Transcript Filler Materials
Filler Materials
Medical Aspects
Prof. Dr. med. P. Graf
Munich
Aesthetic Operations/Treatments
Aesthe tic Ope rations/Treatments in the USA 2000-2012 (Source: ASPS)
7000000 6000000 5000000 Breas t Augm entation Blepharoplas ty Lipos uction Rhinoplas ty Abdom inoplas ty Botulinum toxin 4000000 3000000 2000000 1000000 0
Year
Operations versus Minimal invasive Treatments 16000000 14000000 12000000 10000000 8000000 6000000 4000000 2000000 0
Aesthetic/Reconstructice Operations/Treatm ents 2000-2012 in the USA (Source: ASPS)
total, operative cosmetic total minimal nivasive cosmetic total cosmetic total operative reconstructive
Year
Filler-Material (Selection)
Silicon Polytetrafluoräthylen (PTFE) Collagen Hyaluronic Acid Acryl (Plexiglas) Polyacrylamid Poly-L-lactic acid Calcium-Hydroxylapatit Autologous Tissue (Fat)
Filler Material (Composition)
Plastic Material
Silikon
PTFE
PMMA Organic Material
Collagen
Hyaluronic Acid
Autologous Fat
Filler Material (Consistency)
hard
Silicon
PTFE
Goldthreads „ liquid“
Collagen
Hyaluronic Acid
Acryl Microspheres
Autologous Fat
Silicon (Hard Consistency)
inert Material
Nonresorbable
No indication as filler material for wrinkles
Deep positioning
Indication for contour improvement (Breast, chin, etc.)
Silicon (Chinaugmentation) Die Darstellung Die Darstellung präoperativer Fotos in in ärztlichen Internetseiten nicht erlaubt nicht erlaubt
Collagen
Low Immunogenicity (3%)
Resorbable
Superficial and deep Positioning
Bovine spongiform encephalopathy (BSE)
Hyaluronic Acid I
No Immunogenicity
Resorbable (6 Months)
Superficial and deep positioning
Hyaluronic Acid II Pattern of Intercellular Space The intercellular space of the skin is filled by collagen fibers which are located in a matrix of polysaccharides (=hyaluronic acid).
Hyaluronic Acid III Microstructure, Properties An important function of hyaluronic acid is its property of water retention.
Hyaluronic Acid IV Intradermal/Subdermal Positioning of Filler
Hyaluronic Acid V Injection Technique Linear Injection technique Serial step-by-step Injection technique
Hyaluronic Acid VI Lip Augmentation
Nonresorbable Filler Material Acryl-derivates, Calcium-Hydroxylapatit, Poly-L-Lactic Acid, etc.
Non- / Low-Resorbable Deep Positioning Immunogenicity ?
-Foreign Body reaction -Inflammation -Infection -Fistula
Complications I Transdermal Migration of Acryl Microspheres (PMMA), (=Plexiglas)
Complications II intravascular Injection Skin necrosis after accidental intravascular injection of PMMA
Complications III
Blindness from: Complications of Injectable Fillers, Part 2: Vascular Complications
Aesthetic Surgery Journal
Claudio DeLorenzi
y 2014 34: 584-600
Bacterial Biofilm I
from: https://en.wikipedia.org/wiki/BiofilmResp.
from: Looking for Chinks in the Armor of Bacterial Biofilms Monroe D PLoS Biology Vol. 5, No. 11, e307 http://biology.plosjournals.org/perlserv/?request=slideshow&type=figure&doi=10.1371/journal.pbio.0050307&id=89595
A biofilm is any group of microorganisms in which cells stick to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance (EPS). Biofilm extracellular polymeric substance, which is also referred to as slime (from: https ://en.wikipedia.org/wiki/Biofilm)
Bacterial Biofilm II “Biofilms are ubiquitous. Nearly every species of microorganism, not only bacteria have mechanisms by which they can adhere to surfaces and to each other. Biofilms will form on virtually every non-shedding surface in a non-sterile aqueous (or very humid) environment.” “Biofilms can grow in showers, pipes, on teeths, catheters, contact lenses, heart valves, etc.” https://en.wikipedia.org/wiki/Biofilm
Bacterial Biofilm III in Soft Tissue Fillers Bacterial biofilm formation and treatment in soft tissue fillers Morten Alhede et al. April 2014 Pathogens and Disease doi: 10.1111/2049-632X.12139
„…Evaluation of treatment strategies showed that once the bacteria had settled (into biofilms) within the gels, even successive treatments with high concentrations of relevant antibiotics were not effective. Our data substantiate bacteria as a cause of adverse reactions reported when using tissue fillers, and the sustainability of these infections appears to depend on longevity of the gel. Most importantly, the infections are resistant to antibiotics once established but can be prevented using prophylactic antibiotics. …“
Complications Inflammation, Foreign Body Reaction, Fistulas
Consequences Think!
Would you like to have a permanent filler?
Do you inform your patients who ask for permanent fillers about foreign body reactions, inflammations, infections, fistulas?
Do you inform about alternatives (hyaluronic acid, fat transfer)?
Antibiotic prophylaxis?
Fat Transplantation by E. Lexer in Munich
Autologous Fat Transplantation Application Neurosurgery Ophthalmology Urology Aesthetic Surgery etc.
Autologous Fat Transplantation Lipofilling No immunogenicity Resorption Deep positioning (subcutaneous) Operation
Autologous Fat Transplantation Healing Process
Autologous Fat Transfer Resorption
Rates of Resorption in Literatur 20 - 100% Own Investigations: 55,6% (47 - 68%)
Causes of trauma to transplanted fat grafts By suction of fat (mechanical, high vacuum) By preparation of graft (mechanical, drying) By injection of fat graft (high pressure) By late ischemia within the body (high tissue pressure)
Autologous Fat Transfer Minimization of Resorption
Atraumatic treatment is critical for Rates of resorption (=success) of fat transfer
Avoid potentially damaging substances (Adrenalin?) Gentle suction (diameter of canula, size of vacuum) Atraumatic preparation of fat graft Careful preparation („ Cleaning“) of aspirated fat Careful Injection (short, thick canula) Good dissemination of graft Avoid high tissue pressure
Autologous Fat Transfer Operative Technique
Autologue Fat Transfer “Cleaning“
Autologous Fat Transfer Injection
Autologous Fat Transfer nasolabial
Die Darstellung präoperativer Fotos in ärztlichen Internetseiten ist in Deutschland leider nicht erlaubt