Soft Tissue Augmentation

(see Table 6-22)
  • Used for augmentation of soft tissue (i.e., lips, nasolabial folds) and wrinkles
  • Injectable fillers may be composed of hyaluronic acid, collagen, fat, calcium hydroxylapatite
  • Side effects/complications include but not limited to bruising, granuloma formation, hematoma and infection
   
 
   
     
  Three to five percent of the population have an allergy to bovine collagen  
     
          
Table 6-22 Injectable Fillers
 NameCompositionDuration
(months)
Level of implantationComments
 
Cosmoderm I
Human collagen + plain lidocaine
3–4 months
Superficial to mid-dermis
No pretesting, from neonatal foreskin
 
Zyderm I
Bovine collagen + lidocaine
3–4 months
Superficial to mid-dermis
+ Pretesting (two tests 2–4 weeks apart)
 
Autologen
Human collagen
(from pt’s own skin)
4–9 months
Mid-dermis
No pretesting
 
Hylaform
Hyaluronic acid (from rooster comb)
3–6 months
Mid-dermis
No pretesting
 
Restylane
Hyaluronic acid (from bacterial fermentation)
4–6 months
Mid-dermis
No pretesting
 
Zyderm II
Bovine collagen + plain lidocaine
3–6 months
Mid-dermis
+ Pretesting
 
Artecoll
Polymethylmethacrylate beads in bovine collagen suspension
Permanent
Deep dermis
+ Pretesting
 
Cosmoplast
Human collagen crosslinked w/ glutaraldehyde + plain lidocaine
3–4
Deep dermis
 
Hyaloform plus
Hyaluronic acid
(rooster comb)
3–6
Deep dermis
 
Perlane
Hyaluronic acid (bacterial fermentation)
3–9
Deep dermis
 
Zyplast
Bovine collagen crosslinked w/ glutaraldehyde + plain lidocaine
3–5
Deep dermis
+ Pretesting
 
Isolagen
Cultured autologous human fibroblasts
Unclear
Versatile
 
Juvederm
Hyaluronic acid
3–6
Dermis (level varies if ultra or plus)
 
Radiesse
Calcium hydroxylapatite microspheres in polysaccharide gel
9 months–5 years
Subdermal
Can be seen on
x-ray
 
New-Fill, Sculptra
Poly-L-lactic acid
24
Subdermal
FDA-approved for HIV-associated lipoatrophy
 
Alloderm
Acellular human cadaveric dermis
3–6
Subdermal implant
 
Autologous graft
Fat harvested from patient
6–24