Dermal Fillers: Types, Indications, and Complications

Abstract

There are many types of dermal fillers currently used for cosmetic and medical indications in routine clinical practice. Fillers can be classified as temporary, semipermanent, or permanent depending on the length of time the substance remains in tissue. They can also be classified by the composition of the product. Materials can be based on collagen (bovine, porcine, and human), hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, polymethal methacrylates, and polyacrylamide gels, among others. Temporary fillers are the products most often used for cosmetic purposes, in particular hyaluronic acid. This is due to the ease of application of fillers based on this substance, the good results obtained, and their safety profile. This review presents an overview of the techniques used for the correct placement of dermal fillers and the most common clinical indications for these procedures. It also covers the nature, properties, and mechanisms of action of the principal temporary, semipermanent, and permanent dermal fillers as well as the indications for each type of material. Finally, we describe the most common complications encountered and their treatment.

Development and characterization of hyaluronic acid-lysine nanoparticles with potential as innovative dermal filling

“…Different types of filler agents are used as cosmetic strategy in order to prevent or reverse loss of extracellular matrix (Sánchez-Carpintero, Candelas, Ruiz-Rodrígues, 2010). The most common fillers reported in literature and clinically used are as follows: collagen (bovine, porcine or human), synthetic or animal hyaluronic acid (HA), poly(L-lactic acid), calcium hydroxyapatite, poly(methyl methacrylate), silicon, and hydroxyethyl methacrylate (Sánchez-Carpintero, Candelas, Ruiz-Rodrígues, 2010).…”

“…The most common fillers reported in literature and clinically used are as follows: collagen (bovine, porcine or human), synthetic or animal hyaluronic acid (HA), poly(L-lactic acid), calcium hydroxyapatite, poly(methyl methacrylate), silicon, and hydroxyethyl methacrylate (Sánchez-Carpintero, Candelas, Ruiz-Rodrígues, 2010). In that context, HA has become more popular and widely used as soft tissue filler due to its major advantages (Edwards, Fantasia, Iovino, 2006;Requena et al, 2011).…”

Ischemical Problems after Filler Injections: Anatomical Details and Practical Guide Lines to Avoid Disasters

“…National Library of Medicine's PubMed database was utilized to have an overview of the effi cacy, safety and outcomes and to fi nally fi nd out the optimal use of hyaluronidase.  Use hyaluronic acid based product that is a temporary and biodegradable product and can be in part break down by hyaluronidase [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…There are few cases reported in which only with this shrewdness doctors solved the cases  If the massage is not enough apply hot/warm water gauze and topical 2% nitroglycerin paste to stimulate quick vasodilation and restore blood supply [27], to the affected area as frequently as every 1 to 2 hours initially and disburse the bulk of the fi ller material respectively [28].…”

“…When potent vasoactive drugs are used, the patient shoul be carefully monitored in the hospital [15]. Even if patient presentation is delayed, treatment is still recommended because it may restore normal circulation and speed the healing process [34][35]  Oral prednisone, 20 to 40mg daily, for three to fi ve days is recommended because it helps to decrease the infl ammatory component of the injury and prevent further vascular compromise [27][28]  If necrosis is progressive and not responsive to the above treatments, hyperbaric oxygen therapy should be considered [36]  Of note, topical oxygen therapy, low molecular weight heparin, systemic steroids, sildenafi l, plateletrich plasma, fi ller removal through puncture and intravenous prostaglandin are reported to be benefi cial [15-35-37-38]  Localized skin breakdown should be treated with topical (with or without systemic) antibiotics, and antivirals should be used especially if necrosis is around the mouth [8][9]  Also adipose-derived stem cell injection to boost the healing process and tissue regeneration promoting angiogenic processes. However, exact mechanisms are not yet come out into the open [39]  Keeping the wound covered with ointment to prevent crusting and keeping out bacteria until healing is complete is important.…”