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  1. The dermal filler market is rapidly growing worldwide, and several innovations have led to a parallel expansion in product variety.

  2. Currently, a variety of dermal fillers are available for use including temporary fillers (i.e., hyaluronic acid fillers), semi-permanent fillers (i.e., calcium hydroxylapatite and poly-L-lactic acid), and permanent fillers (i.e., polymethylmethacrylate, silicone, autologous fat). Hyaluronic acid fillers are the most frequently used for soft tissue augmentation.

  3. It is important for the aesthetic practitioner to understand the unique physicochemical and rheological properties of the available dermal fillers to achieve optimal cosmetic outcomes. Additionally, the aesthetic practitioner should be well educated on any potential adverse effects and complications associated with soft tissue filler injection, so that they can be prevented or treated appropriately should they arise.

  4. Pre-procedural patient assessment including a discussion of appropriate expectations and potential adverse events is critical prior to treatment with dermal fillers.

  5. Newer hyaluronic acid products have been developed recently, specifically, a collection of fillers uniquely designed to be more flexible and to more closely resemble naturally occurring hyaluronic acid, indicated for dynamic wrinkles and folds with less reactivity.

  6. Research is ongoing to develop filler products that address the shortcomings of the earlier products while incorporating and expanding on their advantages. Additional hyaluronic acid products, combination hyaluronic acid-calcium hydroxylapatite products, and a number of novel filler products are currently in development.

  7. To keep astride with the rapidly changing cosmetic dermatology arena, it behooves the aesthetic practitioner to be aware of the current availability, application, and future potential of dermal fillers.

The dermal filler market is rapidly growing worldwide, and several innovations have led to a parallel expansion in product variety. According to the 2018 American Society of Dermatologic Surgery physician survey, there has been a 78% increase in soft tissue filler treatments since 2012.1 Similarly, based on the 2018 International Society of Aesthetic Plastic Surgery survey, injection of hyaluronic acid (HA) fillers was the second most performed non-surgical procedure with 3 729 833 procedures worldwide (Table 25-1).2 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.

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TABLE 25-1 Soft Tissue Augmentation Procedures Performed in 2018 by Members of the Academy of Aesthetic Plastic Surgeons in the United States


Number Performed in 2018

Fat injections

49 413

Calcium hydroxylapatite (Radiesse/Radiance)

30 349

Hyaluronic acid

763 000

Poly-L-Lactic Acid (Sculptra)

21 798

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 ...

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