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from PART THREE - FILLERS AND NEUROTOXINS
Published online by Cambridge University Press: 06 July 2010
Fillers
Better fillers will become available for clinical use, and they should accomplish the golden rule of absolute safety (but this corresponds to the perfect filler, which is yet to be discovered). Available products correct wrinkles and provide volume and have the advantage of off-the-shelf use and no donor site morbidity, but their longevity and side effects still cannot be guaranteed. The perfect filler should be safe, autogenous, dynamic, resistant to the aging process, and long lasting or permanent, with no immunologic or toxic effects.
We have classified fillers in the following way:
transient, with a duration up to eighteen months
long lasting or semipermanent, with a duration up to or more than five years
permanent
As to their origin, they can be derived by one of the following means:
Fillers can be animal-derived collagen products (Zyderm/Zyplast, Inamed/Aesthetics) with transient results. These were available for some years in Chile, but surgeons were reluctant to conduct the required allergy tests, by which they feared to lose patients.
Fillers can be allogenic human collagen products (Cosmoderm/Cosmoplast, Inamed/Aesthetics; Alloderm as a decellularized dermal allograft, Cymetra, LifeCell Corp.; preserved-bank fascia lata, Fascian, Fascia Biosystems) with long-lasting results, but these are very expensive, and expense is the most likely reason why they have little popularity in South America.
Fillers can be synthetic materials that derive from fermentation of a bacterial strain streptococcus, giving stabilized hyaluronic acid of nonanimal origin (Restylane/Perlane, Q-Med; Captique, Inamed/Aesthetics; Puragen, Mentor; Juvéderm, Leaderm; Teosyal, Belotero, Varioderm, Rofilan, Esthelis, and others). All have only transient results and are extensively used in South America, but our patients think that they could last longer based on the cost-effect concept (their cost being higher than the cost of collagen-based materials).
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