Abstract
Since the approval of the United States’ first hyaluronic acid (HA) filler in December 2003, HA fillers have become mainstays of soft tissue augmentation due to their favorable safety profile and minimally invasive treatment nature. The past two decades have not only brought an expansion in the popularity of HA fillers, but also in the number of available HA filler products and indications for cosmetic enhancement. Accordingly, HA filler injection has become one of the most commonly performed cosmetic procedures worldwide. The progression of HA filler products is a study in both biomedical engineering advancements, as well as evolving concepts of beauty and cosmesis. In this chapter, we review the history of these products, including their composition and indications for use. We then explore the prospect of HA fillers for the future of esthetic medicine, as they remain a vital component of nonsurgical soft tissue augmentation.
Highlights
In the non-surgical arena, soft tissue augmentation rapidly accelerated with the first reports of autologous fat transfer in the late 19th century; concomitantly, reports began to emerge from Europe on the use of injectable paraffin for rhytide reduction and soft tissue rejuvenation [1]
After the spread of paraffin injections across Europe and Asia, reports of embolic complications, as well as late-onset granulomatous reactions led to their eventual removal from the realm of esthetic practice, non-medical/illicit injection of paraffin-containing substances still remain a sporadic issue in clinical practice today
Over the following twenty years, silicone found widespread popularity across the United States, with the Dow Corning Corporation developing an injectable form of the material in the mid-1960s
Summary
Typically thought of as outgrowths of modern medicine, interventions for esthetic and cosmetic purposes are well documented through multiple civilizations across history. After the spread of paraffin injections across Europe and Asia, reports of embolic complications, as well as late-onset granulomatous reactions (later called ‘paraffinomas’) led to their eventual removal from the realm of esthetic practice, non-medical/illicit injection of paraffin-containing substances still remain a sporadic issue in clinical practice today. It was not until the 1940s that a new injectable agent found widespread use. Illicit silicone injection remains an issue across the world today, and clinicians should be mindful of this entity in the evaluation of granulomatous reactions following non-medical cosmetic treatments. While other non-HA fillers were approved by the FDA for use in the following years – poly-Llactic acid (SculptraTM), polymethylmethacrylate (BelafillTM), and RadiesseTM (calcium hydroxylapatite) among the most commercially successful – HA fillers have risen as some of the most popular agents available for nonsurgical facial cosmesis
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