pre Restylane
Post Restylane
http://www.rePpREPREstylane.com/index2.asp?mid=12
Sculptra is a polymer of lactic acid and has been approved from the FDA
for use in reversing the soft tissue wasting seen in AIDS. It is effective
in filling in soft tissue defects in the face by attracting collagen, not by a
direct filling effect. It requires several treatments over a 3 to 6 month
period and results in a lasting (not permanent) filling of the defect
pre sculptra
post sculptra (4 treatments)
Artefill is a new permanent injectable filler that has
just become available in the U.S. It has been used very successfully
in Canada and Europe for several years. It is made up of Polymethylmethacrylate (PMMA) beads suspended in Bovine Collagen (as a
delivery system). Its allergenisity is low, but skin tests are suggested
as in zyderm use. The collagen component absorbs, but the beads of PMMA
are permanent. Tissue filling is incremental. Areas to be filled are
not overcorrected and repeat fillings after 2 to 3 months are suggested until the
desired results are obtained.
Allorderm is collagen in tissue form.
Specifically it is acellular human collagen. Treatment to remove all the
living cellular components of the tissue creates a relatively safe
implant. It has good bulk and has been used in lip enhancement, deep
creases, and post surgical defects. It often is completely absorbed within
six months, but occasionally can give a lasting result. Insertion is done
in a similar manner as the SAM implant, a minor surgical procedure.
CHIN (& OTHER FACIAL) IMPLANTS
Silastic and other non reactive materials are
used to make solid implants that most commonly are used to build up the chin as
a primary procedure, or to correct "witch's chin" deformities in the
aging face. These are very well tolerated. Chin implants,
especially, because of the thick pad of soft tissue that makes up the presenting
part of the chin, are not usually detectable by self palpation or by appearance
once healing has occurred. Any other defect of the skeleton of the face
can be helped with this type of implant, but most other areas have thinner skin
and the implants must be placed judiciously to prevent visible and palpable
abnormalities.
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