الفهرس 
Aging of the skinOnly 14 pages are availabe for public view
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Abstract
Dermal fillers have revolutionized the field of cosmetic dermatology. With the aging of baby boomers, dermal fillers have become a sought-after rejuvenation procedure as they offer a youthful, three-dimensional look with minimal downtime.
Dermal fillers are substances used in soft tissue augmentation to enhance or replace volume that is lost in any part of the skin or subcutaneous fat. Fillers form an effective tool in rejuvenation, either as a stand-alone treatment or in combination with other procedures such as Laser resurfacing or botulinum toxin.
Fillers can be classified either on the basis of longevity in tissues, or site of placement or filler material origin. Temporary fillers are those which stay in the tissue for less than a year as collagen (Human and porcine) and HA, semipermanent fillers stay for up to 1-2 years (e.g., CaHA and PLLA) while permanent fillers are substances that remain in the tissue more than two years as (silicon and PMMA). On the basis of site of placement fillers can be classified in to dermal, subdermal and supraperiosteal. On the basis of the filler material origin to Heterograft, Allograft, Autograft and Synthetic material.
Silicone preparation is clear, colorless, odorless, and has an oily aspect. Liquid injectable silicone is a permanent soft tissue filler that is injected into the deep dermis or subdermal plane to produce fibroplasia and a gradual increase in tissue volume. Use of large quantities of impure silicone has led to a number of serious complications including migration of the product, cellulitis and even death.
Bovine collagen was the first filler available and included the formulations of Zyderm® and Zyplast® which characterized by giving natural appearance and little swelling but had the disadvantages of being in need to two skin sensitivity tests and short acting.
Human collagen (Cosmoderm® and Cosmoplast®); were introduced to eliminate the need for allergy testing. All of the collagen products have clinical effects lasting from 1 to 4 months. The main clinical advantage of the human collagen products is their ability to correct the most superficial lines with smooth flow characteristics as their carrier is phosphate-buffered saline.
Porcine collagen (Evolence and Evolence Breeze) characterized by being versatile, no skin sensitivity tests and relatively long lasting but they are painful to inject.
There are many types of hyaluronic acid dermal fillers most of them are bacteria derived (Restylan, Perlane, Captique, Juvederm ultra, Juvederm ultra plus, Purgan, pervelle, Elevess and pervelle silk) the last two types contain anaesthesia while Hyaloform and Hyaloform plus were derived from avian sources. they need no skin testing and having the characters of hyaluronic acid.
Hyaluronic acid fillers are popular because they offer an excellent balance of efficacy, safety, and duration of cosmetic benefit and have the unique advantage of reversibility.
Hyaluronic Acid fillers can easily be removed whenever the practitioner considers necessary by injecting commercially available hyaluronidase into the concerned area.
Synthetic facial fillers are composed of a biosynthetic polymer (e.g., poly-l-lactic acid (PLLA) e.g Sculptra (Table 11), calcium hydroxylapatite(CaHA) e.g Radiess, polymethyl-methacrylate (PMMA)e.g Artefill ) cmbined with differing injectable carriers, including hydrogels, beads and liquids.
The use of autologous fat has been advocated for tissue augmentation for over a century. The best donor sites are the thighs, buttocks, medial knees, and abdomen. The physician must remove the fat atraumatically with a machine-assisted syringe or by hand.
Fillers are mainly used in the rejuvenation of facial areas as in facial lines (wrinkles, folds), lip enhancement, facial deformities, depressed scars, periocular melanoses, sunken eyes, dermatological diseases as angular cheilitis, scleroderma, AIDS lipoatrophy, Nasal depressions, post acne scars and chicken pox scars or in non facial areas as in neck, corns and calluses to reduce pain and risk of ulcer formation.
Contraindications of dermal fillers are generally rare they include absolute as hypersensitivity to products or un realistic expectations, or relative as keloidal tendency or patient with autoimmune disease.
The choice of the injection technique depends on the indication, its location, the filler substance, size of the needle and the experience of the injector.
The commonly techniques include: Linear threading technique at which the needle is inserted into the defect and tunneled through at the appropriate depth. Serial puncture at which the skin is held taut then the product is delivered in a small bolus to fill the defect. Fanning technique similar to the threading technique, but the direction of the needle is continually changed in a radial fashion and cross-hatching technique involves a series of threads injected in a perpendicular fashion to each other.
Patients should be asked to avoid extreme cold or heat for 48 hours. Massaging of the treated area and strenuous physical activity should be avoided for six hours. Patients are asked to sleep with their heads elevated for one night; skin care routine may be followed after 24 hours.
The ideal filler should be characterized by being Safe, non-immunogenic, non-carcinogenic, non-teratogenic, non-infectious and have low abuse potential, look and feel natural and show reproducible long-term benefit, It should be cost-effective, easy to use, and removable (or self-remitting) if required or desired.
Temporary fillers have fewer complications and transient adverse effects when compared to semipermanent and permanent fillers. Adverse effects could be injection-related or filler material-related and may appear either immediately or later,they include erythema-transient or permanent, hypersensitivity reactions, haematomas and ecchymoses, pain, infections, reactivation of herpes simplex, Nonhypersensitivity-related swelling, acneiform eruptions, skin necrosis, embolism (blindness), Tyndall effect.implant migration, inflammatory, nodules, telangectasia, granuloma, lipotrophy, the treatment of complications should be aggressive and initiated as soon as possible after occurrence.