Therapeutics in Dermatology
A reference textbook in dermatology
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Fillers for facial wrinkles and depressions

12 April 2013, by PONS-GUIRAUD A.


The number of fillers on the market rises exponentially every year, offering patients and healthcare professionals a wide variety of options for the correction of both visible signs of skin aging and natural and age-related morphological changes.

The various presentations available, particularly those containing hyaluronic acid, are suitable for all zones and, with their different degrees of cross-linking and concentrations, can be used for the effective correction of all cutaneous and subcutaneous tissue changes.

Volumizers are a more recent development that are gaining in popularity. Most of these products contain highly cross-linked hyaluronic acid, ceramics or L-polylactic acid.

Combined injections of classic fillers and volumizers generally yield very good results, on condition that the indication is appropriate and the product carefully selected and injected by a trained professional.

Injectable degradable products are well tolerated. The side effects are minor (bruising and swelling) and transient. However, erythematous, indurated and slowly-resorbing granulomas may emerge some time after the injections, often when the pre-procedure anamnesis is incomplete or the patient presents contraindications which are not taken into account. They may also be caused by a cross-linking ingredient in the product used or by protein residues.

Non-degradable products cause large granulomas which are often observed long after the patient has been treated. These result in both physiological and psychological distress and are refractory to virtually all treatments.

Since June 1998, these materials have been officially placed on the "medical devices" list and manufacturers must therefore apply for and be granted CE marking, the European product and manufacturing method quality certification, but which does not guarantee that the products certified have been studied in clinical trials or that they will not cause adverse events.

Product traceability is ensured by noting the brand, manufacturer, batch number and expiry date of the product used in the patient’s notes.

Doctors using these products must declare any adverse events observed with these products to the Materiovigilance Commission. Practitioners failing to report such events may be fined or even run the risk of a prison sentence.

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