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[65]
months. [45,46] However, the augmentation effect lasts for at induce neocollagenesis in rabbit tissue. In Kim-Jongseo’s
least 24 months due to the neocollagenesis. [47] study, the PCL-based dermal filler was injected intra-dermally
in the temporal area in human tissue. The results revealed
Short-term adverse events, including swelling, bruising, that PCL-based filler is capable of inducing neocollagenesis
erythema, pain, inflammation, and pruritus, are frequently, for up to 13 months after injected intra-dermally in human
but they usually disappear in a few days. The rate of tissue. However, further clinically study and safety study
granuloma formation of Sculptra® has been reported should be introduced before it could be finally used as a
as high as 44%. The formation of granuloma greatly biostimulory filler in human. [62]
[48]
influences patient’s appearance. Treatment of granulomas
includes surgical excision and intralesional injection of Cross-linked CMC
corticosteroids. Surgical excision is not recommended Five-eight chemically cross-linked CMC is now available as skin
[49]
except as a last resort. The corticosteroids used to treat filler for the correction of facial defects and imperfections.
granulomas need to be injected repeatedly. [50,51] There are It was first used in the pharmaceutical industry since the
also severe systemic adverse effects, which is very rare, 1960s as an excipient and for drug delivery. A commercially
with only one case reported as an anaphylactic reaction available product based on cross-linked CMC is Erelle™
necessitating treatment interruption. [52] (Total Action, Bioitech Italy Ltd, Rome, Italy). It consists of
a non-particulate, viscoelastic, monophasic gel based on
CaHA cross-linked CMC in isotonic saline solution. One study of
CaHA is a biocompatible, biodegradable, resorbable and CMC injection in 350 patients with 3-year follow-up revealed
biostimulory filler that contains microspheres which can that CMC could effectively and durably correct nasolabial
stimulate the endogenous production of collagen. The wrinkles for 9-12 months. Product reapplication over
[66]
product has a texture resembling native soft tissue and a 36-month period did not lead to an increase in adverse
migration is minimal. Histopathologically, microspheres effects, which always remained rare and of little clinical
[53]
of CaHA stimulate almost no foreign body reaction and significance, usually consisting of bruising and redness.
[67]
they appear bluish in color and round or oval in shape. It However, further safety studies and clinical trials should be
is suggested that the microspheres of this implant are conducted be finally published in the market.
degraded by enzymatic breakdown rather than phagocytosis.
The microspheres appear packed together, with bluish color, Autologous fat
round or oval shape, 25 to 40 μm in size, and surrounded by Fat grafting is revolutionizing plastic surgery by providing
some fibrin fibers but little cellular infiltrate.
methodologies to less invasively transfer fatty tissue. The
initial attempts at soft-tissue augmentation revolved around
Initial augmentation is afforded by the implant itself, but
in a few months the palpable implant diminishes further in the surgical use of autologous fat to reconstruct facial scars
[68]
size and has disappeared clinically at 9 to 12 months. When in 1893. It then were largely used for nasolabial folds
macrophages begin to degrade the implant, new collagen injection, forhead augmentation, temporal augmentation,
[69]
may form around the CaHA microspheres. [54] breast augmentation, mid face lift. PRP and cell-assisted
lipotransfer using adipose-derived stem cells have recent
[70]
Injectable microspheres of CaHA have been successfully been developed to enhance the survival rate of fat grafting.
used for correction of lipoatrophy of HIV patients receiving There is certain inconsistent reabsorption rate and longevity
antiprotease treatment and for smoothing moderate lasts once the fat survives. [71-75] Adverse effects include
wrinkles. [55-59] When this agent is injected in the lips, it prolonged edema and ecchymosis which will fade several
tends to induce a high incidence of nodules. Migration days after injection. There is also a risk of necrosis and
[60]
[76]
to a distant location from the injection site, a foreign body infection. There are also vascular complications, which
granulomatous reaction, seen as blue-gray microspheres in may lead to vision loss and stroke after injection of fat into
the extracellular matrix or within multinucleated giant cells the glabella and nasolabial folds have been reported. [77,78]
has also been reported. [61] Proper injection technique is critical for fat injection.

Polycaprolactone-based dermal filler PERMANENT FILLERS
A promising new biodegradable collagen stimulatory filler,
composed of 70% aqueous carboxymethylcellulose (CMC) gel Permanent fillers include polymethyl-methacrylate (PMMA),
carrier (Ellans é™; Aqtis Medical, a Sinclair Company; Utrecht, silicone, polyacrylamide hydrogel, polyvinylpyrrolidone-
The Netherlands) and 30% synthetic polycaprolactone (PCL) silicone suspension, polyalkylimide gel, polyvinylhdydroxide
microspheres has recently been introduced to the market. microspheres suspended in polyacrylamide gel and others.
Its unique tuneable longevity gives the dermal filler variable Permanent fillers are non-resorbable and could provide
durations for up to 4 years [Ellans é™ -S (1 year), Ellans é™ -M long-lasting revolumization results. They could also induce
(2 years), Ellans é™ -L (3 years) and Ellans é™ -E (4 years)] and fibrogenesis and collagen production, but complications
is therefore ideal for those seeking long-lasting results. [62] such as granulomas are more frequent in subcutaneous
injection with such filler. [79]
The PCL-based dermal filler is proved to be safe and durable
in use in facial treatment and in hand rejuvenation in a Paraffins
clinical trial. [63,64] Furthermore, PCL-based dermal filler could Paraffins were initially used for aesthetic procedures to
Plast Aesthet Res || Vol 3 || Mar 23, 2016 95