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Bovine collagen

• Brands: Zyderm I (for superficial wrinkles), Zyderm II (for moderate to deep wrinkles), and Zyplast (for deeper lines, deep acne scars, and lip augmentation). Zyplast lasts longer than Zyderm I and Zyderm II. Avoid Zyplast injection at vascular areas such as between the eye brows.
• Approximate longevity: 6 months.
• Description and use: bovine collagen has been used for injectable filler for about 30 years. Originally, bovine collagen was used to correct acne scars, pockmarks, and lipoatrophy. Later bovine collagen was for wrinkle correction and lip enhancement.
• Side effects: mainly allergic reactions. So skin tests are required. About 3% to 4% of people should not receive the injection because of allergic reactions. If the patient is not allergic to bovine collagen, other side effects are rare. Possible side effects include over-correction, inflammation, bruising, infection, and necrosis. So far two irreversible vision losses are reported.
• Requirements: skin tests are required before injection. About 3% to 4% of people develop erythema and swelling after the skin test. Because the reactions often do not show immediately after the first test, it is safer to have a second skin test 2 or 4 weeks after the first skin test even if there is no reaction after the first skin test.

Human-derived collagen

• Brands: Autologen, Cosmoderm, Cosmoplast, and Cymetra. Autologen is generally obtained and processed from the patient’s own skin. Cosmoderm I, Cosmoderm II and Cosmoplast are counterparts of Zyderm I, Zyderm II and Zyplast. Cymetra is micronized cadaveric-derived collagen.
• Approximate longevity: 4 to 7 months.
• Description and use: Human-derived collagen is produced in recent years to avoid the side effects that can be caused by bovine collagen.
• Side effects: even less than bovine collagen. Possible reactions include bruising, erythema and swelling.

Hyaluronic acid

• Brands: Hylaform, Restylane, Juvederm, Perlane, and Macrolane. Hylaform is produced from rooster combs. The other four are of nonanimal origin, produced from bacterial fermentation.
• Approximate longevity: 6 months.
• Description and use: hyaluronic acid is one of the components of the normal skin. It is able to capture large amount of water and acts as a free radical scavenger. The hyaluronic acid filler is used for filling wrinkles, soft tissue augmentation, correcting scars and facial lipoatrophy.
• Side effects: in theory there is no risk of an allergic reaction compared with collagen fillers but it may cause more swelling and bruising. These side effects, however, disappear in a few days and usually do not need any treatment.

Hyaluronic acid plus dextranomer microparticles

• Brands: Matridex and Reviderm intra.
• Approximate longevity: at least a year.
• Description and use: Hyaluronic acid plus dextranomer microparticles lasts longer than Hyaluronic acid. It has been used for wrinkle treatment and lip augmentation.
• Side effects: one case of red nodules growing on the treated skin 4 weeks after the injection of Matridex is reported.

Poly-L-lactic acid

• Brands: Sculptra and New-Fill.
• Approximate longevity: at least a year. After poly-L-lactic acid is degraded, the effect often lasts two years because poly-L-lactic acid also stimulates collagen production.
• Description and use: poly-L-lactic acid is generally used for correcting lipoatrophy and facial cosmetic augmentation.
• Side effects: about 30% to 40% patients develop nodules, which can last months or years without treatments. These nodules are often palpable but not visible. Short-term symptoms that last a few days include erythema, bruising, swelling, pain, inflammation, and itchiness, and these reactions happen frequently.

Calcium hydroxylapatite

• Brands: Radiance and Radiesse.
• Approximate longevity: at least a year.
• Description and use: calcium hydroxylapatite has a similar function to poly-L-lactic acid but causes almost no reaction. Calcium hydroxylapatite also stimulates collagen production and its texture resembles native soft tissue. The calcium hydroxylapatite filler is used for correction of lipoatrophy and smoothing moderate wrinkles.
• Side effects: almost none. If calcium hydroxylapatite is injected into lips, however, there is a high chance of developing nodules.

Paraffin

• Description: paraffin is no longer used as a filler because of its high incidence of side effects but some patients are still suffering from paraffin injections they got many years ago because paraffin injection is permanent.
• Approximate longevity: permanent.

Silicone

• Brands: brands of silicone oil are Silikon 1000 and Silskin; brands of silicone gel are MDX 4-4011 and Silastic.
• Approximate longevity: permanent.
• Description and use: silicone is the most studied filler, which can be used for correction of small wrinkles or scars and soft tissue augmentations, such as breast implants. More recently, it has also been used for facial lipoatrophy.
• Side effects: with time, silicone gel can move to a spot that is quite distant from where it was injected. At the sites of injections, patients might experience pain, erythema, bruise, different skin color, tissue hardening, inflammation, nodules and scars.

Polyvinylpyrrolidone-silicone suspension

• Brands: Bioplastique.
• Approximate longevity: permanent.
• Description and use: Polyvinylpyrrolidone-silicone suspension usually remains at the injected site and thus solves the migrating problem of silicone gel. It has been mostly used for the correction of facial wrinkles and lip augmentation.
• Side effects: the main reason why this filler is less likely to migrate is that the silicone particles in this suspension is larger. But because of that, it is more likely to give rise to serious foreign body reactions.

Polymethylmethacrylate (PMMA)microspheres in bovine collagen

• Brands: Artecoll, Arteplast, and Artefill.
• Approximate longevity: permanent.
• Description and use: bovine collagen is only used as a carrier. 80% of bovine collagen is gone in 1 to 3 months whereas PMMA microspheres can persist for at least several years. This filler has been used for the correction of facial wrinkles and furrows, perioral lines, lip and philtrum augmentation and scar revision.
• Side effects: a foreign body reaction, such as granulomas, generally appears from 6 to 24 months after the treatment, affecting about 0.6% of the patients. It can also emerge several years after the injection. To get the desired results, it is important for the doctor to make sure that the injection is neither too deep nor too superficial. One case of disfiguring facial swelling is reported after the use of Artecoll.
• Requirements: intradermal tests are required before the first use of this filler because bovine collagen induces allergy to about 3% to 4% of the population.

Ethylmethacrylate (EMA) and hydroxyethylmethacrylate (HEMA) particles in hyaluronic acid gel

• Brands: Dermalive and Dermadeep.
• Approximate longevity: permanent.
• Description and use: Hyaluronic acid is used as a carrier, which disappears in about 3 months, whereas EMA and HEMA particles persist for at least years. Dermalive has similar uses to Artecoll while Dermadeep is used to correct larger defects because it contains larger particles.
• Side effects: since the components are not from animals, allergy reactions are less probable than with Artecoll. Similar to Artecoll , it is important for the doctor to to make sure that the injection is neither too deep nor too superficial. Short-term side effects include redness, pain and swelling. Long-term side effects include tissue hardening, swelling, and nodules, which appear months after injection.

Polyacrylamide hydrogel

• Brands: Aquamid, Interfall, OutLine, Royamid, Formacryl, Argiform, Amazingel, Bio-Formacryl, and Kosmogel.
• Approximate longevity: permanent.
• Description and use: Polyacrylamide hydrogel has been used mostly in China, Ukraine, and the former Soviet Union for breast, buttock, and calf augmentation. More recently, it has been used in European countries for the treatment of facial lipoatrophy.
• Side effects: nodules, infection, and skin pigmentation. Extremely rare cases include bone erosion and facial ulceration. And it may delay the detection of breast cancer if used for breast augmentation.

Polyalkylimide gel

• Brands: Bio-Alcamid.
• Approximate longevity: permanent.
• Description and use: Polyalkylimide gel has been used for buttock augmentation, and the correction of lipoatrophy, irregularities after liposculpture, scar depressions, posttraumatic atrophy, pectus excavatum or other malformations of the skeleton.
• Side effects: swelling, bruising, nodules, and, in particular, infections, but no granulomas.

Polyvinylhydroxide microsphere in polyacrylamide gel

• Brands: Evolution.
• Approximate longevity: permanent.
• Description and use: Evolution is mostly used for lip augmentation.
• Side effects: none has been reported.

Conclusion

Side effects from a degradable impermanent dermal filler can go away with time but adverse results from permanent dermal fillers generally require surgery to remove. Not all side effects are caused by the filler materials. Quality products and correct procedures from a qualified doctor are extremely important to minimize any unwanted results. For pain reduction, seek for dermal fillers mixed with anesthetic solution, such as lidocaine.

Reference: “Adverse reactions to injectable soft tissue fillers”.