Background: Dermal fillers are cosmetic injections that temporarily treat signs of aging.While hyaluronic acid (HA) fillers have been in forefront of the cosmetic industry, non-HA-based alternatives have increased in popularity over the past decade. Algeness is an agarose gel-based dermal filler marketed as a natural and biodegradable alternative to HA.
Background Radiesse is a calcium hydroxylapatite (CaHA)‐based filler first FDA‐approved in 2006 for the treatment of human immunodeficiency virus‐associated lipodystrophy and moderate to severe facial wrinkles, particularly the nasolabial folds. It has since expanded into new formulations and has been approved for jawline contouring and treatment of dorsal hand volume loss. CaHAs provide the basis of the filler's appeal, inducing biostimulation of stromal components including collagen, elastin, and vasculature. The carboxymethylcellulose gel carrier gives the filler its notoriously stiff volumizing effects, intended for deeper placement, typically in the subdermal and supraperiosteal planes. Since its inception, innovative efforts have been ongoing to take advantage of the filler's biostimulatory effects without its volumization. Objectives To describe novel uses of dilute, hyperdilute, and HA‐mixed CaHA filler. Methods A review was performed on current available literature and consensus guidelines. Conclusions Diluted and hyperdiluted Radiesse allow for widespread treatment, providing patients the dermal rejuvenation they desire, without the firm volumizing effects seen with undiluted product. This has led to an explosion in off‐label use including treatment of skin laxity of the face, neck and decolletage, arms, abdomen, buttocks, and thighs. Clinicians have also begun combining the CaHA filler with hyaluronic acid‐based fillers to induce skin regeneration while providing a more flexible and softer volume replacement. Radiesse' uses continue to evolve with alterations in the original formula, allowing for increasingly customized product to meet each patient's individual needs.
The advancement of dermal fillers has progressed from animal collagen extraction to a spectrum of recombinant DNA, nanotechnology, and biostimulation. Consumers now have a variety of fillers to choose from, including organic fillers composed of hyaluronic acid and calcium hydroxyapatite, as well as synthetic fillers made from poly‐l‐lactic acid and polymethylmethacrylate. This piece serves to add to the open dialogue discussing the prognosis, prospects, and potential pitfalls of dermal fillers. Expansion of product indications and technical alterations are currently changing the dermal fillers' landscape. The potential for new approaches to side effect mitigation or adjunct pigment modification is still exploratory. Furthermore, with social implications increasingly coming into frame, healthcare providers and companies seem geared toward developing effective, safe, and equitable products while maintaining a process of rigorous review and quality control processes. As such, future developments of this medical tool appear promising; fillers seem poised to imbue a role as dynamic as the tissues they were conceived to restore.
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