Injectable soft tissue fillers: Permanent agents
- Alastair Carruthers, FRCPC
Alastair Carruthers, FRCPC
- Clinical Professor, Department of Dermatology and Skin Science
- University of British Columbia
- Jean Carruthers, MD, FRCSC
Jean Carruthers, MD, FRCSC
- Clinical Professor, Department of Ophthalmology and Visual Sciences
- University of British Columbia
- Shannon Humphrey, MD, FRCPC, FAAD
Shannon Humphrey, MD, FRCPC, FAAD
- Clinical Assistant Professor, Department of Dermatology and Skin Science
- University of British Columbia
- Section Editors
- Jeffrey S Dover, MD, FRCPC
Jeffrey S Dover, MD, FRCPC
- Section Editor — Cosmetic Dermatology
- Associate Clinical Professor of Dermatology
- Yale University School of Medicine
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
Soft tissue fillers are 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. In contrast to resorbable fillers such as hyaluronic acid, fillers that contain polymethylmethacrylate microspheres, silicone, or hydrogel polymers persist indefinitely in tissue. Cautious and conservative use of permanent fillers is essential, as improper injection techniques can lead to long-lasting adverse effects.
The efficacy, use, and adverse effects of permanent soft tissue filling agents will be reviewed here. Information on resorbable soft tissue fillers and an overview of the clinical use and complications of soft tissue fillers are available elsewhere. (See "Injectable soft tissue fillers: Temporary agents" and "Injectable soft tissue fillers: Overview of clinical use".)
Many patients can achieve cosmetically pleasing results with temporary fillers, and the decision to utilize a permanent filling agent should be considered carefully. In the event that a hyaluronic acid gel (a commonly used temporary filling agent) is placed incorrectly in tissue, the adverse cosmetic result can be rapidly corrected through the administration of hyaluronidase or can be left to spontaneously resolve over the course of several months as the filler is degraded. In contrast, unfavorable cosmetic results following misplacement of permanent fillers may require surgical intervention and may be difficult or impossible reverse. (See "Injectable soft tissue fillers: Temporary agents", section on 'Reversal'.)
Additionally, use of a filling agent with a limited duration of effect provides the clinician with the flexibility to respond to changes in patient preferences and allows the clinician to adjust the placement of fillers in concordance with the cutaneous and structural changes that occur with age over time. Thus, patients who desire treatment with permanent filling agents must be screened carefully. Patients who are unsure of their desired outcomes, who have a history of unsubstantiated poor satisfaction with cosmetic treatments, or who are new to the use of soft tissue fillers are poor candidates for treatment with permanent agents.
As with semipermanent filling agents, blindness can occur if embolization of a permanent filler substance inhibits perfusion of the central retinal branch of the ophthalmic artery. Most reported cases of blindness following use of a permanent filler have involved autologous fat injections; however, cases of blindness following injection of polymethylmethacrylate microspheres and liquid silicone also have been reported [1,2]. (See "Injectable soft tissue fillers: Overview of clinical use", section on 'Early adverse effects' and "Central and branch retinal artery occlusion".)
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- POLYMETHYLMETHACRYLATE MICROSPHERES
- Mechanism of action
- Adverse effects
- HYDROGEL POLYMERS
- Polyacrylamide hydrogel
- - Mechanism of action
- - Efficacy
- - Use
- - Adverse effects
- Polyalkylimide hydrogel
- - Mechanism of action
- - Efficacy and use
- - Adverse effects
- LIQUID INJECTABLE SILICONE
- Mechanism of action
- Efficacy and safety
- AUTOLOGOUS FAT
- SUMMARY AND RECOMMENDATIONS