The products used in the Fillers

In sequence we will present the products more used all over the world as Fillers. Naturale Clinic's doctors are continually researching and they participate in Congress and events around the country and abroad. They are updated and then, they are capable to choose the most appropriate Fillers products for each aesthetic alteration that their patients present.

            Restylane and Juvederm are modern products used as the Fillers for wrinkles. The base is the not animal Hialuronic Acid. He is not definitive and it only causes very rarely allergy. The results are very good but it should be repeated after on average of 6 months. They are the most indicated for lips and fine wrinkles. PMMA has been used now and it is the base of the new technique known like Bioplasty and it is very well accept, the results are more durable, staying by years. It is preferred for Bioplasty, correction of the Nose and deeper wrinkles and furrows.

There are several other products that have been used as Fillers for wrinkles on the face.  Every day a new product is offered to the doctors, showing the interest that this treatment type is taking.

            The Naturale Clinic always accompanies the emergence of new products to offer to the patients the best. However, we stand out about the importance that this treatment must be performed by doctors with experience in this area. The bad application performed can be disastrous.

            There are several available products, and they can be used in agreement with the patient's needs, the doctors' experience and the legislation of health and readiness of the products that is not the same in all the countries.

            The diversity of products demonstrates the great interest that this procedure, the Fillers, caused among patients and that it was transmitted to the chemical industry. This interest ended for producing a great amount of options. Only the doctors will be able to choose the best product for each situation, based on experience and in the patient's needs. In the list below there are some of the most known products used today and it’s followed with the comments about some Fillers.

PlasmaGel®

Proteins of the own patient's plasma treated with C Vitamin.

            It is a mixture derived of the own patient, an emulsion of the patient's plasma is prepared and treated with C Vitamin. The protein of the own patient's plasma is removed and mixed with vitamin C. The product can be injected again to obtain Fillers of tissues. It is not permanent, the obtained product lasts from 3 to 5 months, but a part stays as permanent Filler, about 7 or 10%. It doesn't cause allergies, because it is derived of the own patient.

Restylane®

Perlane®

Restylane Touch®

Restylane Dies Lines ®

Macrolane®

Hialuronic Acid

Laboratory Q - Méd Suécia

            It is a Hialuronic Acid that exists in 3 molecules sizes. With 10.000 molecules per ml, 100.000 per ml, and Perlane, with 500.000 per ml. Each molecular size is indicated for a different treatment, from the fine wrinkles to the Fillers of lips.

Hylaform ®

Hialuronic Acid

            It is a Hialuronic Acid of animal origin, obtained of rooster crest. As the other hialuronic acids is not permanent.

Juvederm ®

Hialuronic Acid

Laboratory:  L.E.A. Derm

            It is a Hialuronic acid with a not animal origin, available in 3 molecular sizes, 18, 24 and 30. As the other Hialuronic acids are not permanent. Juvederm 18 is used for fine wrinkles as around of the eyes and the perioral wrinkles. Juvederm 24 for medium wrinkles and furrows and Juvederm 30 for increase of lips and wrinkles and deeper furrows.

Rofilan Hylan Gel ®

Hialuronic Acid

            It is a Hialuronic acid with no animal origin. It is crossed with a natural acid, and their molecules has a larger size, 2,5 million Daltons, while most of the others have 1,5 million Daltons. Being expected a larger duration, but as the other Hialuronic acids it is not permanent.

Zyderm ®

Collagen

INAMED Aesthetics

            It is a Collagen of bovine origin and needs tests before the treatment, because the allergy risk. Although rare, it is real and it reaches from 1 to 4% of the patients. The test should be applied and waited from 4 to 6 weeks to observe the reaction. The applications are a little painful. There are two types, 1 and 2 and they are used for wrinkles and small and medium furrows.

Zyplast ®

Collagen

INAMED Aesthetics

            It is a Collagen of bovine origin and needs tests before the treatment, because of the allergy risk, although rare, it is real and it reaches from 1 to 4% of the patients. The test should be applied and to wait from 4 to 6 weeks to observe the reaction. The applications are a little bit painful. They are used for wrinkles and more pronounced furrows. 

 Restoplast ®

Collagen

            It is a Collagen of bovine origin and needs tests before the treatment, because the allergy risk, although rare, it is real. The test should be applied and waited from 4 to 6 weeks to observe the reaction. The applications are a little painful.

 CosmoDerm ®

Human Collagen

INAMED Aesthetics

            It is a Collagen of human origin and according to the manufacturer doesn't need tests before the treatment.  It is obtained at laboratory. It‘s elaborated with Lidocaine for larger comfort in the application.

CosmoPlast ®

Human Collagen INAMED Aesthetics

            It is a Collagen of human origin and according to the manufacturer it doesn't need tests before the treatment.  It is obtained at laboratory. It’s elaborated with Lidocaine for larger comfort in the application.

Bioplastique ®

Dimethyl-Siloxane

            It is a polymer consisting of phase gel, not permanent, the Polyvinilpirrolidone plasdone hydro gel, and a permanent phase, constituted of Dimethyl-Siloxane in a base of 38% of siloxane and 62% of absorbable part.

Its origin duration and allergy indications are described below.

Arteplast ®

Polymethyl methacrylate 

            It’s composed of micro spheres of suspended Polymethyl methacrylate in a gelatinous solution. In studies with mice, it has been demonstrated that re-absorption of the gelatin that was substituted by autogenous collagen happened. In this animal model they found migration of fibroblasts in 9 days and presence of new collagen in 3 weeks.

Artecoll ®

Polymethyl methacrylate 

            Artecoll, that consists of spheres of Polymethyl methacrylate   - PMMA, suspended in bovine collagen. In the base of 75% of a suspension of collagen to 3,5%, for 25% of PMMA, associated with Lidocaine to 0,3%. Because of the presence of bovine collagen, there is risk of allergic reactions, that it can be minimized with previous tests.

Metacrill ®

Polymethyl methacrylate 

            Micro spheres of PMMA, from 40 to 60 mµ, in colloidal vehicle the carboxi-gliconato hydrolytic of magnesium, form the implant Metacrill.

PMMA

Newplastic®

Polymethyl methacrylate 

Biomedical

            The polymethyl methacrylate was synthesized in 1902 and patented like Plexiglas in 1928 and used as orthopedic cement. It was used since 1950 as orthopedic cement, odontologic material, and intraocular lenses. Since 1991, it has been used as Fillers material.

It is radiolucent, extremely durable, and completely biocompatible. It is no carcinogenic and it presents low thermal and electric conductivity. Local side effects of the methacrylate application are rare. It is the implant that we prefer in Bioplasty at Naturale Clinic. PMMA is offered in concentrations of polymethyl methacrylate of 2%, 10% and 30%, in solution with a re-absorbable gel and local anesthetic.

History

            Neuber in 1883 was the first to use autolog fat for tissue increase. Gersuny, in 1899, was the first to use a bio-material to correct an aesthetic deformity. He injected paraffin in the scrotal bag of one patient's that had removed the testicles for tuberculosis treatment. Lexer treated a molar depression and a retrognatism with injectable implants, modifying the technique of Neuber, in 1910. Dimethyl-Siloxane began to be used still in the decades from 40 to 50 and only recently, the siloxane 350, received a certification in Europe, as Filler. 

            Ersek, R. described the ideals characteristics of a material for Tissue increase. The material should be bio-inert, permanent, with size of the particles large enough to impede migration, but small enough to allow implantation with a traumatic Cannulas, to have clear color, malleable after implantation but stable after molding, and it doesn't accumulate in other tissues. 

            Smaller particles than 60 mµ are susceptible to be fagocitated and transported to regional lymph nodes. Very small particles can stay indefinitely in the intracellular and the size is approximately the size of the macrophage (20 to 40 mµ) they cause the cellular death, they attract other phagocytes and they can unchain a chronic inflammatory process. It is desirable as soon as the particles of the injected material are larger than 60 mµ, because they are not susceptible to be fagocitated.

            The material presented by Ersek, R. was Bioplastique, a polymer consisting of a phase gel, not permanent, the Polyvinilpirrolidone plasdone hydro gel, and a permanent phase, constituted of polidimetilsiloxane in a base of 38% of Dimethyl-Siloxane and 62% of the absorbable part.

            The polymethyl methacrylate was synthesized in 1902 and patented like Plexiglas in 1928 and used as orthopedic cement. They were both used since 1950 as orthopedic cement, odontologic material, and intraocular lenses. Since 1991 it has been used as Filler material.

            It is radiolucent, extremely durable, and completely biocompatible. It is not carcinogenic and it presents low thermal and electric conductivity. Local side effects of the methacrylate application are rare.

            Lemperle G is described in 1991 the Arteplast that is composed of Micro spheres of suspended Polymethyl methacrylate in a gelatinous solution. In studies with mice, it has demonstrated that reabsorption of the gelatin that was substituted by autogenous collagen happened. In this animal model they found migration of fibroblasts in 9 days and presence of new collagen in 3 weeks. After deposition, the density of the new collagen progressively increased, resulting in an impairment of the space among the Microespheres, which possibly could take the loss of some volume of the correction with this material. It was not found phagocytosis even with spheres from 20 to 40 mµ, with a size theoretically susceptible for being fagocitated.

            In 1995, Lemperle G detailed results in humans with the use of Artecoll, which consists of micro spheres of PMMA from 20 to 40 mµ, suspended in bovine collagen. In the base of 75% of a suspension of collagen to 3,5%, for 25% of PMMA, associated with Lidocaine to 0,3%. Because of the presence of bovine collagen, there is risk of allergic reactions that can be minimized with previous tests. Lemperle describes that the injected collagen is fagocitated by macrophages in 1 to 4 months and each micro sphere of Polymethyl methacrylate is involved with autogenous collagen. The micro spheres would just serve as a stimulus for formation of connective tissue.

  Micro spheres of PMMA, from 40 to 60 mµ, in colloidal vehicle the hydrolytic with carboxi-gliconato of magnesium, form the implant Metacrill. 

            The polimetietacrilato presented by Nácul A, PMMA is offered in concentrations of polymethyl methacrylate of 2%, 10% and 30%, in solution with a reabsorbable gel and local anesthetic.