Primary goal: Fill in wrinkles and grooves caused by loss of natural dermal collagen and fat
Secondary goals: None
Special anatomy: None; used to fill out depressions around the eyes, between the brows, as well as on the rest of the face.
Anesthesia: None for bovine collagen; Autologen may require mild local anesthesia
Operative technique: A non-surgical technique. The tissue filler is placed into a syringe and injected through a needle into the middle of the dermis in the area of the skin depression. Multiple injections to achieve a layering effect may be used, as well as gentle massage to smooth out any obvious "beading".
Variations: Zyderm and Zyplast are preparations of bovine (cow) collagen, while Dermalogen is of human origin (donor skin from cadaver tissue banks) and Autologen is derived from the patient's own tissues. Fat is obtained by liposuction or direct excision from the patient's own tissues.
Advantages: Of the materials listed above, Autologen holds the most promise because of its lack of allergic reactions, no chance for transfer of a communicable disease, and its longer-lasting effect. The process to harvest and produce the product is involved and thus more expensive and requires preliminary planned removal of a sample of the patient's skin (usually during earlier surgery), which is then sent off for commercial processing to extract the natural collagen.
Limitations: Collagen of animal origin not only disappears rapidly (sometimes in one or two months), but also carries a relatively high chance of stimulating allergy. While Dermalogen is carefully tested for communicable disease, it is from a human donor source, which may not be ideal. Synthetic materials (silicone oil, Teflon paste, Gore-tex, etc.) are used rarely because of their tendencies to cause chronic inflammation, infection, and extrusion.
Care and recovery: None
Risks and complications: As noted above.
Comments: Autologen has been called the "next-generation ideal implant" for facial soft tissue augmentation. At present, however, the complexity of its harvesting and preparation will obviously limit use. It takes about six weeks to prepare but can then be stored for up to five years. Multiple treatments (2-5) are usually required to best fill out a defect, but the correction is long-lasting (four years or more).
Recently, there has been a surge of interest in injecting fat removed during liposuction into areas of facial depression, such as into furrows between the brows or the grooves between the nose and cheek. The biggest drawback to injecting fat is its highly unpredictable disappearance, ranging from almost none at all to 100%. We have seen several patients who suffered substantial distortion of the lower eyelids from fat injected into the area of slight hollowness between the lid and upper cheek. Because the fat pellets had become firmly incorporated into the eyelid and orbital tissues, removal was difficult and some contour irregularity persisted.
A whole new "crop" of European tissue fillers will soon be available in the United States. As with all such materials, each has its own set of advantages and disadvantages.
