Soft-tissue Fillers: What Options Are Available Today?

Abstract

Carl Troilius, MD, Malmoe, Sweden , is an ASAPS corresponding member. Until recently, surgeons had few options for facial rejuvenation in younger patients who were not ideal candidates for rhytidectomy. Tissue fillers now offer many advantages for these patients, who do not have advanced skin laxity, jowls, nasolabial folds, or platysmal bands but who do have early subcutaneous ptosis and atrophy, skin folds, and wrinkles. Today's market offers a variety of soft-tissue fillers, which can be divided into 3 types: autologous, allogenic, and synthetic. The ideal soft-tissue filler would be biologically inert and noncarcinogenic, and it would elicit no immune response. It would be resistant to resorption, would not migrate, and would not support growth of microorganisms. It would be easy to shape, remove, and sterilize. Unfortunately, our options today are less than ideal. There is no soft-tissue filler in existence that meets all of these criteria; the selection process therefore requires a compromise with respect to some of them. When one reviews the published literature, it is evident that different physicians emphasize different characteristics regarding the selection of a soft-tissue filler. Several authors1,2 have reported aesthetically pleasing and stable long-term results with autologous free-fat transplantation. Good results have also been obtained by injecting a …