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Facial enhancements using dermal fillers
Clinics in Dermatology (2009) 27, S1–S2
Commentary
Facial enhancements using dermal fillers In recent years, the increasing health consciousness of society and a renewed emphasis on looking and feeling younger have led to an explosion of approaches to reverse the effects of aging on physical appearance. Nowhere are the effects of aging more telling than on the face. Aging causes fundamental changes in the skin, soft tissue, and skeletal support structures of the human face. Because of repeated sun exposure and intrinsic factors such as loss of hydration and collagen production, the skin loses its elasticity, which produces wrinkles and folds in the face and neck. In addition to dermal changes, aging leads to volume loss and redistribution of facial soft tissue, resulting in relative hollows under the eyes and cheeks and accumulation of skin near the brow, jaws, chin, and neck. Aging results in changes not only to the appearance and quality of the skin but also in the soft-tissue structures underlying the face. As a consequence, aesthetic correction of age-related changes in the face must address the appearance and quality of the skin as well as the underlying soft-tissue structural changes and volume loss characteristic of the aging process.
Various agents Agents designed to improve the appearance and quality of aged skin have been available for many years. These include sunscreens, moisturizers, α-hydroxy acids, and retinoid therapy. More recently, chemical peels as well as ablative and nonablative laser treatments have been added to the armamentarium. Age-related structural changes were traditionally corrected with surgery; however, the advent of dermal fillers, beginning with the United States Food and Drug Administration approval of bovine collagen for cosmetic use in 1982, has allowed less invasive corrective procedures with less recovery time. The most widely used primary components of dermal fillers include bovine and 0738-081X/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.clindermatol.2008.12.004
human collagens, hyaluronic acids, polymethylmethacrylate, and autologous fat. Although these agents produce satisfactory short-term or long-lasting cosmetic results, they are merely space-filling agents. The newer-generation dermal fillers not only restore volume in the face but also correct the changes in collagen synthesis and activity that underlie agerelated volume loss.
Contributors This supplement to Clinics in Dermatology reviews the use of dermal fillers in the emerging field of facial aesthetics. In the first contribution, my colleagues and I discuss the various agents available for correcting age-related changes in the quality and appearance of facial skin, as well as such structural changes as volume loss and soft-tissue redistribution in the face. These agents include chemical peels, nonablative and ablative laser therapies, botulinum toxin, collagen (bovine, human, and porcine), autologous fat, hyaluronic acids, calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate. In the second contribution, Tiffani K. Hamilton, MD, focuses on the newer-generation dermal fillers, which include calcium hydroxylapatite and injectable poly-L-lactic acid. These stimulatory dermal fillers correct facial volume loss through their space-filling capacity as well as by stimulating fibroblast activity, collagen synthesis, and softtissue growth. On the basis of her clinical experience as a cosmetic dermatologist, Dr. Hamilton provides an in-depth review of these agents and introduces novel injection techniques that allow these agents to be used to their full potential. The cosmetic results of facial rejuvenation procedures involving dermal fillers depend to a great extent on injection technique, including placement of the needle, depth of injection, choice of needle, angle of needle placement, and postinjection procedures.
S2 In the third and final contribution of this supplement, Richard N. Sherman, MD, explains appropriate injection techniques for all of the primary dermal fillers and outlines ways to avoid dermal filler complications such as papules, nodules, and skin infections. Judicious injection technique, along with careful attention to patient expectations, can help avoid complications and optimize cosmetic outcomes of facial rejuvenation procedures. This educational supplement has been developed to serve as an introductory guide for dermatologists entering the emerging field of facial rejuvenation and aesthetics. As patients increasingly seek noninvasive approaches to
Commentary facial enhancement with minimum recovery time, dermatologists should increase their awareness of dermal fillers and the appropriate use of these agents in facial rejuvenation procedures. Neil S. Sadick, MD Weill Cornell Medical College Cornell University Sadick Aesthetic Dermatology 911 Park Avenue New York, NY 10021, USA E-mail address: [email protected]
Commentary
Facial enhancements using dermal fillers In recent years, the increasing health consciousness of society and a renewed emphasis on looking and feeling younger have led to an explosion of approaches to reverse the effects of aging on physical appearance. Nowhere are the effects of aging more telling than on the face. Aging causes fundamental changes in the skin, soft tissue, and skeletal support structures of the human face. Because of repeated sun exposure and intrinsic factors such as loss of hydration and collagen production, the skin loses its elasticity, which produces wrinkles and folds in the face and neck. In addition to dermal changes, aging leads to volume loss and redistribution of facial soft tissue, resulting in relative hollows under the eyes and cheeks and accumulation of skin near the brow, jaws, chin, and neck. Aging results in changes not only to the appearance and quality of the skin but also in the soft-tissue structures underlying the face. As a consequence, aesthetic correction of age-related changes in the face must address the appearance and quality of the skin as well as the underlying soft-tissue structural changes and volume loss characteristic of the aging process.
Various agents Agents designed to improve the appearance and quality of aged skin have been available for many years. These include sunscreens, moisturizers, α-hydroxy acids, and retinoid therapy. More recently, chemical peels as well as ablative and nonablative laser treatments have been added to the armamentarium. Age-related structural changes were traditionally corrected with surgery; however, the advent of dermal fillers, beginning with the United States Food and Drug Administration approval of bovine collagen for cosmetic use in 1982, has allowed less invasive corrective procedures with less recovery time. The most widely used primary components of dermal fillers include bovine and 0738-081X/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.clindermatol.2008.12.004
human collagens, hyaluronic acids, polymethylmethacrylate, and autologous fat. Although these agents produce satisfactory short-term or long-lasting cosmetic results, they are merely space-filling agents. The newer-generation dermal fillers not only restore volume in the face but also correct the changes in collagen synthesis and activity that underlie agerelated volume loss.
Contributors This supplement to Clinics in Dermatology reviews the use of dermal fillers in the emerging field of facial aesthetics. In the first contribution, my colleagues and I discuss the various agents available for correcting age-related changes in the quality and appearance of facial skin, as well as such structural changes as volume loss and soft-tissue redistribution in the face. These agents include chemical peels, nonablative and ablative laser therapies, botulinum toxin, collagen (bovine, human, and porcine), autologous fat, hyaluronic acids, calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate. In the second contribution, Tiffani K. Hamilton, MD, focuses on the newer-generation dermal fillers, which include calcium hydroxylapatite and injectable poly-L-lactic acid. These stimulatory dermal fillers correct facial volume loss through their space-filling capacity as well as by stimulating fibroblast activity, collagen synthesis, and softtissue growth. On the basis of her clinical experience as a cosmetic dermatologist, Dr. Hamilton provides an in-depth review of these agents and introduces novel injection techniques that allow these agents to be used to their full potential. The cosmetic results of facial rejuvenation procedures involving dermal fillers depend to a great extent on injection technique, including placement of the needle, depth of injection, choice of needle, angle of needle placement, and postinjection procedures.
S2 In the third and final contribution of this supplement, Richard N. Sherman, MD, explains appropriate injection techniques for all of the primary dermal fillers and outlines ways to avoid dermal filler complications such as papules, nodules, and skin infections. Judicious injection technique, along with careful attention to patient expectations, can help avoid complications and optimize cosmetic outcomes of facial rejuvenation procedures. This educational supplement has been developed to serve as an introductory guide for dermatologists entering the emerging field of facial rejuvenation and aesthetics. As patients increasingly seek noninvasive approaches to
Commentary facial enhancement with minimum recovery time, dermatologists should increase their awareness of dermal fillers and the appropriate use of these agents in facial rejuvenation procedures. Neil S. Sadick, MD Weill Cornell Medical College Cornell University Sadick Aesthetic Dermatology 911 Park Avenue New York, NY 10021, USA E-mail address: [email protected]