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Injectable soft tissue fillers: Temporary agents

Alastair Carruthers, FRCPC
Jean Carruthers, MD, FRCSC
Shannon Humphrey, MD, FRCPC, FAAD
Section Editors
Jeffrey S Dover, MD, FRCPC
Charles E Butler, MD, FACS
Deputy Editor
Abena O Ofori, MD


Soft-tissue fillers can be used alone or in combination with other aesthetic procedures to correct wrinkles and to restore tissue volume lost due to aging, lipoatrophy, or other causes. As opposed to permanent fillers, which persist indefinitely, temporary fillers are eventually resorbed by the body. Some agents, such as injectable collagen and hyaluronic acids, function primarily through a volume-filling effect. Others, including calcium hydroxylapatite and poly-L-lactic acid fillers, act as scaffolds for endogenous collagen formation.

The type of defect to be treated and the desired duration of effect influence the selection of a soft tissue filler (table 1). Regardless of which agent is selected, clinician familiarity with the product utilized is crucial; improper injection techniques result in poor cosmetic outcomes and an increased incidence of adverse effects. Although some adverse effects resolve spontaneously with time, other adverse effects (eg, tissue necrosis) may result in permanent sequelae, such as scarring.

The characteristics, efficacy, and adverse effects of several types of biodegradable soft tissue fillers will be reviewed here. An overview of the principles of the clinical use and complications of soft tissue fillers, as well as a discussion of permanent soft tissue fillers are available elsewhere. (See "Injectable soft tissue fillers: Permanent agents" and "Injectable soft tissue fillers: Overview of clinical use".)


Hyaluronic acid is a naturally occurring glycosaminoglycan that is an essential component of the extracellular matrix of the dermis. The molecule plays a key role in the maintenance of skin structure and function, and its high water-binding capacity is of value for the maintenance of moisture in the skin [1].

The injection of exogenous hyaluronic acid into the skin effectively reduces visible signs of volume loss, while simultaneously providing a natural look and feel after treatment. These features, plus a relatively low risk for adverse effects have made hyaluronic acid-based fillers the most commonly used injectable soft tissue fillers worldwide (table 1) [2]. Although the US Food and Drug Administration (FDA) has approved hyaluronic acid fillers only for the treatment of nasolabial folds, these products have been used for a variety of other indications, including marionette lines, glabellar rhytides, age-related volume loss in the dorsal hands, and augmentation of the lip, chin, and cheeks [3-5]. The clinical effects of treatment typically persist for 6 to 12 months (table 1) [6].


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Literature review current through: Sep 2016. | This topic last updated: Aug 12, 2016.
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  1. Beasley KL, Weiss MA, Weiss RA. Hyaluronic acid fillers: a comprehensive review. Facial Plast Surg 2009; 25:86.
  2. Bray D, Hopkins C, Roberts DN. A review of dermal fillers in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2010; 18:295.
  3. Hanke CW, Rohrich RJ, Busso M, et al. Facial Soft-Tissue Fillers conference: Assessing the State of the Science. J Am Acad Dermatol 2011; 64:S66.
  4. www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/GeneralandPlasticSurgeryDevicesPanel/UCM349459.pdf (Accessed on May 09, 2013).
  5. Cohen JL, Dayan SH, Brandt FS, et al. Systematic review of clinical trials of small- and large-gel-particle hyaluronic acid injectable fillers for aesthetic soft tissue augmentation. Dermatol Surg 2013; 39:205.
  6. Duranti F, Salti G, Bovani B, et al. Injectable hyaluronic acid gel for soft tissue augmentation. A clinical and histological study. Dermatol Surg 1998; 24:1317.
  7. Tezel A, Fredrickson GH. The science of hyaluronic acid dermal fillers. J Cosmet Laser Ther 2008; 10:35.
  8. Kablik J, Monheit GD, Yu L, et al. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg 2009; 35 Suppl 1:302.
  9. Pinsky MA, Thomas JA, Murphy DK, et al. Juvéderm injectable gel: a multicenter, double-blind, randomized study of safety and effectiveness. Aesthet Surg J 2008; 28:17.
  10. Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 2007; 143:155.
  11. Varani J, Schuger L, Dame MK, et al. Reduced fibroblast interaction with intact collagen as a mechanism for depressed collagen synthesis in photodamaged skin. J Invest Dermatol 2004; 122:1471.
  12. Lambert CA, Colige AC, Lapière CM, Nusgens BV. Coordinated regulation of procollagens I and III and their post-translational enzymes by dissipation of mechanical tension in human dermal fibroblasts. Eur J Cell Biol 2001; 80:479.
  13. Kessler D, Dethlefsen S, Haase I, et al. Fibroblasts in mechanically stressed collagen lattices assume a "synthetic" phenotype. J Biol Chem 2001; 276:36575.
  14. Kinney BM. Injecting Puragen Plus into the nasolabial folds: preliminary observations of FDA trial. Aesthet Surg J 2006; 26:741.
  15. Onesti M, Toscani M, Curinga G, et al. Assessment of a new hyaluronic acid filler. double-blind, randomized, comparative study between Puragen and Captique in the treatment of nasolabial folds. In Vivo 2009; 23:479.
  16. Matarasso SL, Carruthers JD, Jewell ML, Restylane Consensus Group. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg 2006; 117:3S.
  17. Carruthers J, Carruthers A, Maberley D. Deep resting glabellar rhytides respond to BTX-A and Hylan B. Dermatol Surg 2003; 29:539.
  18. Carruthers J, Carruthers A. A prospective, randomized, parallel group study analyzing the effect of BTX-A (Botox) and nonanimal sourced hyaluronic acid (NASHA, Restylane) in combination compared with NASHA (Restylane) alone in severe glabellar rhytides in adult female subjects: treatment of severe glabellar rhytides with a hyaluronic acid derivative compared with the derivative and BTX-A. Dermatol Surg 2003; 29:802.
  19. Bosniak S, Cantisano-Zilkha M, Glavas IP. Nonanimal stabilized hyaluronic acid for lip augmentation and facial rhytid ablation. Arch Facial Plast Surg 2004; 6:379.
  20. Carruthers J, Klein AW, Carruthers A, et al. Safety and efficacy of nonanimal stabilized hyaluronic acid for improvement of mouth corners. Dermatol Surg 2005; 31:276.
  21. Narins RS, Brandt F, Leyden J, et al. A randomized, double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds. Dermatol Surg 2003; 29:588.
  22. Carruthers A, Carey W, De Lorenzi C, et al. Randomized, double-blind comparison of the efficacy of two hyaluronic acid derivatives, restylane perlane and hylaform, in the treatment of nasolabial folds. Dermatol Surg 2005; 31:1591.
  23. Rao J, Chi GC, Goldman MP. Clinical comparison between two hyaluronic acid-derived fillers in the treatment of nasolabial folds: hylaform versus restylane. Dermatol Surg 2005; 31:1587.
  24. Baumann LS, Shamban AT, Lupo MP, et al. Comparison of smooth-gel hyaluronic acid dermal fillers with cross-linked bovine collagen: a multicenter, double-masked, randomized, within-subject study. Dermatol Surg 2007; 33 Suppl 2:S128.
  25. Narins RS, Dayan SH, Brandt FS, Baldwin EK. Persistence and improvement of nasolabial fold correction with nonanimal-stabilized hyaluronic acid 100,000 gel particles/mL filler on two retreatment schedules: results up to 18 months on two retreatment schedules. Dermatol Surg 2008; 34 Suppl 1:S2.
  26. Grimes PE, Thomas JA, Murphy DK. Safety and effectiveness of hyaluronic acid fillers in skin of color. J Cosmet Dermatol 2009; 8:162.
  27. Schweiger ES, Riddle CC, Tonkovic-Capin V, Aires DJ. Successful treatment with injected hyaluronic acid in a patient with lip asymmetry after surgical correction of cleft lip. Dermatol Surg 2008; 34:717.
  28. Bugge H, Negaard A, Skeie L, Bergersen B. Hyaluronic acid treatment of facial fat atrophy in HIV-positive patients. HIV Med 2007; 8:475.
  29. Denton AB, Tsaparas Y. Injectable hyaluronic acid for the correction of HIV-associated facial lipoatrophy. Otolaryngol Head Neck Surg 2007; 136:563.
  30. Bechara FG, Gambichler T, Brockmeyer NH, et al. Hyaluronic acid new formulation: experience in HIV-associated facial lipoatrophy. Dermatology 2008; 217:244.
  31. DeLorenzi C, Weinberg M, Solish N, Swift A. The long-term efficacy and safety of a subcutaneously injected large-particle stabilized hyaluronic acid-based gel of nonanimal origin in esthetic facial contouring. Dermatol Surg 2009; 35 Suppl 1:313.
  32. Skeie L, Bugge H, Negaard A, Bergersen BM. Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV-positive patients: 3-year follow-up study. HIV Med 2010; 11:170.
  33. Lindqvist C, Tveten S, Bondevik BE, Fagrell D. A randomized, evaluator-blind, multicenter comparison of the efficacy and tolerability of Perlane versus Zyplast in the correction of nasolabial folds. Plast Reconstr Surg 2005; 115:282.
  34. Lupo MP, Smith SR, Thomas JA, et al. Effectiveness of Juvéderm Ultra Plus dermal filler in the treatment of severe nasolabial folds. Plast Reconstr Surg 2008; 121:289.
  35. Moers-Carpi M, Vogt S, Santos BM, et al. A multicenter, randomized trial comparing calcium hydroxylapatite to two hyaluronic acids for treatment of nasolabial folds. Dermatol Surg 2007; 33 Suppl 2:S144.
  36. Moers-Carpi MM, Tufet JO. Calcium hydroxylapatite versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month, multicenter, prospective, randomized, controlled, split-face trial. Dermatol Surg 2008; 34:210.
  37. Levy PM, De Boulle K, Raspaldo H. Comparison of injection comfort of a new category of cohesive hyaluronic acid filler with preincorporated lidocaine and a hyaluronic acid filler alone. Dermatol Surg 2009; 35 Suppl 1:332.
  38. Levy PM, De Boulle K, Raspaldo H. A split-face comparison of a new hyaluronic acid facial filler containing pre-incorporated lidocaine versus a standard hyaluronic acid facial filler in the treatment of naso-labial folds. J Cosmet Laser Ther 2009; 11:169.
  39. Weinkle SH, Bank DE, Boyd CM, et al. A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine. J Cosmet Dermatol 2009; 8:205.
  40. Raspaldo H, De Boulle K, Levy PM. Longevity of effects of hyaluronic acid plus lidocaine facial filler. J Cosmet Dermatol 2010; 9:11.
  41. Brandt F, Bank D, Cross SL, Weiss R. A lidocaine-containing formulation of large-gel particle hyaluronic acid alleviates pain. Dermatol Surg 2010; 36 Suppl 3:1876.
  42. Lupo MP, Swetman G, Waller W. The effect of lidocaine when mixed with large gel particle hyaluronic acid filler tolerability and longevity: a six-month trial. J Drugs Dermatol 2010; 9:1097.
  43. Monheit GD, Campbell RM, Neugent H, et al. Reduced pain with use of proprietary hyaluronic acid with lidocaine for correction of nasolabial folds: a patient-blinded, prospective, randomized controlled trial. Dermatol Surg 2010; 36:94.
  44. Patel MP, Talmor M, Nolan WB. Botox and collagen for glabellar furrows: advantages of combination therapy. Ann Plast Surg 2004; 52:442.
  45. Prager W, Steinkraus V. A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero ® Basic versus Restylane ® for correction of nasolabial folds. Eur J Dermatol 2010; 20:748.
  46. Glogau RG, Kane MA. Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers. Dermatol Surg 2008; 34 Suppl 1:S105.
  47. Kono T, Kinney BM, Groff WF, et al. Randomized, evaluator-blind, split-face comparison study of single cross-linked versus double cross-linked hyaluronic acid in the treatment of glabellar lines. Dermatol Surg 2008; 34 Suppl 1:S25.
  48. Arlette JP, Trotter MJ. Anatomic location of hyaluronic acid filler material injected into nasolabial fold: a histologic study. Dermatol Surg 2008; 34 Suppl 1:S56.
  49. Greco TM, Elenitsas R. Localization and histological characterization of injected hyaluronic acid in excised nasolabial fold tissue. J Drugs Dermatol 2010; 9:399.
  50. www.accessdata.fda.gov/cdrh_docs/pdf11/p110033s018d.pdf (Accessed on August 12, 2016).
  51. www.galdermausa.com/IFU/Restylane_IFU.pdf (Accessed on August 12, 2016).
  52. Jordan DR. Soft-tissue fillers for wrinkles, folds and volume augmentation. Can J Ophthalmol 2003; 38:285.
  53. Requena L, Requena C, Christensen L, et al. Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1.
  54. Hirsch RJ, Narurkar V, Carruthers J. Management of injected hyaluronic acid induced Tyndall effects. Lasers Surg Med 2006; 38:202.
  55. Douse-Dean T, Jacob CI. Fast and easy treatment for reduction of the Tyndall effect secondary to cosmetic use of hyaluronic acid. J Drugs Dermatol 2008; 7:281.
  56. Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg 2009; 35 Suppl 2:1672.
  57. Lupton JR, Alster TS. Cutaneous hypersensitivity reaction to injectable hyaluronic acid gel. Dermatol Surg 2000; 26:135.
  58. Lowe NJ, Maxwell CA, Lowe P, et al. Hyaluronic acid skin fillers: adverse reactions and skin testing. J Am Acad Dermatol 2001; 45:930.
  59. Leonhardt JM, Lawrence N, Narins RS. Angioedema acute hypersensitivity reaction to injectable hyaluronic acid. Dermatol Surg 2005; 31:577.
  60. Matarasso SL, Herwick R. Hypersensitivity reaction to nonanimal stabilized hyaluronic acid. J Am Acad Dermatol 2006; 55:128.
  61. Patel VJ, Bruck MC, Katz BE. Hypersensitivity reaction to hyaluronic acid with negative skin testing. Plast Reconstr Surg 2006; 117:92e.
  62. Arron ST, Neuhaus IM. Persistent delayed-type hypersensitivity reaction to injectable non-animal-stabilized hyaluronic acid. J Cosmet Dermatol 2007; 6:167.
  63. Bisaccia E, Lugo A, Torres O, et al. Persistent inflammatory reaction to hyaluronic acid gel: a case report. Cutis 2007; 79:388.
  64. André P. Evaluation of the safety of a non-animal stabilized hyaluronic acid (NASHA -- Q-Medical, Sweden) in European countries: a retrospective study from 1997 to 2001. J Eur Acad Dermatol Venereol 2004; 18:422.
  65. Saylan Z. Facial fillers and their complications. Aesthet Surg J 2003; 23:221.
  66. Fernández-Aceñero MJ, Zamora E, Borbujo J. Granulomatous foreign body reaction against hyaluronic acid: report of a case after lip augmentation. Dermatol Surg 2003; 29:1225.
  67. Hönig JF, Brink U, Korabiowska M. Severe granulomatous allergic tissue reaction after hyaluronic acid injection in the treatment of facial lines and its surgical correction. J Craniofac Surg 2003; 14:197.
  68. Jordan DR. Delayed inflammatory reaction to hyaluronic acid (Restylane). Ophthal Plast Reconstr Surg 2005; 21:401.
  69. Edwards PC, Fantasia JE, Iovino R. Foreign body reaction to hyaluronic acid (Restylane): an adverse outcome of lip augmentation. J Oral Maxillofac Surg 2006; 64:1296.
  70. Ghislanzoni M, Bianchi F, Barbareschi M, Alessi E. Cutaneous granulomatous reaction to injectable hyaluronic acid gel. Br J Dermatol 2006; 154:755.
  71. Al-Shraim M, Jaragh M, Geddie W. Granulomatous reaction to injectable hyaluronic acid (Restylane) diagnosed by fine needle biopsy. J Clin Pathol 2007; 60:1060.
  72. Bardazzi F, Ruffato A, Antonucci A, et al. Cutaneous granulomatous reaction to injectable hyaluronic acid gel: another case. J Dermatolog Treat 2007; 18:59.
  73. Okada S, Okuyama R, Tagami H, Aiba S. Eosinophilic granulomatous reaction after intradermal injection of hyaluronic acid. Acta Derm Venereol 2008; 88:69.
  74. Mamelak AJ, Katz TM, Goldberg LH, et al. Foreign body reaction to hyaluronic acid filler injection: in search of an etiology. Dermatol Surg 2009; 35 Suppl 2:1701.
  75. Sage RJ, Chaffins ML, Kouba DJ. Granulomatous foreign body reaction to hyaluronic acid: report of a case after melolabial fold augmentation and review of management. Dermatol Surg 2009; 35 Suppl 2:1696.
  76. Alsaad SM, Fabi SG, Goldman MP. Granulomatous reaction to hyaluronic acid: a case series and review of the literature. Dermatol Surg 2012; 38:271.
  77. Beleznay K, Carruthers JD, Carruthers A, et al. Delayed-onset nodules secondary to a smooth cohesive 20 mg/mL hyaluronic acid filler: cause and management. Dermatol Surg 2015; 41:929.
  78. Artzi O, Loizides C, Verner I, Landau M. Resistant and Recurrent Late Reaction to Hyaluronic Acid-Based Gel. Dermatol Surg 2016; 42:31.
  79. Schanz S, Schippert W, Ulmer A, et al. Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol 2002; 146:928.
  80. Peter S, Mennel S. Retinal branch artery occlusion following injection of hyaluronic acid (Restylane). Clin Exp Ophthalmol 2006; 34:363.
  81. Hirsch RJ, Cohen JL, Carruthers JD. Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection embolus and a proposed algorithm for management with hyaluronidase. Dermatol Surg 2007; 33:357.
  82. Inoue K, Sato K, Matsumoto D, et al. Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers. Plast Reconstr Surg 2008; 121:127e.
  83. Burt B, Nakra T, Isaacs DK, Goldberg RA. Alar necrosis after facial injection of hyaluronic Acid. Plast Reconstr Surg 2010; 125:199e.
  84. Bachmann F, Erdmann R, Hartmann V, et al. The spectrum of adverse reactions after treatment with injectable fillers in the glabellar region: results from the Injectable Filler Safety Study. Dermatol Surg 2009; 35 Suppl 2:1629.
  85. D'Acunto C, Pazzaglia M, Raone B, et al. Xanthelasma palpebrarum: a new adverse reaction to intradermal fillers? Br J Dermatol 2013; 168:437.
  86. Brody HJ. Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement. Dermatol Surg 2005; 31:893.
  87. Soparkar CN, Patrinely JR, Tschen J. Erasing restylane. Ophthal Plast Reconstr Surg 2004; 20:317.
  88. Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthal Plast Reconstr Surg 2006; 22:335.
  89. Hirsch RJ, Brody HJ, Carruthers JD. Hyaluronidase in the office: a necessity for every dermasurgeon that injects hyaluronic acid. J Cosmet Laser Ther 2007; 9:182.
  90. Pierre A, Levy PM. Hyaluronidase offers an efficacious treatment for inaesthetic hyaluronic acid overcorrection. J Cosmet Dermatol 2007; 6:159.
  91. Vartanian AJ, Frankel AS, Rubin MG. Injected hyaluronidase reduces restylane-mediated cutaneous augmentation. Arch Facial Plast Surg 2005; 7:231.
  92. Lee A, Grummer SE, Kriegel D, Marmur E. Hyaluronidase. Dermatol Surg 2010; 36:1071.
  93. Andre P, Fléchet ML. Angioedema after ovine hyaluronidase injection for treating hyaluronic acid overcorrection. J Cosmet Dermatol 2008; 7:136.
  94. Menon H, Thomas M, D'silva J. Low dose of Hyaluronidase to treat over correction by HA filler--a case report. J Plast Reconstr Aesthet Surg 2010; 63:e416.
  95. Radiesse® injectable implant: Instructions for use. Franksville, WI: BioForm Medical, Inc; 2008.
  96. Marmur ES, Phelps R, Goldberg DJ. Clinical, histologic and electron microscopic findings after injection of a calcium hydroxylapatite filler. J Cosmet Laser Ther 2004; 6:223.
  97. Graivier MH, Bass LS, Busso M, et al. Calcium hydroxylapatite (Radiesse) for correction of the mid- and lower face: consensus recommendations. Plast Reconstr Surg 2007; 120:55S.
  98. Tzikas TL. A 52-month summary of results using calcium hydroxylapatite for facial soft tissue augmentation. Dermatol Surg 2008; 34 Suppl 1:S9.
  99. Smith S, Busso M, McClaren M, Bass LS. A randomized, bilateral, prospective comparison of calcium hydroxylapatite microspheres versus human-based collagen for the correction of nasolabial folds. Dermatol Surg 2007; 33 Suppl 2:S112.
  100. Tzikas TL. Evaluation of the Radiance FN soft tissue filler for facial soft tissue augmentation. Arch Facial Plast Surg 2004; 6:234.
  101. Cuevas S, Rivas MP, Amini S, Weiss E. Radiesse for aesthetic soft tissue augmentation. Am J Cosmet Surg 2006; 23:190.
  102. Jacovella PF, Peiretti CB, Cunille D, et al. Long-lasting results with hydroxylapatite (Radiesse) facial filler. Plast Reconstr Surg 2006; 118:15S.
  103. Jansen DA, Graivier MH. Evaluation of a calcium hydroxylapatite-based implant (Radiesse) for facial soft-tissue augmentation. Plast Reconstr Surg 2006; 118:22S.
  104. Alam M, Yoo SS. Technique for calcium hydroxylapatite injection for correction of nasolabial fold depressions. J Am Acad Dermatol 2007; 56:285.
  105. Sadick NS, Katz BE, Roy D. A multicenter, 47-month study of safety and efficacy of calcium hydroxylapatite for soft tissue augmentation of nasolabial folds and other areas of the face. Dermatol Surg 2007; 33 Suppl 2:S122.
  106. Sklar JA, White SM. Radiance FN: a new soft tissue filler. Dermatol Surg 2004; 30:764.
  107. Comite SL, Liu JF, Balasubramanian S, Christian MA. Treatment of HIV-associated facial lipoatrophy with Radiance FN (Radiesse). Dermatol Online J 2004; 10:2.
  108. Roth JS. Restorative approaches for HIV-associated lipoatrophy. PRS Notebook 2005; 10:24.
  109. Busso M, Karlsberg PL. Cheek augmentation and rejuvenation using injectable calcium hydroxylapatite (Radiesse). Cosmet Dermatol 2006; 19:583.
  110. Silvers SL, Eviatar JA, Echavez MI, Pappas AL. Prospective, open-label, 18-month trial of calcium hydroxylapatite (Radiesse) for facial soft-tissue augmentation in patients with human immunodeficiency virus-associated lipoatrophy: one-year durability. Plast Reconstr Surg 2006; 118:34S.
  111. Carruthers A, Carruthers J. Evaluation of injectable calcium hydroxylapatite for the treatment of facial lipoatrophy associated with human immunodeficiency virus. Dermatol Surg 2008; 34:1486.
  112. Marmur E, Green L, Busso M. Controlled, randomized study of pain levels in subjects treated with calcium hydroxylapatite premixed with lidocaine for correction of nasolabial folds. Dermatol Surg 2010; 36:309.
  113. Bass LS, Smith S, Busso M, McClaren M. Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results. Aesthet Surg J 2010; 30:235.
  114. Sankar V, McGuff HS. Foreign body reaction to calcium hydroxylapatite after lip augmentation. J Am Dent Assoc 2007; 138:1093.
  115. Reddy KK, Brauer JA, Anolik R, et al. Calcium hydroxylapatite nodule resolution after fractional carbon dioxide laser therapy. Arch Dermatol 2012; 148:634.
  116. Sung MS, Kim HG, Woo KI, Kim YD. Ocular ischemia and ischemic oculomotor nerve palsy after vascular embolization of injectable calcium hydroxylapatite filler. Ophthal Plast Reconstr Surg 2010; 26:289.
  117. Carruthers A, Liebeskind M, Carruthers J, Forster BB. Radiographic and computed tomographic studies of calcium hydroxylapatite for treatment of HIV-associated facial lipoatrophy and correction of nasolabial folds. Dermatol Surg 2008; 34 Suppl 1:S78.
  118. Valiyaparambil J, Rengasamy K, Mallya SM. An unusual soft tissue radiopacity--radiographic appearance of a dermal filler. Br Dent J 2009; 207:211.
  119. Alam M, Havey J, Pace N, et al. Large-particle calcium hydroxylapatite injection for correction of facial wrinkles and depressions. J Am Acad Dermatol 2011; 65:92.
  120. Sculptra® (injectable poly-L-lactic acid) Prescribing Information. Bridgewater, NJ: Dermik Laboratories; 2006.
  121. Valantin MA, Aubron-Olivier C, Ghosn J, et al. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS 2003; 17:2471.
  122. Moyle GJ, Lysakova L, Brown S, et al. A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med 2004; 5:82.
  123. Mest DR, Humble G. Safety and efficacy of poly-L-lactic acid injections in persons with HIV-associated lipoatrophy: the US experience. Dermatol Surg 2006; 32:1336.
  124. Borelli C, Kunte C, Weisenseel P, et al. Deep subcutaneous application of poly-L-lactic acid as a filler for facial lipoatrophy in HIV-infected patients. Skin Pharmacol Physiol 2005; 18:273.
  125. Burgess CM, Quiroga RM. Assessment of the safety and efficacy of poly-L-lactic acid for the treatment of HIV-associated facial lipoatrophy. J Am Acad Dermatol 2005; 52:233.
  126. Bodokh I, Simonet P. [Polylactic acid injections (Newfill) in the treatment of facial lipodystrophy in HIV-positive patients]. Ann Dermatol Venereol 2006; 133:429.
  127. Cattelan AM, Bauer U, Trevenzoli M, et al. Use of polylactic acid implants to correct facial lipoatrophy in human immunodeficiency virus 1-positive individuals receiving combination antiretroviral therapy. Arch Dermatol 2006; 142:329.
  128. Moyle GJ, Brown S, Lysakova L, Barton SE. Long-term safety and efficacy of poly-L-lactic acid in the treatment of HIV-related facial lipoatrophy. HIV Med 2006; 7:181.
  129. Carey DL, Baker D, Rogers GD, et al. A randomized, multicenter, open-label study of poly-L-lactic acid for HIV-1 facial lipoatrophy. J Acquir Immune Defic Syndr 2007; 46:581.
  130. Hanke CW, Redbord KP. Safety and efficacy of poly-L-lactic acid in HIV lipoatrophy and lipoatrophy of aging. J Drugs Dermatol 2007; 6:123.
  131. Levy RM, Redbord KP, Hanke CW. Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-L-lactic acid: a prospective 3-year follow-up study. J Am Acad Dermatol 2008; 59:923.
  132. Narciso P, Bucciardini R, Tozzi V, et al. Immediate versus delayed surgical intervention for reconstructive therapy of HIV-associated facial lipoatrophy: a randomized open-label study. AIDS Res Hum Retroviruses 2009; 25:979.
  133. El-Beyrouty C, Huang V, Darnold CJ, Clay PG. Poly-L-lactic acid for facial lipoatrophy in HIV. Ann Pharmacother 2006; 40:1602.
  134. Mest DR, Humble GM. Retreatment with injectable poly-l-lactic acid for HIV-associated facial lipoatrophy: 24-month extension of the Blue Pacific study. Dermatol Surg 2009; 35 Suppl 1:350.
  135. Beer K. A single-center, open-label study on the use of injectable poly-L-lactic acid for the treatment of moderate to severe scarring from acne or varicella. Dermatol Surg 2007; 33 Suppl 2:S159.
  136. Onesti MG, Troccola A, Scuderi N. Volumetric correction using poly-L-lactic acid in facial asymmetry: Parry Romberg syndrome and scleroderma. Dermatol Surg 2009; 35:1368.
  137. Sadick NS, Palmisano L. Case study involving use of injectable poly-L-lactic acid (PLLA) for acne scars. J Dermatolog Treat 2009; 20:302.
  138. Sadove R. Injectable poly-L: -lactic acid: a novel sculpting agent for the treatment of dermal fat atrophy after severe acne. Aesthetic Plast Surg 2009; 33:113.
  139. Vleggaar D, Bauer U. Facial enhancement and the European experience with Sculptra (poly-l-lactic acid). J Drugs Dermatol 2004; 3:542.
  140. Woerle B, Hanke CW, Sattler G. Poly-L-lactic acid: a temporary filler for soft tissue augmentation. J Drugs Dermatol 2004; 3:385.
  141. Vleggaar D. Facial volumetric correction with injectable poly-L-lactic acid. Dermatol Surg 2005; 31:1511.
  142. Salles AG, Lotierzo PH, Gimenez R, et al. Evaluation of the poly-L-lactic acid implant for treatment of the nasolabial fold: 3-year follow-up evaluation. Aesthetic Plast Surg 2008; 32:753.
  143. Lowe NJ, Maxwell CA, Lowe P, et al. Injectable poly-l-lactic acid: 3 years of aesthetic experience. Dermatol Surg 2009; 35 Suppl 1:344.
  144. Narins RS, Baumann L, Brandt FS, et al. A randomized study of the efficacy and safety of injectable poly-L-lactic acid versus human-based collagen implant in the treatment of nasolabial fold wrinkles. J Am Acad Dermatol 2010; 62:448.
  145. Palm MD, Woodhall KE, Butterwick KJ, Goldman MP. Cosmetic use of poly-l-lactic acid: a retrospective study of 130 patients. Dermatol Surg 2010; 36:161.
  146. Sculptra (injectable poly-L-lactic acid) Prescribing information. http://products.sanofi-aventis.us/sculptra/sculptra.html (Accessed on May 13, 2011).
  147. Sculptra Aesthetic (injectable poly-L-lactic acid) Prescribing information.http://products.sanofi-aventis.us/sculptra_aesthetic/sculptra_aesthetic.html (Accessed on May 13, 2011).
  148. Reszko AE, Sadick NS, Magro CM, Farber J. Late-onset subcutaneous nodules after poly-L-lactic acid injection. Dermatol Surg 2009; 35 Suppl 1:380.
  149. Barton SE, Engelhard P, Conant M. Poly-L-lactic acid for treating HIV-associated facial lipoatrophy: a review of the clinical studies. Int J STD AIDS 2006; 17:429.
  150. Narins RS. Minimizing adverse events associated with poly-L-lactic acid injection. Dermatol Surg 2008; 34 Suppl 1:S100.
  151. Wildemore JK, Jones DH. Persistent granulomatous inflammatory response induced by injectable poly-L-lactic acid for HIV lipoatrophy. Dermatol Surg 2006; 32:1407.
  152. Goldan O, Garbov-Nardini G, Regev E, et al. Late-onset infections and granuloma formation after facial polylactic acid (New-Fill) injections in women who are heavy smokers. Plast Reconstr Surg 2008; 121:336e.
  153. Alijotas-Reig J, Garcia-Gimenez V, Vilardell-Tarres M. Late-onset immune-mediated adverse effects after poly-L-lactic acid injection in non-HIV patients: clinical findings and long-term follow-up. Dermatology 2009; 219:303.
  154. Sclafani AP. Applications of platelet-rich fibrin matrix in facial plastic surgery. Facial Plast Surg 2009; 25:270.
  155. Sclafani AP. Platelet-rich fibrin matrix for improvement of deep nasolabial folds. J Cosmet Dermatol 2010; 9:66.