Organizations there are various packing materials, soft tissue filling materials in the field of aesthetic surgery also constantly have new development. The ideal packing material should be: it is best to autograft material, it doesn't exist immune rejection problem; Can persist for a long time, but not necessarily is permanent; No pain, and placed easily; Best can through injections into; Price is not expensive, and less side effects, such as do not appear: skin bruises, irritation, inflammation, migration, etc., and certainly not toxic, not deformed, do not cause cancer. Any packing material must be in the United States to get food and drug administration (FDA) approved to use. But in some countries, such as Western Europe, some without FDA approval of fillings are also widely used. At present foreign commonly used filler has the following categories.
1 bovine collagen
20 years ago was allowed to use in the treatment of wrinkle and scar on the first packing product is collagen (collagen). In clinical trials in 1977, in 1981 the FDA approved. This is a cow dermal collagen, was removed after pepsin digestion telopeptide (telopeptides) reduces its antigenicity of 0.5 mL and 1.0 mL of injection, containing 95% 5% of collagen type I and type III collagen. Product has 3 kinds: the first kind of product is Zyrerm I, in the phosphate buffer for 35 mg/mL bovine collagen content, and contains 0.3% lidocaine anesthetic; Zyrerm II bovine collagen content is 65 mg/mL; Zyplast its content is 65 mg/mL, but it was handed in even after glutaraldehyde, therefore immunity is lighter, and the role of resistance to bacterial collagenase. Injection in deep of the skin can maintain a long time after the injection, the bovine collagen within the organization. Reserved for 6-9 months. Because it is a foreign protein, when skin allergy test present local allergic reaction 3.5%. Even if the skin test were negative, there are still 1% 5% patients before and after the injection allergic reactions. Skin test in the inside of the forearm, generally appear in within 72 h of reaction, but may also be extended to skin test after one month. Skin test again the positive response rate fell to 1%, the second skin test should be in 2-4 weeks after skin test for the first time can be, and shall be carried out on the other side of the forearm. Injection treatment, therefore, generally have until 6 weeks after skin test for the first time to start. If injection therapy has stopped for a year, need injection must be skin test again. Allergic reactions occur in commonly 4 to 6 months, but also can be delay to 2 years.
Usage: can use local anesthesia before injection, such as using EMLA local daub ointment, and apply ice packs to reduce the bruises. Zyrerm I use 30 or 32 needles into the skin leather shallow, don't need too much. Zyplast needle injection in reticular layer of dermis with 30 top or middle, if injected too deep will be absorbed quickly, subcutaneous tissue injection too shallow will leave small bumps. In the weeks after injection, mouth RGK should undertake appropriate massage. Some physicians to take first in deep dermal injection ZyPlast Zyrerm 1 or 2, then injected into dermal shallow, reserved to extend the time limit. Injection around the mouth because it is more fair, save time will shorten [5]. Complications: a sexual reaction have bruises, herpes, aseptic abscess. Don't will Zyplast note on the brow area, or is likely to cause skin necrosis and scar hyperplasia. The consequences of this could be for a small vascular compression. Bovine collagen injection mainly allergic reaction was swelling. Nitroglycerin ointment treatment more difficult, once produce available treatment to dilate blood vessels, and remove the injection; Can also be used hormones, such as antihistamine drug treatment. Recently reported ring spore fungus element according to the weight of 5 mg/kg for 5 A day can produce effect, allergic reaction disappeared, 3 weeks and not relapse after drug withdrawal [6]. So far, the use of bovine collagen injections have been more than two million people, for weeks, nasolabial groove mouth and spat the wrinkles, is safe and effective non permanent corrective material, some are also used in the brow and wrinkle around eyes, but the author does not choose the latter, that deal with eye wrinkles with botulinum toxin injection would be preferable.
2 autologous collagen (autologen)
This is taken from patients with autologous skin after preparation of collagen products, peptide not eliminate, its performance is very stable, can the impedance enzyme digestion. Every square inch of skin preparation of 3.5% concentration of collagen preparations about 3 ml. Skin tissue can be stored frozen for five years. Injection treatment 2 weeks interval can be repeated injections, until satisfied. Used to eliminate fine wrinkles, leather face sag and lip augmentation. To add local anesthesia, injection can maintain 18 months after injection. Its advantage is no need for skin test, no allergic reaction. Disadvantages are taken from the body organization, preparation needs a long time (several weeks), the price is more expensive, pain during injection.
3 Isolagen
Isolagen is made from skin fibroblasts, usually from ear with 3 mm after the biopsy needle to cultivate the skin made 6 weeks after injection, skin test after 2 weeks, 1-1.5 mL of autologous fibroblasts and collagen in patients with mixture for parenteral administration. Interval of 2 to 3 weeks can be repeated injections, until satisfied. This is a kind of use of autologous active fibroblasts treated methods, is used to pack the dermis, subcutaneous defect, and can also be sex, light aging scar caused by the defects of filling. But its effect to the injection after 3-4 months to pay off, injection of fibroblasts in 12-24 months can still collagen secretion. Since 1995, the author observed the four and a half years, confirmed the content is still valid. The authors observed that patients in the injection of 3 years after its dermal thickening obviously. Kuo, etc. To find out, after injecting Isolagen used laser to be able to continue stimulating fibroblast secrete collagen. Goldberg, found with Q - switch Nd: YAG laser (1064 nm), also can cause collagen injection area increased. CO2 laser can relieve wrinkles, increase collagen. Moy 's confirmed that hydroxyl
Artecoll Artecoll
This preparation has won FDA approval, is composed of methyl acrylic acid methyl ester (Polymethylmethacrylate, PMMA), 30 to 40 mm diameter of small particles suspended in 1:3 bovine collagen preparations, with 0.3% lidocaine. Immunity is weak, the microsphere surface is smooth, has been used in dental prosthesis for many years. After injection, the bovine collagen gradually decompose, PMMA little grains in three months was collagen packages, no foreign body reaction, also do not move in the body, its effect is lasting. Invention has been 22 years history since 1985, artecoll in Germany since 1989 for the first time applied to the human body has been 18 years of history, and seven years after the European Union, the United States FDA five years of clinical validation.
Method of use: with 27 needle empty needle will take fan injection into the subcutaneous tissue, a moderate amount of injection, do not have to overload injection. Injection to complete moderation for partial pressure, and massage gently inject area in 3-5 days. Generally 2-3 times to repeat injection can achieve long-term effect. Early complications: there is swelling, sensitive, bruises, the allergic reaction similar Zyderm and Zyplast, later period, because this product can exciting fiber hyperplasia, may cause the happening of the granuloma, its incidence is about 1/1, 0000. Due to the relatively thick, 27, a needle injection, injected into the skin depth. If injection is too shallow, partial will be white, touch feel thicker. Another Resoplast, is a cattle single molecule collagen solution, the concentration of 3.5%, 6.5%, and its essence is no PMMA Artecoll. Have a similar allergic and Zyderm I, II, indications and usage. The FDA is not recognized.
6 hyaluronic acid (hyaluronic acid)
Sweden obtained FDA certification of Q - Med AB company's facial wrinkle with coagulation Restylane injections. Restylane composition is hyaluronic acid, after injection and the integration of human skin tissue, and absorb and lock water molecules, in order to achieve anti-wrinkle effect. Compared with collagen injections, Restylane in the case of less dosage can achieve same anti-wrinkle effect, and the treatment course is short. Restylane is through the cells of sugar after fermentation to produce another kind of hyaluronic acid preparations, it is non-toxic, no immunity. Does not contain lidocaine. Can be injected into 3-4 ml each time. Used for or in the nasolabial groove for long lip. Restylane sticky (20 mg/mL), Restylane won FDA approval, has been widely used around the world. It has a large water imbibition, therefore after injection effect is lasting. Its advantage is not need to be refrigerated, good packaging can be stored at room temperature for at least 2 years after. Once opened, must use within 24 h. Will hold 18 months after injection. A group of 158 line with Restylane anti-wrinkle and lip, 85% - 85%, satisfied with the injection of eight months later, still have the satisfaction of 50% to 70%. Almost no complications. 30 a needle injection injection in reticular layer of dermis and shallow. Want interval can be repeatedly injected, but 2 weeks.
Hyaluronic acid indications: to eliminate facial static lines (including the eye fine lines, eye end grain; the lacrimal groove; pouch; law grains, etc.), full lips, modify lip, chin, nose is increased; Nasal type transformation, buccal, fill the concave hole, etc.
Hyaluronic acid injections of advantages: 1. Only very few side effects, reasons: a. is one of human dermal tissue, short staying time in the human body, in the eight months to 3 years for the body to break down, there will be no long-term side effects of b. not protein, therefore cause an allergic reaction to reduce the chance of a lot of 2. Can be used to tentatively full lips, chin, nose type transformation, etc. 3. The filling evenly, there would be no edge or granular material residual 4. Simple and safe, fast and efficient: miniature plastic without invasive, intradermal injection, to avoid the risk of surgery, the tiny cosmetic use local injections at the same time, so the effect can see immediately. 5. Natural ingredients: from the biological tissue, therefore no foreign body sensation and foreign material. 6. Comfortable and no pain: tiny cosmetic USES injections, like an injection, local micro bulge slightly only pain, no pain, easy to be accepted by customer. 7. Affordable: miniature plastic surgery costs between life cosmetology and plastic surgery, the price is relatively cheap.
Hyaluronic acid side effects: after injection of hyaluronic acid may lead to temporary phenomenon of minor redness, swelling, itching, usually disappear after a few days. Sometimes just typed, the skin feels there will be something like particles (invisible to the naked eye), will be gone in about 3 days. Hyaluronic acid to note: 1. Within 24 hours after injection to make fixed shape, should avoid to contact region 2. Don't in the injection site ice or hot compress 3. After a short period of time to avoid strenuous exercise 4. Based maintenance program to maintain general after injection, not special massage in the treatment area 5. One week after injection to avoid do sauna 6. One week after injection to avoid taking aspirin or other similar huoxue huayu drug 7. Abundant lip postoperative week, eating don't touch the lips as far as possible, avoid eating too cold or hot food, make hyaluronic acid erosion is accelerated. Hyaluronic acid wrinkle
7 Alloderm
The same leather from bodies, by removing the epidermis and dermis cell component preparation, generally is buried in the subcutaneous layer, no antigenicity. But, after all, is a variant of his infection more likely to pay special attention to. After implantation of fibroblasts can infiltration in the host, and vascular ingrowth. It is a kind of effective object used to organize the fill, since 1992, at least 3 500 patients application, a
9 Silicone
Pure silicone granule was widely used as a filling injection, due to its stimulating granulation hyperplasia, and thus can have a lasting support. But often because of granuloma hyperplasia of excessive, will cause the distortion of the shape. Therefore, in 1965, the FDA banned it as injection filling agent. Once the granuloma, processing more difficult, need operation, injection of corticosteroids can reduce inflammatory reaction and inhibit excessive hyperplasia.
10 Fibrel
This is a kind of containing the patient serum, epsilon - amino acetic acid (epsilon - aminocaproic acid) and pig gelatine mixture, cause trauma reactions after injected into the skin. Patients of fibrin encase infusion and successful fiber cell ingrowth. Must also be skin allergy testing in advance. Due to large stimulus, will note in middle dermis, postoperative days there will be a localized swelling. Although not very ideal, but the preservation time is longer.
Class 11 botox injection with botulinum toxin BTX - A after modification, the recent market. The products in the cosmetic industry has been widely applied to the dynamic performance of eliminating wrinkles surgery, has advantages of easy operation, no wound, effect is good, the beauty industry as: biological anti-wrinkle technology. Evaluation: botulinum toxin a cheaper price, simple operation. But effect duration is short, should keep long-term effects need to repeated injections. Injection of also easy cause facial nerve paralysis, expression is not natural.
12 ogilvy form, this product is medical polyacrylamide hydrogel for body, developed by jilin fuhua medical polymer materials co., LTD, after injected ogilvy fixed water gel and new product, its appearance is the same as water injection type of breast prosthesis. Volume is 180 ml, 200 ml, 260 ml and 220 m, l240ml. When production according to the volume to the appropriate type B water gel powder. Acrylamide monomer content is below 10%. Injection, suitable for all kinds of facial wrinkles such as forehead lines, glabella wrinkles and crow's feet, nasolabial groove lines and mouth Zhou Wen etc. Can be used to increase the thickness of labial ministry, but the face skin has folliculitis is disabled. This product has passed ISO9002 international quality system certification assessment: injectable implants because happen serious clinical consequences, has rarely used. False body breast enhancement is also in a wide range of applications. Injection preparations is associated with clinical scleroma, redness and swelling. Granulomatous reaction cannot be ignored.
13. The Evolution and the Outline, whelan
Through the CE certification in 2000 a new generation of animal filler material. Divided into two broad categories. EVOLUTION is a kind of effective synthetic skin filler, the attach to the viscoelastic do not absorb water permeable sphere formation of the gel. Specific components in poly (ethylene 2 microspheres, polyethylene cationic polymer, phosphate buffer, water for injection. It does not contain any ingredient of animal origin, and no ingredients derived from genetically modified organisms. Apply to fill the deep lines and wrinkles, full lips, improve facial profile, fill concave scar. The OUTLINE is not a structure of microspheres. Is a variety of wrinkles can absorb the perfect series of fillers, including three products: FINE is applicable to shallow wrinkles and skin shallow wrinkles, half-life 1 year. What is suitable for the shallow wrinkles, fine wrinkles and creases, fuller lips, half life 2 years. ULTRA is suitable for the deep wrinkles, fine wrinkles and creases, half-life for facial plastic for five years. They through the replacement work on the extracellular matrix play: slow absorption of polypropylene cationic polymer hydrogel as a filter, make the implant peripheral WBC rearrangement, at the same time promote the soluble extracellular molecules to enter (collagen, elastic protein, polysaccharide, fiber, etc.). These molecules in the extracellular environment are negatively charged at EVOLUTION and the OUTLINE of moderate positive power of attraction, in the EVOLUTION of these molecules together to form micro fiber permeability observed sphere hole connected to form the stable layer 3 network structure. This process is controllable physical process, rather than physiological processes, the implants will remain stable and maintain about 65% of the initial volume. Entirely by synthetic material, do not contain potential immunogenicity material, does not need the allergy test before injection, can directly use the normal temperature preservation, all the general initial treatment will have swelling, general retreat for a few hours. A tiny case, swelling will last all day. Bruises: top skin (fine wrinkles) injection, rarely cause bruises, but deeper injection may cause. By using Vc immediately after treatment mask, bruises and swelling can be stopped. The OUTLINE for CE certification, the United States FDA approval.
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