M. Goisis (editor) - Injections in aesthetic medicine. Atlas of full-face and full-body treatment

Mario Goisis (Corresponding author)

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In the 1960s, liquid silicone injection became a popular cosmetic treatment []. Like paraffin, silicone is an inert, clear, oily substance that is easily injected and, unfortunately, had similar disastrous sequelae. Silicone, a polymer of dimethylsiloxanes, was first used in Japan during the 1940s for breast augmentation. This practice spread to the United States (California, Texas and Nevada), in 1965, Dow Corning developed a purified silicone that could be used for injection, called MDX44011. In subsequent years, it was noted that the injected silicone would migrate and fistulize, and it had resulted in several deaths. Some patients with severe complications required mastectomies. Because of the complications encountered in the Las Vegas showgirls injected with silicone, Nevada was the first state to ban the use of injectable silicone. In 1964, Weiner coined the term siliconoma to describe the soft tissue granuloma that developed from injected silicone. These disfiguring inflammatory responses could sometimes be seen decades after silicone had been injected. Although medical-grade silicone was also used to treat facial wrinkles and augment the lips, the U.S. Food and Drug Administration (FDA) considered it an investigational device and never approved silicone for cosmetic use. In 1964, the FDA regulated the use of injectable silicone as a drug, and the Medical Device Amendments of 1976 restricted the use of silicone as a device. After reports of the sequelae of injected silicone, in 1979, the FDA and the American Medical Association condemned the use of injectable liquid silicone. Although today medical-grade silicone is available for ophthalmic use in the treatment of detached retinas, its cosmetic use is considered illegal in some states. In spite of the problems encountered with injectable liquid silicone, silicone injections are still performed in Europe, Canada, Mexico and by some physicians in the United States. Since 1994, two medical-grade silicone products were available to treat detached retinas, and use of these products cosmetically is considered off-label. Even though the use of injectable silicone for cosmetic purposes is federally banned and illegal in some states, some physicians feel that in the hands of experienced surgeons, injections can be extremely efficacious. They purport the microdroplet injection technique using a small needle and deep injection into the dermis and subcutaneous fat. These injections are performed in multiple treatments over 1- to 3-month intervals. The authors strongly suggest not to use liquid silicon and to consider this use illegal.

Giorgio Persichetti, Valentina Isgr

Bovine collagen has been the most widely used filler material in the early 2000s (See Table ). Three products have been manufactured and distributed by Inamed: Zyderm I, Zyderm II, and Zyplast. Inamed has been acquired by Allergan at the end of 2005. Allergan continued marketing these products until the end of 2010. In June 2008, Johnson & Johnson patented their own product, Evolence, derived from porcine collagen. The production of Evolence has been suddenly discontinued in November 2009.

Zyderm I corrected fine lines quite well, particularly fine perioral and crows-feet lines. Zyderm II, designed to correct average lines, offers an average duration of 36 months. Zyplast was designed to correct deep wrinkles in thick skin and to restore facial volume (lips and outline of the face). It generally lasted 612 months [].

Evolence has been recommended for the treatment of moderate to deep wrinkles, fold and lines, including hard-to-treat nasolabial folds.

Due to the possible allergic reactions concerning the use of heterologous collagen, a preliminary test was mandatory before injection.

A double test was recommended because positive reactions to treatment have been reported in 0.31.5 % of patients even after clinical selection and initial testing [].

Pons-Guiraud [] recommends the following protocol, which can take up to 7 weeks to complete. The first injection (0.1 mL) is given in the anterior aspect of the forearm, followed by a reading at 72 h. A positive reaction is characterized by a change in the contour of the injected implant, erythema, oedema, occasionally pruritus and, rarely, by an indurated papule or inflamed dermal nodule. All positive reactions contraindicate collagen injections. A second injection is given 15 days later, followed by readings 3 days and 4 weeks later. Any positive reaction to the test or double test contraindicates the collagen injection. If there is any doubt, bovine (ACACB) and human (ACACH) anticollagen antibodies must be measured.

Concerning complications, a study performed by Castrow and Krull [] on behalf of 316 practitioners, covering approximately 7,000 patients who demonstrated negative test results revealed a side-effect rate at the injection site of 1.5 %.