COSMECEUTICALS

AESTHETIC MEDICINE – Part 5

Synthetic Polymers
 Synthetic compounds have gained favour as soft-
tissue augmentation agents for several reasons:
 cost-effectiveness,
 consistent formulation with the possibility for mass
production,
 limited immunogenicity
 potential for permanent and/or long-term effects.
Synthetic Polymers
 One of the first synthetics on the market was
silicone.
 Despite excellent cosmetic results, problems with
migration and foreign-body reactions have
precluded FDA and Conformite´ Europe´ene (CE)-
mark approval for cosmetic purposes
 Synthetic Polymers
 In general, synthetic facial fillers are
composed of a biosynthetic polymer
(e.g., poly-L-lactic acid, calcium
hydroxyapatite and
polymethylmethacralate) combined
with differing injectable carriers,
including hydrogels, beads and
liquids
 May lead to more permanent results
>>raise concerns over long-term side
effects or adverse events.
Synthetic Polymers
 One such product gaining wide popularity among
plastic surgeons in the Far East is Aquamid, a
polyacrylamide hydrogel.
 Several large case series in the literature have
reported a high rate of adverse events with its use
>> granuloma formation and subclinical infections,
>> raising concerns over long-term safety
Calcium Hydroxyapatite
 CaHA is the major mineral component of bone.
 Radiesse (BioForm Medical, Inc, San Mateo,
California) is a biostimulatory dermal filler
consisting of CaHA microspheres suspended in an
aqueous gel matrix that also contains glycerin and
sodium hydroxycellulose.
 The bone mineral microspheres do not cause
hypersensitivity reactions -- allergy testing is not
necessary
Calcium Hydroxyapatite
 The gel matrix is absorbed at 6 to 8 weeks after
injection; >> same time, the host's fibroblast
response is stimulated, >> a bony matrix is formed
that serves as a scaffold for the new collagen.
 The bone mineral microspheres degrade into
calcium and phosphate ions over time, and the
augmentation effect gradually diminishes.
 CaHA is considered a semipermanent filler, with
clinical effects reported to last for 2 to 5 years
Poly-L-Lactic Acid
 Sculptra (Dermik Laboratories, Bridgewater, New Jersey) is
an injectable implant that contains microparticles of PLLA
 An injectable formulation of PLLA was first approved by
the FDA in 2004 for the treatment of facial lipoatrophy
associated with HIV infection.
 Although not yet approved for the following uses,
injectable PLLA is also widely used for the correction of
deep lines, wrinkles, folds, and creases, such as crow's-feet,
nasolabial folds, marionette lines, and oral rhytides, as well
as for volume augmentation in the buccal and temple areas.
Poly-L-Lactic Acid
 Injectable PLLA works in two phases.
 The PLLA microspheres initially act as a transient
space-filling volumizer and are gradually degraded and
metabolized to carbon dioxide and water.
 The PLLA injection also stimulates fibroblastic
activity, resulting in the formation of collagen and
other connective fibers during a period of several
months.
 Soft-tissue volume is gradually corrected over
time, with effects lasting for 18 to 24 months