Arun K Garg - Dermal Fillers for Dental Professionals

Permanent Fillers

The “holy grail” among dermal filler manufacturers is a product that boasts the safety profile of HAs but without resorption, and promises a permanent (5+ years) improvement in facial appearance. Today, only one agent has been shown to approach that ideal.

Polymethylmethacrylate

To date, the only “permanent” filler material approved by the FDA is composed of polymethylmethacrylate (PMMA), a nonbiodegradable, biocompatible, synthetic polymer that is also used in various medical materials and devices, including dental prostheses. A PMMA dermal filler is made of tiny microspheres carried in a collagen gel. When injected, it initiates a foreign-body reaction that eventually leads to the production of new collagen. The collagen carrier provides immediate volume and lift in the short term, while the nonbiodegradable PMMA microspheres have a long-term “bulking” effect. 20

Bellafill (Suneva Medical) was the first (and so far only) PMMA dermal filler to be FDA cleared (under a different trade name) for the correction of folds and wrinkles (Fig 3-12). It consists of 20- to 50-µm microspheres of PMMA suspended in a bovine collagen gel carrier, which acts as a glue, preventing the microspheres from clumping and allowing for new tissue ingrowth. Because the collagen is derived from an animal source, skin allergy testing is required 4 weeks prior to treatment. The collagen carrier is absorbed within 1 month of injection and replaced by the patient’s connective tissue within 3 months. 21 The inherent downside to a “permanent” filler is that it is less forgiving when mistakes are made or complications arise.

FIG 3-12Bellafill is a unique, dual-acting dermal filler indicated for deep folds in the midface and lower face and to treat moderate to severe pitted atrophic facial acne scars. Composed of sterile PMMA microspheres suspended in a purified bovine collagen gel carrier, it works by adding both immediate lift from the collagen and long-term (up to 5 years) volume correction from the production of new collagen supported by the microsphere matrix. Because it contains bovine collagen, a skin test is required before use.

Conclusion

Understanding the active components in dermal fillers and their properties allows clinicians to make informed decisions about the products that are currently available and new ones on the horizon. Obviously, clinical factors are equally important. When selecting a dermal filler product, key factors include treatment area, degree of volume loss, and longevity. Furthermore, the rheologic properties of each dermal filler material narrow its applicability. In general, a thinner, more supple filler is used for minor rhytids, lips, scars, and frown lines, while a structure-oriented filler is best for high-volume-loss rhytids, chins, and malar regions. All of these qualities are discussed in detail in later chapters, which cover the step-by-step injection procedures, beginning with the esthetic consultation.

References

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