Non-Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review

Abstract

There has been an increasing role in the use of injectable fillers for rejuvenation of the aging face. In this systematic review, we aim to evaluate the existing literature related to soft tissue fillers of the midface. Specifically, we focus on the non-hyaluronic acid fillers including polymethylmethacrylate (PMMA), poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and autologous fat. A systematic review was conducted in November 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with PubMed and Embase databases. Medical Subject Headings terms used were “cheek” OR “midface” OR “malar” and “filler” OR “poly-L-lactic acid” OR “calcium hydroxyapatite,” “autologous fat” OR “polymethylmethacrylate” OR “Artefill” OR “Bellafill” OR “Radiesse” OR “Sculptra.” The initial search identified 271 articles. After 145 duplicates were removed, 126 studies were screened for relevance by title and abstract. A total of 114 studies were eliminated based on inclusion and exclusion criteria. Twelve articles underwent full-text review. Seven articles were included in the final analysis consisting of four non-hyaluronic filler products: PMMA, PLLA, CaHA, autologous fat. Most patients were highly satisfied with their results. Due to the gradual volumizing effects of PMMA, PLLA, and CaHA, patient satisfaction generally improved over time. Minor adverse reactions related to treatment included bruising, swelling, and pain. Nodule formation was reported in PLLA and CaHA studies. For autologous fat, 32% of the original injection volume remained at 16 months post-treatment, which still provided clinically improved malar enhancement. Dermal fillers are an attractive treatment option for the aging face due to their high patient satisfaction, long-lasting effects, and low side-effect profile. Patients should be appropriately counseled on the delayed effects of non-HA fillers. Autologous fat is a good option in many patients with the major drawback of unpredictable longevity, which may require a secondary procedure. Future studies should examine the longevity and long-term side effects of these fillers.

Application of high‐frequency ultrasound in detection and identification of nasal filling injection materials

“…However, some studies have found that the monomer of polyacrylamide hydrogel is neurotoxic and the incidence of adverse reactions such as pain, deformity, and persistent swelling is high, 8 Food and Drug Administration in China has banned the use of Olmaxidine for medical treatment for more than 10 years; however, there are still a large number of people who are carriers of Olmeidine which exists potential risk. The main components of calcium hydroxyapatite‐based filler are mainly extracted from bones and teeth; therefore, it has high histocompatibility and is non‐toxic 9 . Calcium hydroxyapatite‐based filler is often used to fill moderate or severe facial wrinkles, 10 which is not easily displaced, and can stimulate fibroblast proliferation and collagen formation, improve skin quality, and the effect is stable and lasting.…”

Human dermal fibroblast response to hyaluronic acid-based injectable dermal fillers: an in vitro study

“…There are limitations to this study. We solely focused on HA-based IDFs and other types of soft tissue fillers based on different materials (e.g., polymethylmethacrylate, poly-L-lactic acid, and calcium hydroxyapatite) [22] were not included in our comparative analysis. Additionally, four biomarkers measured in our research (i.e., type I collagen, III collagen, elastin, and TGF-β1) were selected based on the existing knowledge about fibroblast response to IDFs; the remaining two markers (i.e., IL-1β and 8-OHdG) were included as indicators of inflammation and oxidative DNA damage, respectively.…”

Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

“…The AFIL is safe and with good efficacy for UVPF. The materials that had a longer duration with permanent (long-lasting) effects in the body include autologous fat, calcium hydroxylapatite (Radiesse), ArteSense, and particulate silicone [ 31 ]. Autologous fat is safe and widely accepted with fewer adverse effects such as umbilical herniation [ 32 ].…”