Arun K Garg - Dermal Fillers for Dental Professionals

References

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2.Dayan SH, Bassichis BA. Facial dermal fillers: Selection of appropriate products and techniques. Aesthetic Surg J 2008;28:335–347.

3.Smith KC, Comite SL, Balasubramanian S, Carver A, Liu JF. Vibration anesthesia: A noninvasive method of reducing discomfort prior to dermatologic procedures. Dermatol Online J 2004;10:1.

4.Zeiderman MR, Kelishadi SS, Tutela JP, et al. Vapocoolant anesthesia for cosmetic facial rejuvenation injections: A randomized, prospective, split-face trial. Eplasty 2018;18:e6.

5.Nestor MS, Ablon GR, Stillman, MA. The use of a contact cooling device to reduce pain and ecchymosis associated with dermal filler injections. J Clin Aesthet Dermatol 2010;3:29–34.

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Dermal Filler Selection

A cardinal rule in dentistry also applies to esthetic facial rejuvenation with fillers: Product selection is key to achieving successful results. Yet, there are dozens of filler products for practitioners to choose from, including some autologous agents. A survey of the dermal filler landscape, including a brief history of its evolution, will give the novice esthetic practitioner a bird’s-eye perspective of how the field developed, along with a ground-level understanding of how to quickly navigate the market and make informed choices.

Dermal Filler Classifications

Dermal fillers can be classified in terms of longevity, biodegradability, and mechanism of action.

Longevity

Facial dermal fillers are usually described as short-acting, long-acting, or “permanent,” but there is wide latitude in how these terms are defined. Generally speaking, a short-acting filler can be expected to last up to 1 year, a long-acting filler up to 2 years, and a filler labeled as permanent (an obvious misnomer) for 5 years or more. 1,2In most discussions, duration of effect of a given product is a relative concept that makes reference to other products as the standard of comparison.

Biodegradability

Biodegradability, which has a major impact on a product’s longevity, is another classification that strays into gray territory. 3,4A product or agent can be labeled as (1) a biodegradable filler, (2) a filler with biodegradable particles, or (3) a nondegradable filler. Biodegradable fillers are fully reabsorbed by the body and are consequently short-lived. Fillers with biodegradable particles act by stimulating a response in the body to produce its own collagen before resorbing, which results in a longer-lasting effect. Nondegradable fillers are dual-acting: They induce a foreign-body reaction that stimulates the deposition of new collagen, but the nondegradable particles ultimately become permanently integrated into the connective tissue of the skin.

Mechanism of action

As the discussion of biocompatibility suggests, fillers can also be classified according to their mechanism of action. 5,6In this category, a distinction is made between a volumizer , which is a filler that achieves its effect by taking up space (giving added importance to the amount of product injected), and a stimulator , one that in some way induces the body to produce new collagen. Again, some products fit neatly into one of these two categories, while others fall somewhere in between.

As with dental treatments, a one-size-fits-all approach to facial augmentation will not yield optimal results. As dermal filling options continue to expand and evolve, the clinician must understand the unique properties and characteristics of each product and apply that knowledge to developing an individual treatment plan for each patient. Box 3-1lists the qualities of an ideal filler product in terms of its safety, effectiveness, and convenience. 7–9The remainder of this chapter explains how each agent available is classified and measures up to the qualities of an ideal filler. For convenience, the discussion proceeds from short-acting to long-acting to permanent fillers, which—not coincidently—corresponds to the order in which they evolved.

BOX 3-1Properties of the ideal dermal filler

Safety

Nonimmunogenic

Noncarcinogenic

Nonteratogenic

Noninfectious

Efficacy

Long-term benefit

Natural feeling

Nonmigratory

Reproducible results

Practicality

Cost-effective

Easy to use

FDA-cleared

Removable or reversible

Long shelf life

As in dentistry, many products are used off-label by experienced dermatologists; the present discussion is restricted to those that have been cleared by the U.S. Food and Drug Administration (FDA) for specific facial cosmetic indications (Fig 3-1 and Table 3-1). 10

FIG 3-1Dermal filler products have been FDA cleared for specific treatments but are often used off-label in other areas of the face. (Adapted from the American Society of Plastic Surgeons. 10 )

TABLE 3-1Dermal fillers approved by the FDA for use in the United States

Short-Acting Fillers