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INTRODUCTION

The dermal filler market is rapidly growing worldwide. According to the American Academy of Aesthetic Plastic Surgeons, 1,448,716 people received hyaluronic acid (HA) injections by plastic surgeons in 2007 (Table 23-1). The actual number is likely much higher when factoring in procedures performed by dermatologists and other aesthetically oriented physicians and physician extenders. Although collagen products (Zyplast and Zyderm) were the first dermal fillers to become widely available, collagen fillers have largely been replaced by HA fillers.

TABLE 23-1Soft Tissue Augmentation Procedures Performed in 2007 by Members of the Academy of Aesthetic Plastic Surgeons

The ultimate goal of dermal fillers is to smooth out wrinkles and folds, even out scars, volumize furrows and sunken valleys, contour unevenness and laxity, and sculpt skin into a 360-degree, rejuvenated look. Over the last quarter century, several kinds of products suitable for soft tissue augmentation have become available, with intense industry research yielding more and more filler options with increasing regularity. Different regulatory mechanisms usually leave the US a few months or years behind other developed countries in making the latest products available to patients.

HISTORY

In 1893, by transplanting fat from the arms into facial defects, Neuber became the first physician to practice soft tissue augmentation.1 In the middle of the 20th century, soft tissue augmentation could best be characterized by the use of silicone. Although popular in the 1940s and 1950s, silicone use was associated with the development of foreign body granulomas, which ultimately prompted the banning of silicone in 1992 until a new form of the substance (intended for ophthalmologic use) was approved by the United States Food and Drug Administration (FDA) in the late 1990s. In the meantime, though, the field of soft tissue augmentation had come into its own, in the 1970s, with the introduction by Stanford University researchers of animal-derived collagen implants.2 By the 1980s, the use of collagen injections for wrinkles had entered the mainstream. While Americans were enjoying the benefits of bovine collagen fillers (i.e., Zyderm and Zyplast), other countries began to experiment with dermal HA fillers such as Hylaform and later Restylane in the mid to late 1990s. The beginning of the 21st century ushered in the introduction of newer nonbovine collagen fillers, CosmoDerm and CosmoPlast, and HA fillers, such as Captique and Juvéderm, as well as other synthetic fillers, Sculptra, Radiesse, and Artefill into the United States market. With different forms of soft tissue augmentation agents currently available in the United ...

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